Citation Nr: 21062507 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 16-28 662 DATE: October 7, 2021 ORDER Service connection for benign essential tremor is denied. Service connection for thyroid cancer is denied. Service connection for hypothyroidism is denied. FINDINGS OF FACT 1. The Veteran has not been found to have any direct exposure to ionizing radiation, or any other herbicides or chemicals, during her military service. 2. It is less likely than not that the Veteran's benign essential tremor began in or was otherwise caused by the Veteran's active military service. 3. It is less likely than not that the Veteran's thyroid cancer began in or was otherwise caused by the Veteran's active military service. 4. It is less likely than not that the Veteran's hypothyroidism began in or was otherwise caused by the Veteran's active military service. CONCLUSIONS OF LAW 1. The criteria for service connection for benign essential tremor have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for thyroid cancer have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for hypothyroidism have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from January 1976 to September 1976. The matter is on appeal before the Board from a December 2015 rating decision. The Veteran provided testimony at a Board hearing in April 2020 before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Board remanded the issues for further development in June 2020. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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). Service connection may also be established with certain chronic diseases, based upon a legal presumption, which occurs by showing that the disorder manifested itself to a degree of 10 percent disabling or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Additionally, service connection may be established under 38 C.F.R. § 3.303(b), when a symptom or symptoms of a chronic disease are noted in service, or within a year of the date of separation from service, and when chronicity is established through a continuity of symptomatology after service. The continuity of symptomatology provision is an alternative method to establishing service connection for the specific chronic diseases listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 718 F.3d 1331 (Fed. Cir. 2013). Service connection may be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order to prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). Service connection may be granted on a presumptive basis for certain diseases resulting from exposure to an herbicide agent (including Agent Orange) for Veterans who, during active military, naval, or air service, served in the Republic of Vietnam between January 1962 and May 1975, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). Service in Vietnam includes the landmass and the territorial sea, which is defined as the 12 nautical miles surrounding Vietnam. See Procopio v. Wilkie, 913 F.3d 1375-1376, 1379-1380 (Fed. Cir. 2019). Service connection may also be granted on a presumptive basis for certain diseases specific to radiation exposed Veterans, i.e., a Veteran that engaged in a radiation risk activity under 38 U.S.C. § 1112(b)(2) and 38 C.F.R. § 3.309(d). Service Connection Essential Tremor, Thyroid Cancer, and Hypothyroidism The Veteran asserts that her benign essential tremor, her thyroid cancer, and her hypothyroidism were caused by exposure to radiation and hazardous chemicals during her basic training at Fort McClellan. Over the course of the appeal, the Veteran has submitted multiple treatises pertaining to chemicals and assessments of Fort McClellan, as well as treatises pertaining to chemicals and their effects on a person's health. In addition, the Veteran has submitted private medical records documenting her diagnoses and the progression of her diseases, along with physicians statements reflecting that exposure to ionizing radiation would have significantly increased her risk for developing thyroid cancer, as well as other disorders. For example, a letter from a neurologist was submitted on May 2, 2016, in which it was explained that the cause of cervical dystonia is often never discovered. Possibilities such as genetic mutation, brain structure abnormalities, and other issues were noted. However, the Veteran was reported to have no family history of cervical dystonia or other movement disorder. She was noted to have been exposed to high amounts of chemicals related to her occupation in Alabama. As such, the physician opined that it was quite likely that this was related to her underlying diagnosis of cervical dystonia, especially given the fact that she had no family history or anything else in her history that would be a comorbid factor and could potentially contribute to this. A letter from a physician's assistant was submitted on April 28, 2019, in which it was indicated that the Veteran suffers from multiple symptoms that so far have not been linked to a specific disease process. As such, the Veteran has been seen by multiple specialists in an attempt to secure a diagnosis. The physician's assistant reported that they understood the Veteran to have served in the military and to have been exposed to many chemicals, as well as possible radiation. Thus, due to a lack of a specific diagnosis it would be reasonable to presume that many of the Veteran's illnesses are related to chemical exposure while in the military. An additional letter from a physician was submitted on April 30, 2020, in which the Veteran was noted to have been diagnosed with and treated for thyroid cancer. The physician explained that while it can never be known what exactly causes a person to get cancer, but that it was known what risk factors can significantly increase a person's chance of getting different types of cancer. The physician indicated that it is known for a fact that radiation exposure can significantly increase a person's risk for thyroid cancer, noting that 10 years after the Chernobyl tragedy there was a large number spike in the cases of thyroid cancer. The physician stated that the Veteran's history has in it that she had