Citation Nr: 21069126 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 20-06 037 DATE: November 17, 2021 ORDER Entitlement to service connection for peripheral neuropathy is denied. Entitlement to service connection for soft tissue sarcoma is denied. Entitlement to service connection for skin disorder, to include chloracne, is denied. Entitlement to service connection for residuals of prostate cancer is denied. Entitlement to service connection for a thyroid disorder, to include hypothyroidism, is denied. Entitlement to service connection for residuals of testicular cancer is denied. Entitlement to service connection for a heart disorder, to include ischemic heart disease, is denied. Entitlement to service connection for Parkinson's disease and/or Parkinsonism is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had peripheral neuropathy at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had soft tissue sarcoma at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence is against finding that skin disorder, to include chloracne, began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that the Veteran was exposed to herbicide agent(s) during his active service. 5. The preponderance of the evidence is against finding that prostate cancer began during active service, or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that thyroid disorder, to include hypothyroidism began during active service, or is otherwise related to an in-service injury or disease. 7. The preponderance of the evidence is against finding that testicular cancer began during active service, or is otherwise related to an in-service injury or disease. 8. The preponderance of the evidence is against finding that heart disorder, to include ischemic heart disease began during active service, or is otherwise related to an in-service injury or disease. 9. The preponderance of the evidence is against finding that Parkinson's disease and/or Parkinsonism began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 2. The criteria for service connection for soft tissue sarcoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 3. The criteria for service connection for skin disorder, to include chloracne are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 4. The criteria for service connection for residuals of prostate cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 5. The criteria for service connection for thyroid disorder, to include hypothyroidism are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 6. The criteria for service connection for residuals of testicular cancer are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 7. The criteria for service connection for a heart disorder, to include ischemic heart disease are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. 8. The criteria for service connection for Parkinson's disease and/or Parkinsonism are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force as an Air Passenger Specialist (Air Force Specialty Code 60550) from June 1965 until his honorable discharge in September 1968. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). These matters come before the Board of Veterans' Appeals (Board) on appeal from the April 2017 and November 2018 rating decision(s) by the Wichita, Kansas Regional Office (RO) of the United States Department of Veterans Affairs (VA). In May 2021, the Veteran [and his spouse] testified at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A partial transcript of the hearing has been associated with the record on appeal. Specifically, the transcript ended when the Veteran lost connection and the second portion of the transcript is unavailable. In October 2021, the Board contacted the Veteran and offered him an opportunity for an additional hearing. In October 2021, the Veteran's attorney replied to the opportunity for a new Board hearing and advised that the Veteran has declined the opportunity for a new hearing and to decide the case on the current record, including the partial transcript. In June 2020, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to request that the JSRRC, or other official source, investigate and attempt to verify the Veteran's reports of alleged exposure to Agent Orange at Anderson Air Force Base on Guam while supporting aircraft, including C-123 aircraft, during his period of service from June 1965 to September 1968; have JSRRC also provide the histories of the Veteran's unit(s) during the time he served in Guam; have the Veteran identify all medical providers who have treated him for a heart disorder; a thyroid disorder, to include hypothyroidism; prostate cancer; testicular cancer; soft tissue sarcoma; a skin disorder; peripheral neuropathy; and Parkinson's disease/Parkinsonism since August 2019; notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service herbicide agent (Agent Orange) exposure, as well as his in-service and post-service symptomatology regarding his claimed heart disorder; a thyroid disorder, to include hypothyroidism; prostate cancer; testicular cancer; soft tissue sarcoma; a skin disorder; peripheral neuropathy; and Parkinson's disease/Parkinsonism; and to schedule the Veteran for appropriate VA examination(s) (or telehealth interview, review of record, etc., if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed skin disorder. