Citation Nr: 21005199 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 10-40 876 DATE: January 29, 2021 ORDER Service connection for psoriasis, to include as due to Camp Lejeune contaminated water exposure (CLCW) and/or secondary to service-connected Non-Hodgkin’s Lymphoma (NHL) and treatment, is denied. Service connection for type II diabetes mellitus, to include as due to CLCW and/or secondary to service-connected NHL and treatment, is denied. FINDINGS OF FACT 1. The Veteran served at the United States Marine Corps Base Camp Lejeune, North Carolina and exposure to contaminated water at Camp Lejeune has been conceded. 2. The Veteran’s psoriasis is not shown to be causally or etiologically related to his active military service, to include as due to CLCW, and is not shown to be caused or aggravated by a service-connected disability. 3. The Veteran’s diabetes mellitus is not shown to be causally or etiologically related to his active military service, to include as due to CLCW, and is not shown to be caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for psoriasis, to include as due to CLCW exposure and/or secondary to NHL, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for service connection for type II diabetes mellitus, to include as due to CLCW exposure and/or secondary to NHL, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5103, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty military service from October 1962 to October 1966. These matters are before the Board of Veterans’ Appeals (Board) from a December 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2014, the Veteran testified at a hearing before a Veterans Law Judge. A transcript of the hearing is associated with the file. In July 2020, VA notified the Veteran that the Veterans Law Judge who conducted that hearing was no longer employed by the Board. The Veteran was given the option to have another Board hearing, however, as he did not respond to the letter within 30 days, the Board has assumed that the Veteran does not want another Board hearing and will proceed accordingly. The issues were remanded by the Board for further development in January 2015, March 2018, December 2019, and September 2020. In September 2020, the Board remanded for further development, to include obtaining addendum medical opinions addressing whether the Veteran’s claimed disabilities were caused by, proximately due to, related to, and/or aggravated by his service-connected NHL, to include chemotherapy treatment. A review of the record reflects substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A supplemental statement of the case was issued in October 2020. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for direct service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). 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) caused by or (b) aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). In addition, service connection may be granted on a presumptive basis for certain diseases associated with exposure to contaminants (defined as the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE or PERC), benzene, and vinyl chloride) in the on-base water supply located at Camp Lejeune, even though there is no record of such disease during service, if they manifest to a compensable degree at any time after service, in a veteran, former reservist, or a member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at the United States Marine Corps Base Camp Lejeune and/or Marine Corps Air Station New River in North Carolina, during the period beginning on August 1, 1953, and ending on December 31, 1987. See 38 C.F.R. § 3.307(a)(7). This presumption may be rebutted by affirmative evidence to the contrary. Id. The subsequent development of the following eight diseases are deemed associated with exposure to contaminated water at Camp Lejeune: kidney cancer, liver cancer, Non-Hodgkin’s Lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, Aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. § 3.309(f). As such, if a Veteran is diagnosed with a listed condition, then the disability is presumed to be related to service. Id. For claims based upon exposure to the contaminated water supply at Camp Lejeune, service connection can be granted in two ways: (1) on a presumptive basis, or (2) on a direct basis. Service connection may also be granted for certain chronic disabilities, including diabetes mellitus, if manifested as such during service or manifested to a compensable degree within one year after a veteran’s separation from service. 