been exposed to ionizing radiation, which the physician believed to have significantly increased her risk of thyroid cancer and to likely be the cause of why she eventually did get the cancer. The Veteran provided her personal testimony at a Board hearing in April 2020. She noted that she was a cook while in the military. She reported that while she was in the military, she had been in areas that were known to have exposure to radiation. After her service in the military, she started having problems with tremors at about 21, and in her 30s she began having problems with her thyroid. She noted that she had submitted reports that link tremors to sprays that were utilized at Fort McClellan. She explained that her physician had told her that her thyroid cancer was the type that was attributed to radiation exposure. Due to her thyroid cancer, she indicated that she had to have her thyroid removed, and therefore she developed hypothyroidism. While she had been in the service, the Veteran described having a lot of illnesses with symptoms of migraines, fatigue, nausea, and passing out for no reason. However, she noted that she had been unable to find any records. A review of the Veteran's service treatment records (STRs) does not show any diagnoses for tremors, thyroid cancer, or hypothyroidism. Nor do they reflect any complaints or treatments that may be related to tremors, thyroid cancer, or hypothyroidism. The Veteran's record reflects that a radiation exposure estimate was requested from the Army in relation to the Veteran's time at Fort McClellan. A negative response was received in May 2015 pertaining to there being any evidence of the Veteran being exposed to ionizing radiation. Based upon the Veteran's personal testimony pertaining to her illnesses, the copious amounts of treatises submitted pertaining to chemicals and assessments of Fort McClellan, as well as treatises pertaining to chemicals and their effects on a person's health, and the private statements from her physician's and physician's assistant, VA Disability Benefits Questionnaires were completed by a VA examiner and a medical opinion was rendered in September 2020. The examiner indicated the Veteran to have diagnoses of essential tremor, malignant neoplasm of the thyroid and hypothyroidism. Pertaining to the tremor, the VA examiner explained that the Veteran was stationed at Fort McClellan in the early 1970s. She was a cook. She separated from the service after only 8 months. About 2 years later at the age of 21, after her separation from the military, she developed an essential head tremor. She was seen by neurology consultants, where her diagnosis was verified, and she has been treated for this over the years. The examiner noted that the Veteran thinks that her head tremors are related to environmental exposure and chemical agents that were used at Fort McClellan while she was stationed at that location, including "Agent Orange." To this end, the Veteran has submitted multiple environmental papers regarding chemical agents and their presence in soil evaluations at Fort McClellan and has stated that she feels that her essential tremor is related to this exposure. The Veteran asserts that herbicides such as Agent Orange were used at Fort McClellan and that she believes she was exposed to them. The examiner indicated that there is no documentation by the military that Agent Orange was used at Fort McClellan, and it has not been documented as one of the known sites of use/exposure to this toxin, such as in Vietnam. The Veteran contended that some of these agents mixed together would make Agent Orange, but there is no supporting proof for such a claim. There is no verification that the Veteran was ever exposed to any of these agents. Rather, it is only that she thinks they may have been used during the time she was at Fort McClellan. The examiner explained that essential tremor is one of the most common neurological disorders in the general population, and its origin is genetic. The Veteran's condition did not appear until almost 2 years after she separated from the service. Thus, the examiner opined that it is less likely than not that the Veteran's neurological condition of essential tremor is related to her military service activities. Rather, her essential tremor is more likely than not related to her genetics, as this is by far the most common cause of an essential tremor in the general population. The examiner reiterated that essential tremor is one of the most common neurological disorders in the general population. There is no documentation that the Veteran had any exposure to toxic chemicals while stationed at Ft. McClellan. The Veteran believes that because there were toxic substances at Fort McClellan at the same time she was, that she therefore must have been exposed, which in turn caused her various medical conditions including her essential tremor. The examiner stated that there are no facts to verify this line of reasoning. Additionally, there is no evidence that she had any sign of tremor while in the service. Pertaining to thyroid cancer and hypothyroidism, the examiner reiterated that the Veteran was stationed at Fort McClellan in the early 1970s for about three months. She separated from the military after a total of nine months. She was found to have a thyroid mass/lump in her throat decades later in 2013. A workup was suspicious, and she underwent a total thyroidectomy on July 18, 2013. The pathology report showed papillary thyroid carcinoma in a thyroglossal duct cyst. The tumor was "BRAF" positive and she received total ablation with I-131. Since then, the Veteran has been on thyroid replacement hormone. There is no evidence of metastatic disease. The Veteran claimed service connection for her thyroid cancer and resultant surgical hypothyroidism by asserting that her thyroid cancer was caused due to radiation exposure while she was stationed at Fort McClellan. The examiner reasoned that the Veteran had no direct dealings with, or assignment to, nuclear material while in the service. The Army verified via a letter from May 2015, that the Veteran has no record of radiation exposure. She was a