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Herbicide Agent Exposure (Guam) Although the Veteran does not assert, nor does the evidence indicate that the Veteran served in either the Republic of Vietnam (including the waterways) nor Thailand, the Board will discuss the presumption of herbicide agent exposure in both of those locations to illustrate some of the differences between how the law addresses herbicide agent exposure on a presumptive basis. A Veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). The Vietnam era is the period beginning on February 28, 1961 and ending on May 7, 1975 for veterans who served in the Republic of Vietnam, and the period beginning on February 28, 1961 and ending on May 7, 1975, in all other cases. 38 U.S.C. § 101(29)(A). Service in the Republic of Vietnam is "service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam." 38 C.F.R. § 3.307(a)(6)(iii). VA has interpreted this regulation to require "the service member's presence at some point on the landmass or the inland waters of Vietnam" for entitlement to a presumption of exposure to Agent Orange. Haas v. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008), cert. denied, 129 S.Ct. 1002 (2009). Furthermore, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held in 2019 that service in the Republic of Vietnam includes service in the territorial seas of the Republic of Vietnam. See Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). The holding in Procopio was further codified in the Blue Water Navy Act of 2019. 38 U.S.C. § 1116A(c). Service on a U.S. Navy vessel may qualify as duty or visitation in Vietnam, as long as the veteran set foot on land or the vessel nevertheless was in the inland waterways or territorial waters of the Republic of Vietnam. 38 C.F.R. §§ 3.307(a)(6)(iii); Haas, 525 F.3d at 1195, 1197; Gray v. McDonald, 27 Vet. App. 313 (2015); Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). VA maintains a list of US Navy and Coast Guard ships associated with military service in Vietnam that addresses whether the ship was in the inland or offshore waterways and had possible exposure to Agent Orange or other herbicides. For veterans presumed to have been exposed to herbicide agents, certain enumerated diseases shall be service connected even though there is no record of such disease during service, 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). If a veteran was exposed to an herbicide agent during active military, naval, or air service, service connection is presumed for the following disorders: AL amyloidosis; bladder cancer; chloracne or other acneform disease consistent with chloracne; type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin's disease; hypothyroidism; Ischemic heart disease (including but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery); and stable, unstable and Prinzmetal's angina); all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia); multiple myeloma; non-Hodgkin's lymphoma; Parkinson's disease; Parkinsonism; early onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma); bladder cancer; and hypothyroidism. 38 C.F.R. § 3.309(e). A presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for: hepatobiliary cancers; nasal and/or nasopharyngeal cancer; bone and joint cancer; breast cancer; female reproductive cancers; renal cancer; testicular cancer; abnormal sperm parameters and infertility; Amyotrophic Lateral Sclerosis (ALS); chronic persistent peripheral neuropathy; lipid and lipoprotein disorders; gastrointestinal and digestive disease including liver toxicity; immune system disorders; circulatory disorders; respiratory disorders (other than certain respiratory cancers); skin cancer; cognitive and neuropsychiatric effects; gastrointestinal tract tumors; brain tumors; endometriosis; and, any other condition for which VA has not specifically determined a presumption of service connection is warranted. Neither Congress nor the Secretary of Veterans Affairs have established a presumption of exposure to an herbicide agent for service on the island of Guam. Thus, a veteran seeking compensation for disabilities allegedly incurred in as a result to exposure to an herbicide agent on the island of Guam must demonstrate actual exposure to such agent through direct evidence. 