38 U.S.C. § 1101, 1112, 1113; 38 C.F.R. § 3.307, 3.309(a). Where a veteran asserts entitlement to service connection for a chronic disease but there is insufficient evidence that the currently diagnosed chronic disease was chronic during service or within the presumptive period after service, a veteran may still be entitled to presumptive service connection if continuity of symptomatology is shown. This is an alternative method of establishing service connection, but only for those chronic diseases listed under 38 C.F.R. § 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013) (holding that the theory of continuity of symptomology can be used only in cases involving those conditions explicitly recognized as chronic in 38 C.F.R. § 3.309(a)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that his psoriasis and type II diabetes mellitus were caused by the contaminants he was exposed to while stationed at Camp Lejeune. See VA Form 21-526, June 2009. He also contends that his claimed disabilities were secondary to treatment in relation to his service-connected NHL, including chemotherapy. See Statement in Support of Claim, June 2009. As such, the record raises various theories of entitlement: presumptive service connection for exposure to contaminants in the water supply at Camp Lejeune; presumptive service connection for chronic diseases; direct service connection; and secondary service connection. In an effort to provide a concise, thorough, and clear opinion, the Board will address each theory of entitlement separately. Presumptive service connection for exposure to contaminates in the water supply at Camp Lejeune The Regional Office (RO) has conceded the Veteran’s exposure to contaminants while stationed at Camp Lejeune. See Supplemental Statement of the Case, November 2012. As noted above, there is a presumption that certain disabilities are related to exposure to contaminated water at Camp Lejeune. However, the presumption under 38 C.F.R. § 3.309(f) is not for application as the Veteran’s disabilities, psoriasis and type II diabetes mellitus, are not enumerated diseases listed in 38 C.F.R. § 3.309(f). Nonetheless, when a claimed disorder is not entitled to service connection by presumption, direct service connection may nevertheless be established by proof of direct causation on a facts-found basis, to include the presumed exposure to contaminants in the water supply at Camp Lejeune. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). Presumptive service connection for a chronic disease The question for the Board is whether the Veteran has a chronic disease that was noted as chronic in service, or that manifested to a compensable degree within the applicable presumptive period, or whether continuity of symptomatology has existed since service in order to warrant service connection. In this case, type II diabetes mellitus is the only disease enumerated as a chronic disease under 38 C.F.R. § 3.309(a). Therefore, that is the only claim that will be analyzed under chronicity. Service treatment records do not show complaints of or treatment for diabetes mellitus. The earliest post-service documentation of diabetes was in 1997, when it was first diagnosed. This was 31 years post-service. There is no indication in the record that the Veteran had a history of diabetes or otherwise was diagnosed with diabetes prior to his 1997 diagnosis. The record does not show ongoing, persistent, or continuous symptoms since service, therefore, continuity of symptomatology has not been shown. As such, the Board concludes that while the Veteran has diabetes mellitus, which is an enumerated chronic disease under 38 C.F.R. § 3.309(a), there is no probative evidence of record to show it was chronic in service, or manifested to a compensable degree within a presumptive period, nor was there continuity of symptomatology. Thus, service connection for diabetes mellitus is not warranted on a presumptive basis as a chronic disease under the provisions of 38 C.F.R. § 3.309(a). Direct Service Connection The question before the Board is whether service connection is warranted due to any in-service event, illness, or injury, to include the Veteran’s conceded exposure to contaminants in the water at Camp Lejeune. The Board finds direct service connection is not warranted. The record contains a current diagnosis of psoriasis. See C&P examination, July 2017. The record also contains a current diagnosis of type II diabetes mellitus. See C&P examination, July 2017. Thus, the first element of establishing direct service connection has been satisfied for both claimed disabilities. The remaining questions before the Board are whether there was an in-service incurrence of a disease or injury; and whether either of his claimed disabilities are related to an in-service incurrence (nexus), if any. Service records confirm that the Veteran was stationed at Camp Lejeune and therefore was exposed to contaminated drinking water. Service treatment records do not show complaints of or treatment for diabetes or psoriasis. The Veteran’s separation examination in September 1966 document the Veteran had normal endocrine findings and was silent for any diagnosis or treatment of diabetes. The separation examination also documented the Veteran had normal skin upon examination and was silent for any diagnosis