Citation Nr: 20005282 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 17-37 182 DATE: January 22, 2020 ORDER Service connection for prostate cancer is denied. FINDING OF FACT Prostate cancer did not first manifest on active duty service, and is not otherwise shown to be related to service. CONCLUSION OF LAW Prostate cancer was not incurred in wartime service. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served for twenty years on active duty in the United States Navy from January 1988 to January 2008. He timely appealed this matter from a January 2016 rating decision. All available records identified by the Veteran as relating to his claim have been obtained, to the extent possible. The record does not otherwise indicate any existing pertinent evidence that has not been obtained. Examination reports and opinions are thorough and adequate for the Board to render the following decision in the Veteran’s appeal. 38 U.S.C. § 5103A(a)(2). Service connection will be granted if it is shown that the Veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection on a direct basis, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Prostate cancer is not a listed condition, and though a malignancy, is not a tumor. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. When service connection is established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). The Veteran seeks service connection for prostate cancer which he believes had its onset in active service or is proximately due to service-connected disease or injury. Specifically, he reported prostate problems occurring in active service in or about 2000 and continuing post-service until a biopsy in 2015 revealed prostate cancer. The Veteran is competent to testify on factual matters of which he has first-hand knowledge. Washington v. Nicholson, 19 Vet. App. 362 (2005). Service treatment records show that the Veteran was treated for a small mass of left testicle in September 2001, which was not considered disabling. He also was treated in November 2002 for prostatitis. Subsequently, the Veteran was treated for erectile dysfunction in January 2003. At that time laboratory results revealed prostate specific antigen (PSA), normal, at 1.52. The examiner recommended annual PSA and digital rectal examination, due to family history of prostate cancer; further workup was indicated if PSA equaled or was greater than 2. In April 2003, the Veteran was treated for urinary tract infection. His retirement examination in July 2007 noted a history of erectile disorder, with medications and occasional problem. A December 2012 VA male reproduction system conditions examination report revealed a diagnosis of erectile dysfunction, and that the Veteran continued to use Viagra. The date of diagnosis was shown as 1992. No voiding dysfunction was indicated. Chronic prostatitis was not found. There was no history of recurrent symptomatic urinary tract infection. Examination did reveal abnormal prostate—described as somewhat large, hard, with nodular feel. VA records, dated in July 2015, show that the Veteran had undergone a physical examination for a job and his PSA was found to be elevated. A biopsy of the prostate performed in April 2015 revealed one positive site for adenocarcinoma. The Veteran reported no symptoms at that time. He reported that his father had died in his early sixties from prostate cancer. In September 2015, the Veteran reported having problems with frequent urination, daytime voiding of ten-to-fifteen times, and two-to-three times at night. A December 2015 VA prostate cancer examination report revealed a diagnosis of prostate cancer, and additional diagnoses of urinary incontinence and erectile dysfunction. The prostate cancer was noted as active, and the Veteran was to begin radiation therapy in January 2016. Diagnostic testing in December 2015 revealed PSA at 22.4. Following examination, the examiner opined that prostate cancer was less likely than not (less than 50 percent probability) incurred in or caused by active service. In support of the opinion, the examiner reasoned that there is some correlation being noted between long-term prostatitis and development of prostate cancer; and that with only one documented evaluation and treatment noted in service treatment records, long-term prostatitis cannot be established. In February 2016, a private physician indicated that the Veteran had been diagnosed with low-risk prostate cancer; and that the Veteran had prostate-related symptoms dating back many years. The physician indicated that prostate cancer is known as a very slow growing disease, and that autopsy studies from Vietnam Conflict suggested early changes of prostate cancer were present from age 25. The physician reasoned that it was “certainly possible” that the Veteran’s previous symptoms were related to his current condition. The Board finds the opinion to be somewhat speculative in nature, and based solely on possibility. Moreover, the cited autopsy studies involved Vietnam Veterans who presumably were exposed to Agent Orange based on service in Vietnam; prostate cancer is presumptively service-connected for those Veterans. To the contrary, in this case, the Veteran did not serve in Vietnam; there is no record of exposure to Agent Orange or other herbicide agents in active service. The underlying premise of the cited studies is not pertinent to this Veteran. See, e.g., Herlehy v. Brown, 4 Vet. App. 122, 123 (1993). Accordingly, the opinion is afforded no probative value. In July 2017, the Veteran contended that he had all the symptoms of prostate cancer since 2000; and that a biopsy of the prostate was never conducted in active service. In October 2019, he testified that he always had “the same pains, the discomfort and stuff.” It got worse in 2015 and he went to see a urologist, and a biopsy was conducted. He had proton therapy from January 2015 to March 2015, and he now wore absorbent materials because of leakage. Here, the sole competent medical opinion of record regarding the etiology of prostate cancer is against the claim. The December 2015 examiner considered the Veteran’s one-time treatment for prostatitis in service and contemporaneous records. The opinion is consistent with the evidence of record, well-reasoned, and uncontradicted. The Veteran’s opinion, and linking of symptoms in service to cancer, while firmly held, is not competent, as the etiology of prostate cancer and etiology of symptoms are too complex for lay assertions as to causation. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While service connection has been awarded for erectile dysfunction, no examiner has attributed the Veteran’s prostate cancer to service-connected erectile dysfunction. The Veteran’s symptoms of erectile dysfunction had their onset many years prior to prostate cancer. The December 2012 examiner suggested that multiple medications taken by the Veteran for treatment of service-connected degenerative disc disease of lumbar spine caused erectile dysfunction. Moreover, the December 2015 examiner opined that it was not as likely as not that the Veteran’s erectile dysfunction was attributable to prostate cancer. Together, the opinions are broad enough to encompass aggravation. In short, for the reasons and bases set forth above, the Board concludes that the preponderance of the evidence is against granting service connection for prostate cancer. On this matter, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mary C. Suffoletta The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.