1. Entitlement to service connection for peripheral neuropathy 2. Entitlement to service connection for soft tissue sarcoma Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below. The Board notes that the Veteran asserts that he was exposed to herbicide agents during his service at Peterson Air Force Base, Guam. Specifically, the Veteran asserts that during his service on Guam from October 1967 to September 1969, he handled freight and passengers on aircraft, including Agent Orange and that Agent Orange was used for defoliation on Guam. Furthermore, the Veteran's attorney has submitted numerous statements conveying their belief that there was herbicide agent contamination on the island of Guam and their frustration that the claim has not previously been granted. First, the Board finds that there is not a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's VA treatment records and private treatment records are silent for a diagnosis of peripheral neuropathy and soft tissue sarcoma. In the absence of a disability during the pendency of the claim, service connection cannot be established. See Brammer v. Derwinski, 2 Vet. App. 223 (1992). There is also insufficient evidence of a disability at any point during the claim period or shortly before. See McClain v. Nicholson, 21 Vet. App. 219 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Accordingly, entitlement to service connection is denied. However, even if the Board found that the Veteran had a current disability of peripheral neuropathy or soft tissue sarcoma, as will be addressed in greater detail below, the Board finds that the Veteran was not exposed to herbicide agent(s) during his service on the island of Guam. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for skin disorder, to include chloracne The Veteran asserts that he is entitled to service connection for a skin disorder, to include chloracne, because the disability began in 1969 with nodules with blood. The disability symptoms have progressed to appearing with bleeding, lesions on his forearms, back, legs, and head. As a preliminary matter, the Board notes that it appears that the Veteran may have attempted to withdraw this claim. However, since it is unclear as to the final decision of the Veteran to withdraw the claim or not, the Board shall decide the issue. First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran was afforded a VA examination in February 2021. The February 2021 VA examiner diagnosed the Veteran with seborrheic keratoses, skin tags, and sebaceous hyperplasia. See February 2021 VA examination, p. 3. Second, while the evidence does not show any in-service treatment for these skin conditions, they do show (a) a complaint of athlete's foot with bleeding in February 1966; and (b) complaints of acne in September 1965 and September 1966. However, as will be addressed in greater detail below, the Board finds that the Veteran was not exposed to herbicide agent(s) during his service on the island of Guam, which would be applicable if the Veteran had a diagnosis of chloracne. Third, the Board finds that the evidence of record does not support a finding that the Veteran's skin disabilities are related to active service. The Veteran was afforded a VA examination in February 2021. The February 2021 VA examiner opined that the Veteran's skin disabilities are less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness because although the Veteran's service treatment records reflect (a) a complaint of athlete's foot with bleeding in February 1966; (b) complaints of acne in September 1965 and September 1966; neither condition reflects a current diagnosis. The February 2021 VA examiner explained that the Veteran's current diagnosis includes seborrheic keratosis, candidiasis of skin and nail, yeast dermatitis and that seborrheic keratosis is one of the most common noncancerous skin growths in older adults and that while it is possible for one to appear on its own, multiple growths are more common and that seborrheic keratosis often appears on the face, chest, shoulders, or back and has a waxy, scaly, slightly elevated appearance. Although the cause of seborrheic keratosis is unknown (to experts), it appears to be a mix of factors including stress, genes, a yeast that usually lives on skin without causing other problems, some medical conditions and medications, cold and dry weather, or an immune system response. The February 2021 VA examiner further explained that the Veteran's sebaceous hyperplasia is most common in middle-aged or older people with fair skin, especially people that have had a lot of sun exposure are more likely to get sebaceous hyperplasia; skin tags are caused mainly by skin rubbing against skin; and candidiasis of the skin is an infection of the skin and nails caused by the candida fungus and often occur in areas exposed to moisture for long periods of time. The February 2021 VA examiner concluded that none of these disabilities were present during the Veteran's period of active service and therefore the claimed conditions are less likely than not (less than 50 percent probability) incurred in or