or treatment of psoriasis. Private medical records show a diagnosis for diabetes mellitus, type II, in 1997 and a diagnosis of psoriasis in 1990. Regarding the third and final element of service connection, the nexus, medical opinions have been obtained in December 2019 and May 2020. The Veteran underwent a VA Disability Benefits Questionnaire (DBQ) for both disabilities in September 2012; however, only an opinion on secondary service connection was provided. Therefore, those findings will be discussed in the secondary service connection portion of this opinion. Pursuant to the December 2019 Board remand, an addendum medical opinion and a Camp Lejeune Contaminated Water (CLCW) subject matter expert (SME) opinion were received on the issue of diabetes and its relation to service. The results from both opinions were consistent in that the Veteran’s diabetes mellitus was found as less likely than not related to his active duty service, to specifically include as due to the Veteran’s exposure to the contaminates at Camp Lejeune. The rationale provided in the December 2019 VA addendum medical opinion was that there was no medical, clinical or significant research evidence to support the contention that the Veteran’s diagnosed type II diabetes mellitus was etiologically related to his exposure to the contaminants at Camp Lejeune. Per literature review, the examiner noted that diabetes mellitus, type II, is a disease with a clear and specific etiology and diagnosis. Private records show the Veteran was diagnosed in 1997 with diabetes mellitus, approximately 30 years after military service. The examiner referenced that service treatment records are silent for a diagnosis or treatment of type II diabetes mellitus, and the Veteran’s separation examination in September 1966 documented normal endocrine clinical examination findings. The May 2020 Camp Lejeune Contaminated Water opinion confirmed the Veteran’s type II diabetes diagnosis, and found it was less likely than not caused by or related to his exposure to contaminated water. This conclusion was reached due to the older age of diagnosis, latency to recorded diagnosis (31 years), obesity, and lack of scientific evidence show contaminated water causes diabetes mellitus. The expert noted that diabetes is a chronic health condition that affects how the body turns food into energy. With type II diabetes, the body does not use insulin well and cannot keep blood sugar at normal levels. About 90-95 percent of people with diabetes have type II diabetes. It develops over many years and is usually diagnosed in adults. The expert noted that being overweight is the main risk factor for type II diabetes. Other risk factors include inactivity, the less active one is, the greater the risk of type II diabetes; family history, the risk of type II diabetes increases if a parent or sibling has type II diabetes; fat distribution, if fat is stored around the abdomen, there is a greater risk of type II diabetes; race, certain races – including African American, Hispanic, American Indian, and Asian-American are more likely to develop type II diabetes; age, the risk of type II diabetes increases as one ages; prediabetes; gestational diabetes; and polycystic ovarian syndrome in women. Pursuant to the December 2019 Board remand, an addendum medical opinion and a CLCW subject matter expert opinion was received on the issue of psoriasis and its relation to service. In December 2019, the VA examiner opined that the Veteran’s psoriasis was less likely than not etiologically related to his active duty service, to specifically include as due to the Veteran’s exposure to the contaminants at Camp Lejeune. The rationale provided was that, per literature review, psoriasis is a disease with a clear and specific etiology and diagnosis. In addition, psoriasis is not a presumptive condition with confirmed exposure to the contaminates at Camp Lejeune at this time. There is no medical, clinical, or significant research evidence to support the contention that the Veteran’s diagnosed psoriasis is etiologically related to his exposure to the contaminants at Camp Lejeune. The examiner noted that the Veteran was diagnosed with psoriasis in 1990, approximately 24 years after service. Additionally, STRs were silent for any psoriasis condition, diagnosis, or treatment. Additional evidence against the Veteran’s claim consists of the May 2020 Camp Lejeune Contaminated Water SME opinion regarding psoriasis and its relation to service. The expert found that the Veteran’s psoriasis was less likely than not caused by or related to his exposure to CLCW due to the association of psoriasis with chemotherapy, latency to recorded diagnosis (33 years) and lack of scientific evidence. The SME noted that long term studies evaluating solvent exposure and the development of psoriasis are not well supported. The Agency for Toxic Substances and Disease Registry does not identify psoriasis as a reported