cook. The Veteran asserts that she was in the field on occasion. The Veteran has submitted multiple documents about thyroid cancer, it's relation to radiation exposure, and the verified findings of radiation contamination in the soil in parts of Fort McClellan, however, she has not submitted any evidence of her ever being physically located in these areas. There is no claim or evidence that she was ever in contact with, or in close proximity to, the areas of contamination. Rather, the Veteran's claim is merely that by being present at Fort McClellan she was exposed to enough radiation to eventually cause her to develop cancer. The Veteran is correct that thyroid cancer can be associated with radiation exposure, which has been verified by studies at the Chernobyl nuclear accident site among others. However, the examiner explained that thyroid cancer is a very common type of malignancy, and the overwhelming majority of people suffering from it have no association with radiation exposure. There is no evidence that the Veteran was ever exposed to increased radiation while in the service. The Veteran has not indicated any direct exposure event and the Army reports no evidence of any exposure event. Additionally, genetics are felt to be a significant risk factor in thyroid cancer. While the Veteran reports that she is not aware of anyone else in her family having thyroid cancer, this is not adequate to eliminate genetic causes. Female gender alone is a known genetic risk factor for thyroid cancer, as is age. The Veteran has several letters in her records from physicians addressing her thyroid cancer condition and the known association with external radiation exposure, but there are none that state her tumor was caused by radiation exposure acquired during her military service at Fort McClellan. Occasionally the military, with VA following suit, will designate an area or event as especially high risk for medical conditions, such as Vietnam and Agent Orange or Camp Lejeune and water supply, however, there is no such current designation for Fort McClellan. Thus, the examiner opined that it is less likely than not that the Veteran's thyroid cancer and resultant secondary post-procedure hypothyroidism is related to any exposure event associated with her military service. Rather, it is more likely than not that her thyroid cancer is a random occurrence, such as occurs to others in the general population. There is no association with any of her service activities, duties, or exposures. Additionally, there is no documentation of radiation exposure while she was in the service. Further review of the Veteran's VA and private treatment records does not provide any findings of any greater significance than those relayed above. Consideration is given to the Veteran's contentions that her claimed benign essential tremor and thyroid cancer were incurred in or caused by her military service, as well as her contention that her claimed hypothyroidism is secondary to her thyroid cancer. While lay persons are competent to provide opinions pertaining to certain medical issues, the etiology of benign essential tremor, thyroid cancer, and hypothyroidism, as is specific to this case, is outside the realm of common knowledge for someone, such as the Veteran, who does not possess medical training, specialized expertise, or experience. Jandreau v. Nicholson, 492. F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Veteran is competent to report her symptoms relating to her tremor, thyroid cancer, and hypothyroidism, however, no probative value shall be assigned to her contentions pertaining to the etiology of her tremor, thyroid cancer, and hypothyroidism. Based on the foregoing, service connection for benign essential tremor, thyroid cancer, and hypothyroidism is not warranted. The military has researched her claimed exposure to ionizing radiation but did not find her to have any actual exposure. Since the Veteran has not been shown to have exposure to ionizing radiation, and there is no evidence that she was directly exposed to herbicides, as she did not have service in the Republic of Vietnam or in any other areas that are presumed to have exposure to herbicides, the private medical opinions do not hold any substantive weight because they are based upon her claimed exposure. To this end, a layperson's assertions indicating exposure to gases or chemicals during service are not sufficient evidence alone to establish that such an event actually occurred during service. See Bardwell v. Shinseki, 24 Vet. App. 36, 40 (2010). Here, beyond reports of some contamination at Fort McClellan, the base spans a massive geographic area, and the Veteran has not established that she personally was exposed. She has asserted that she was on the base and potentially in areas that may have been contaminated, but such speculation is not sufficient to show actual exposure. In addition, the VA examiner found that the Veteran's essential tremor, thyroid cancer, and hypothyroidism were less likely than not related to her active military service, to include any exposure to ionizing radiation and herbicides or chemicals. The VA examiner provided a very thorough and well rationalized opinion backing their findings. Also, the Veteran has reported that she worked as a cook while in the military, which is reflected by her MOS, and while she contends that she went into areas at Fort McClellan that were purported to be contaminated, she has not actually provided a description of or any evidence of an actual event where she came into contact with any radiation, herbicides, or other chemicals. Thus, service connection is not warranted as there is no evidence of the Veteran having any direct contact with any chemicals or radiation, the private medical opinions are based upon her reported exposure leaving them without weight, and there are thorough and well rationalized VA medical opinions finding that the Veteran's conditions are less likely than not related to her active military service. Accordingly, service connection for benign essential tumor, thyroid cancer, and hypothyroidism are denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.