Citation Nr: 20047050 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 15-22 828A DATE: July 14, 2020 ORDER Entitlement to service connection for benign prostate hypertrophy is denied. REMANDED Entitlement to service connection for a stroke, to include as due to herbicide exposure or secondary to ischemic heart disease and diabetes mellitus, is remanded. FINDINGS OF FACT The Veteran’s benign prostate hypertrophy is not shown to be causally or etiologically related to his herbicide exposure during service. CONCLUSIONS OF LAW The criteria for service connection for benign prostate hypertrophy are not met. 38 U.S.C. § 1131; 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from June 1969 to March 1973, and from April 1973 to December 1975. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Louisville, Kentucky, Department of Veterans Affairs (VA) Regional Office (RO). In August 2018 a Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran’s claims file. Service Connection Entitlement to service connection for benign prostate hypertrophy The Veteran has asserted he suffers from a prostate disability as a result of herbicide exposure during service. Service treatment records (STRs) are void for prostate-related complaints. He has a current diagnosis of benign prostate hypertrophy (BPH). In February 2020, a VA Herbicide Exposure Verification Memorandum was issued, determining that exposure to herbicides is conceded based on the Veteran’s nautical service in the offshore eligible waters as defined in the blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. An enlarged prostate is not included in the list of presumptive service-connected diseases. A veteran may nevertheless prove entitlement to service connection on a direct basis due to herbicide exposure. See Combee v. Brown, 5 Vet. App. 248 (1993); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). The question that remains is whether the current BPH is at least as likely as not related to in-service herbicide exposure. The Board concludes that the preponderance of the evidence is against finding that the Veteran’s BPH is due to herbicide exposure he experienced during service. In March 2020, the Veteran underwent a reproductive system examination. He was diagnosed with benign prostatic hypertrophy, and reported symptoms starting around 5 to 10 years ago. The examiner opined the claimed condition was less likely than not incurred in or caused by an inservice injury, event, or illness. The rationale provided was that only adenocarcinoma of the prostate is associated with exposure to Agent Orange, which the Veteran does not have. There is no medical evidence linking herbicide exposure to BPH. Although the Veteran believes his BPH is proximately due to herbicide exposure, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the VA examiners’ opinion. The March 2020 examination and opinion establishes that the claimed BPH is not due to herbicide exposure in service. The examiner’s rationale was that there is no basis in medical fact to support the claim. Though the exact onset of his BPH is not known, it had an onset of somewhere between 5 and 10 years ago, well after discharge from service. The examiner’s opinion is probative, as it is based on accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no competent opinion to the contrary. Finally, the Veteran has not pointed to any other in-service event, other than herbicide exposure as the cause of his BPH. In other words, the most probative evidence of record does not show that the Veteran’s claimed BPH is due to in-service herbicide exposure. The Board appreciates the Veteran’s sincere belief that his BPH is due to service, but he has not met the three required elements for a grant of service connection. Therefore, the claim must be denied. REASONS FOR REMAND 1. Entitlement to service connection for a stroke. The Veteran asserts that he suffers from history of a stroke as a result of herbicide exposure during service, or in the alternative as secondary to ischemic heart disease (IHD), or diabetes mellitus. In February 2020, a VA Herbicide Exposure Verification Memorandum was issued, determining that exposure to herbicides is conceded based on the Veteran’s nautical service in the offshore eligible waters as defined in the blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. In March 2020, the RO granted service connection for IHD and diabetes mellitus. A stroke is not included in the list of presumptive service-connected diseases. A veteran may nevertheless prove entitlement to service connection on a direct basis due to herbicide exposure. See Combee v. Brown, 5 Vet. App. 248 (1993); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange). In March 2020, he underwent a central nervous system examination and was noted as having a history of stroke. He sustained a left temporal lobe stroke 3 months after his CABG. The examiner opined that his history of stroke was less likely than not incurred in or caused by an in-service injury, event, or illness. The rationale was that strokes are not associated with Agent Orange or with IHD. The Veteran’s representative also submitted an argument asserting that his stroke is either secondary to his diabetes or secondary to his IHD. An addendum opinion is needed addressing these contentions. The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to an appropriate examiner for a supplemental opinion on the etiology of the claim for service connection for a stroke. It is left to the examiner’s discretion whether to examine the Veteran. The examiner is asked to answer the following: Is it at least as likely as not that the Veteran’s stroke is related to his service? Is it at least as likely as not that his stroke was caused OR aggravated (worsened beyond its natural progression) by IHD, or by Diabetes? The examiner is asked to provide opinions as to both causation and aggravation on the secondary service connection claims. The examiner is asked to provide a rationale for any opinions rendered. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, Counsel 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.