health problem due to exposure contaminated with benzene, vinyl chloride, TCE and/or PCE(3). The Veteran was stationed at Camp Lejeune for 1121 days and the levels of solvents were well below those identified in the studies. In addition, the record contains conflicting information regarding the onset of his psoriasis. In a July 2017 record, it was noted the Veteran noticed his psoriasis condition 3-4 months after his first chemotherapy treatment for NHL. However, private treatment records noted the Veteran was diagnosed with psoriasis in 1990. Chemotherapy started in 1999 and stresses the immune system which is a risk factor for psoriasis. The Veteran had no family history and was a nonsmoker. The only evidence of record relating the Veteran’s diabetes mellitus or his psoriasis to his military service are the Veteran’s own contentions. The Veteran is competent to report having experienced symptoms of diabetes or psoriasis, but he is not competent to determine that these symptoms are related to his time in service, specifically to exposure to contaminants while stationed at Camp Lejeune. Lay persons are not competent to link the claimed disabilities to any contaminated water consumption during service. Opinions regarding the nature and etiology of disabilities require medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). As such, the Board does not assign any probative weight to the Veteran’s assertions that his diabetes or his psoriasis are related to his service or his exposure to contaminated water. Although the Board recognizes the Veteran’s sincere belief that he suffers from diabetes mellitus and psoriasis because of service, there is no competent or credible evidence showing that the Veteran’s current disabilities are related to his service, to include his presumed exposure to water contaminants. Medical opinions provided in both 2019 and 2020 all concluded that the Veteran’s current disabilities were less likely than not related to service. The SME expert provided an alternative theory for the etiology of the Veteran’s diabetes mellitus, to include obesity, and noted the lack of scientific evidence supporting the contention the disabilities are related. For psoriasis, the SME noted the relation between psoriasis and chemotherapy and the lack of scientific research relating the two. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims and service connection for type II diabetes and psoriasis on a direct basis must be denied. As the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application, and the claims must be denied. Secondary service connection The Veteran contends his type II diabetes mellitus and psoriasis are secondary to his treatment for his service-connected Non-Hodgkin’s Lymphoma (NHL), including chemotherapy. See Hearing Transcript, page 5. For secondary service connection, the question for the Board is whether the Veteran has a current disability that is proximately due to, the result of, or was aggravated beyond its natural progression by the Veteran’s service-connected Non-Hodgkin’s Lymphoma. The Board finds secondary service connection is not warranted. Service connection was established for his NHL in the January 2018 rating decision, with an effective date of June 11, 2009. The Veteran was diagnosed with NHL in April 1999. See Private Treatment Records, April 1999. He was informed his treatment would require CHOP alone, and he received his first treatment on May 21, 1999. A private medical record from April 29, 1999 notes that the Veteran was being treated for psoriasis, with topical agents and adult onset diabetes mellitus. In addition, there is a medical record that shows the Veteran was being treated for psoriasis as early as 1990. The Veteran was diagnosed with type II diabetes mellitus in 1997. Therefore, medical records show he was being treated for both disabilities prior to receiving treatment for his Non-Hodgkin’s Lymphoma. Additionally, the record contains numerous medical opinions in relation to his secondary theory of entitlement to service connection. In September 2012, the Veteran was afforded a VA Diabetes Mellitus Disability Benefits Questionnaire (DBQ). The examiner confirmed a 1997 diagnosis of type II diabetes mellitus. The examiner opined that the Veteran’s diabetes mellitus was less likely than not proximately due to or the result of the Veteran’s service-connected condition. The rationale provided was that the Veteran’s diagnosis of diabetes was after his diagnosis of NHL and treatment with chemotherapy; 1 year after. The examiner further opined that the Veteran was obese with rotund adipose abdomen and large abdominal girth. Obesity is thought to be the primary cause of type II diabetes in people who are genetically predisposed to the disease. The examiner noted that treatment was managed by restricted diet, prescribed oral hypoglycemic agent(s), prescribed insulin 1 injection per day, and taking (3) oral medications and (1) daily Lantus dosing. In July 2017, the Veteran was afforded a VA Diabetes Mellitus DBQ. The examiner confirmed the 1997 diagnosis date of diabetes mellitus and the Veteran agreed with this date. The examiner opined that the Veteran’s diabetes mellitus was less likely than not proximately due to, the result of, or aggravated by his NHL. The rationale provided was that the records provided clearly document the Veteran was diagnosed with diabetes mellitus in 1997, therefore, it was documented to be diagnosed before his NHL diagnosis and treatment in 1999. Upon examination, the Veteran reported his treatment included management by restricted diet, prescribed oral hypoglycemic agent(s), and one insulin injection per day. Regulation of activities was not required as part of the management of his diabetes mellitus. In the past twelve months, no hospitalizations were noted for episodes of ketoacidosis or hypoglycemic reactions. The Veteran was afforded VA Skin Conditions DBQ’s in both September 2012 and July 2017. In September 2012, the Veteran’s psoriasis diagnosis was confirmed, with a diagnosis date of 2002. The examiner opined that the Veteran’s psoriasis was less likely than not proximately due to or the result of the Veteran’s service-connected disability. The rationale provided was that the Veteran developed psoriasis in 2002, 1-2 years after his diagnosis of NHL and chemotherapy was completed. He was not diagnosed during or immediately after chemotherapy dosing. The skin lesions started on the Veteran’s trunk in 2002. She noted that the immune system plays a key role in psoriasis and is the most prevalent autoimmune disease in the United States. The Veteran reported not being treated with oral or topical medications in the last 12 months for any skin condition. Upon physical examination of the Veteran’s exposed body areas (face, neck and hands), no psoriasis was noted. Treatment for antineoplastic chemotherapy was noted in 2001, with no residual conditions or complications due to the neoplasm (including metastases or its treatment were noted). During the July 2017 VA Skin Conditions DBQ, the examiner opined that the Veteran’s psoriasis was less likely than not proximately due to, the result of, or aggravated by his NHL. The examiner noted that the Veteran reported during today’s examination that he noticed his psoriasis condition starting 3-4 months after he completed his first chemotherapy treatment for his NHL. However, private medical records show the Veteran was diagnosed with psoriasis in 1990 and a note from April 29, 1999 documents the Veteran had a history of psoriasis, prior to his NHL diagnosis. The examiner noted that after review of all records provided, the Veteran’s claimed psoriasis condition was clearly documented to be diagnosed prior to his NHL diagnosis and treatment. The Veteran reported being treated with oral or topical medications on a constant basis for the past 12 months. Upon examination of the exposed body areas (face, neck and hands), no exposed areas were affected. He had slightly erythemic scaling plaques noted on the left upper extremity, right upper extremity, back, right buttock, umbilicus, and right and left lateral trunk consistent with his psoriasis diagnosis. No pain, edema, drainage, or signs of secondary infection were noted. The July 2017 VA opinions on both type II diabetes mellitus and psoriasis did not provide opinions regarding the aggravation prong of secondary service connection. In March 2018, the Board remanded for addendum aggravation opinions. Pursuant to the remand, an addendum aggravation opinion was provided for diabetes mellitus in September 2019. The examiner opined that it was less likely than not that the Veteran’s diabetes mellitus was aggravated by his service-connected Non-Hodgkin’s Lymphoma, to include treatment thereof. In support, she noted the lack of medical or clinical evidence to support the contention the disabilities are linked. The examiner noted that type II diabetes is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. It is a common disorder with a prevalence that rises markedly with increasing degrees of obesity. The prevalence of type II diabetes has risen alarmingly in the past decade, in large part linked to the trends in obesity and sedentary lifestyle. The presence of insulin resistance explains the strong clinical association of type II diabetes mellitus with obesity and other insulin-resistant states. An addendum aggravation opinion was also provided for psoriasis in September 2019. The examiner opined that it was less likely than not that the Veteran’s psoriasis was aggravated by his service-connected Non-Hodgkin’s Lymphoma, to include treatment thereof. The rationale provided was that after a review of the records, to include private hematology/oncology reports, private endocrinology records, private PCP records, and all other records provided for review, there is no medical or clinical evidence