caused by his active military service. Finally, the Board notes that the Veteran is not diagnosed with chloracne, and as addressed above, the Board finds that the Veteran was not exposed to herbicide agent(s) during his active military service. Accordingly, entitlement to service connection for a skin disorder, to include chloracne is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for residuals of prostate cancer 5. Entitlement to service connection for a thyroid disorder, to include hypothyroidism 6. Entitlement to service connection for residuals of testicular cancer 7. Entitlement to service connection for a heart disorder, to include ischemic heart disease 8. Entitlement to service connection for Parkinson's disease and/or Parkinsonism Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below. The Veteran asserts that the above disabilities are related to in-service exposure to herbicide agent(s). Specifically, the Veteran asserts that during his service on Guam from October 1967 to September 1969, he handled freight and passengers on aircraft, including Agent Orange and that Agent Orange was used for defoliation on Guam. First, the Board finds that there are current disabilities. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran has a current diagnosis of ischemic heart disease; residuals of prostate cancer; a thyroid disorder, to include hypothyroidism; residuals of testicular cancer; a heart disorder, to include ischemic heart disease; Parkinson's disease and/or Parkinsonism. See VA treatment records and private treatment records. Second, the Board finds that there was not an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran does not assert, nor does the record reflect an in-service onset of parkinsonism; ischemic heart disease; residuals of prostate cancer; a thyroid disorder, to include hypothyroidism; residuals of testicular cancer; a heart disorder, to include ischemic heart disease; Parkinson's disease and/or Parkinsonism (nor peripheral neuropathy and soft tissue sarcoma). The record does not reflect that herbicide agents were ever present on the island of Guam, let alone utilized on the island of Guam for deforestation. Unlike other locations, such as the Republic of Vietnam, the record does not contain probative evidence that Guam utilized herbicide agents for deforestation, storage, nor for testing purposes. In contrast, the evidence indicates that herbicide agents were never brought to nor stored on the island of Guam. See September 2020 Guam Herbicide Exposure email correspondence and September 2020 VA Memorandum. See also April 28, 2017 JSRRC Formal Finding. The United States Government Accountability Office (GAO) issued a report to the United States Congress in November 2018. Included within the November 2018 report, it is noted that records reflect that only one ship (S.S. Gulf Shipper) stopped on Guam that was carrying Agent Orange (62,750 gallons), Agent Blue (4,620 gallons), and Agent White (31,735 gallons) en route to Vietnam at Port Apra (now Apra Harbor). See November 2018 GAO Report, pp. 29, 30, 71. However, the purpose of the S.S. Gulf Shipper's stop was to offload a mariner for repatriation to the United States. See November 2018 GAO Report, pp. 70. Furthermore, the GAO report notes that three ships stopped at the island of Guam on the return from Vietnam (S.S. Aimee Lykes (1 crewmember) [loaded onto a small motorboat], S.S. Buckeye Atlantic (2 crewmembers), S.S. Overseas Suzanne (one crewmember)) to offload injured crew members. See November 2018 GAO Report, p. 32. The November 2018 GAO report also notes that they found (and the United States Air Force officials agreed) that it is unlikely that [herbicide agents were] shipped by air to or from the island of Guam, noting that the United States Air Force transported small quantities of tactical herbicides by air to Vietnam in 1961 because although it would have been possible to transport 55-gallon drums from Guam to supply operations in Vietnam, it would have been an inefficient method of transporting large quantities of herbicides because each 55-gallon drum of [herbicide agent] weighed approximately 600 pounds (approximately 11 pounds per gallon). See November 2018 GAO Report, pp. 32-33. The Board notes that the November 2018 GAO report noted that the Department of Defense stored and used commercial herbicides on the island of Guam, possibly including n-butyl, 2,4,5-T (including contaminant 2,3,7,8-TCDD), during the 1960s through 1980. See November 2018 GAO Report, p. 33. However, documents do not indicate the use of tactical herbicide agents on the island of Guam. See November 2018 GAO Report, p. 33. The November 2018 GAO report also addresses challenges for Agent Orange testing due to degradation and multiple source contamination, noting that as of the report, it had been nearly 50 years since Agent Orange was last transported and used in support of