to support the contention that the Veteran’s psoriasis has been aggravated by his NHL, to include the treatment. Records provided were silent for any aggravation of the psoriasis condition. Per literature review, psoriasis is a common disorder that affects men and women equally. Although psoriasis can begin at any age, the peak times for disease onset are ages 30 to 39 and 50 to 69 years old. Psoriasis is a complex immune-mediated disease and genetic factors play an important role in susceptibility to psoriasis. In a May 2020 VA medical opinion, the VA examiner noted that chemotherapy treatment (for NHL) stresses the immune system which is a risk factor for psoriasis. The issue was remanded in September 2020 to obtain a new medical opinion to consider this fact. In October 2020, an addendum opinion was rendered addressing secondary service connection between his type II diabetes mellitus and his service-connected NHL. The examiner found that it was less likely than not that the Veteran’s type II diabetes mellitus was caused by, proximately due to, related to, and/or aggravated by his service-connected NHL, to include chemotherapy treatment. The examiner noted private medical records note the Veteran was diagnosed with diabetes mellitus in 1997 and the Compensation and Pension examination in July 2017 document the Veteran confirmed this date of diagnosis. The Veteran was diagnosed with Non-Hodgkin’s Lymphoma in April 1999. Records provided for review are silent for any noted clinical aggravation of the diabetes mellitus condition while undergoing treatment for his NHL. Per literature review, type II diabetes is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion. It is a common disorder with a prevalence that rises markedly with increasing degrees of obesity. The prevalence of type II diabetes has risen alarmingly in the past decade, in large part linked to the trends in obesity and sedentary lifestyle. In October 2020, an addendum opinion was rendered regarding service connection for the Veteran’s psoriasis, as secondary to his treatment for NHL. The examiner opined that the Veteran’s psoriasis was less likely than not caused by, proximately due to, related to, and/or aggravated by his service-connected NHL, to include chemotherapy treatment. The rationale provided was that the record was silent for any noted clinical aggravation of his psoriasis condition while undergoing treatment for his NHL. The examiner noted that based off the record, it was clear that the Veteran was diagnosed and treated for psoriasis prior to his diagnosis and treatment of NHL. The examiner noted an April 1999 medical record documents the Veteran had a history of psoriasis and was treated with topical agents. The examiner noted the May 2020 medical opinion was reviewed; however, it does not change the findings as the record clearly documents the Veteran’s psoriasis condition predates his NHL condition. In addition, the Veteran’s report that his psoriasis began 3-4 months after he completed his first chemotherapy session was considered, however, it cannot be substantiated. Although the Veteran believes his diabetes mellitus and psoriasis are secondary conditions to his service-connected Non-Hodgkins Lymphoma, he is not competent to provide a nexus opinion in this case. The Veteran asserted that his diabetes and psoriasis are a result of the chemotherapy treatment. However, the record does not show he has the requisite medical training or expertise needed to render a competent opinion as to the medical causation as it pertains to this specific disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). His statements in that regard are afforded no probative value. The Board finds the VA examinations and opinions, are more probative as to the nature and etiology of the Veteran’s diabetes mellitus and psoriasis, as they were based on examinations of the Veteran, consideration of an accurate medical history, and followed a review of the service treatment records and post-service treatment records. In summary, there is no competent and probative evidence of record linking the Veteran’s type II diabetes or psoriasis to his active service, to include his service-connected Non-Hodgkin’s Lymphoma or treatment thereof. Medical professionals noted both conditions were diagnosed prior to the NHL diagnosis, and the record contains no clinical documentation illustrating aggravation of either disease, diabetes mellitus or psoriasis, during NHL treatment. Therefore, the preponderance of the evidence is against the claims for secondary service connection. In reaching the conclusions above, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claims, that doctrine is not applicable in the instant appeal, and the claims must be denied. 38 C.F.R. § 3.102; see also Gilbert, 1 Vet. App. at 53. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Krista Johnson, Associate 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.