military operations in Vietnam and it is difficult to find traces ot he two components of Agent Orange (n-butyl 2,4-D and n-butyl 2,4,5-T) because under normal environmental conditions, the n-butyl forms break down rapidly into the acid forms, which has a half-life ranging from several days to many months. See November 2018 GAO Report, pp. 45-46. The November 2018 GAO report notes that the time it takes for the contaminant 2,3,7,8-TCDD to degrade is longer than that for components of Agent Orange (9 to 15 years in surface soil and 25 to 100 years in subsurface soil), however there are multiple sources of the dioxins, including 2,3,7,8-TCDD, and the specific source of the dioxin contamination is difficult to identify. See November 2018 GAO Report, pp. 46-48. The Board notes that the Veteran submitted a portion of the Ground Water Monitoring and Assessment by the Guam EPA 2010 Integrated Report noting "...as a consequence of past Air Force activities at MARBO Annex, the groundwater beneath the Annex area has been impacted by trichloroethylene (TCE) in the northern portion and tetrachloroethene (PCE) in the vicinity of the former MARBO Laundry facility." However, this report (1) does not identify what activities; (2) when the activities occurred; (3) does not add to the Veteran's assertion that herbicide agents were utilized on the island of Guam; nor (4) provide a nexus to the Veteran's current disabilities. Therefore, the Board finds that the partial report is not probative. Included within the May 2021 correspondence from the Veteran's attorney, the attorney asserts that "[they] don't care if Agent Orange was never brought to Guam. The laws and regulations do not say Agent Orange. The laws and regulations do not say tactical herbicide. The instead say herbicide agent and then name them: 2,4-D, 2,4,5-T, TCDD, picloram, and cacodylic acid." See May 2021 Third Party Correspondence. However, the Board notes this is not an accurate representation of the law. 38 C.F.R. § 3.307(a)(6) provides that [d]iseases associated with exposure to certain herbicide agents. (i) For the purposes of this section, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning January 9, 1962, and ending on May 7, 1975, specifically 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid, and picloram. See 38 C.F.R. § 3.307(a)(6). Although there are numerous sources of these chemicals, 38 C.F.R. § 3.307(a)(6) only provides for herbicide(s) used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning January 9, 1962, and ending on May 7, 1975. This difference is what separates herbicide agents and other commercial herbicides. Furthermore, the Veteran's attorney asserts "on page 34 GAO 19-24, it states that "herbicide agents 2-4-D and 2-4-5T were sprayed on Guam." See May 2021 Third Party Correspondence. Once again, the Board notes that the attorney appears to confuse commercial herbicides with herbicide agents. As noted on page 34 of the November 2018 GAO report, commercial herbicides containing 2,4-D were present on Guam, and that commercial herbicides containing 2,4,5-T, which included the contaminant 2,3,7,8-TCDD, had been used for weed control along power lines and substations through 1980. See November 2018 GAO Report, pp. 34. However, first and foremost, as noted above, commercial herbicides are not herbicide agents (they were never used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning January 9, 1962, and ending on May 7, 1975). Second, the commercial herbicides were utilized on Guam through 1980 and the evidence does not reflect the contamination levels (if any) during the Veteran's service nearly 50 years prior to the November 2018 GAO report. Finally, the evidence does not show that the Veteran was exposed to the commercial herbicides. The Board finds that the evidence of record does not establish that during the Veteran's service that the soil and drinking water on the island of Guam were contaminated. Furthermore, the evidence of record does not establish that herbicide agents were used on the island of Guam. Finally, the evidence of record does not show that the Veteran was exposed to herbicide agent(s) during his active military service, nor does it demonstrate any actual exposure to herbicide agent(s) through direct evidence. Thus, without more, the preponderance of the evidence is against a finding of herbicide agent exposure nor an in-service incurrence of ischemic heart disease; residuals of prostate cancer; a thyroid disorder, to include hypothyroidism; residuals of testicular cancer; a heart disorder, to include ischemic heart disease; nor Parkinson's disease and/or Parkinsonism. The second element of service connection has not been met, and an award of service connection is not warranted. See Holton, supra. Accordingly, service connection is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Deemer, 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.