Citation Nr: 21072753 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 14-37 906 DATE: December 6, 2021 ORDER Service connection for benign prostatic hyperplasia (BPH) with polyuria, to include as secondary to the service-connected diabetes mellitus disability or as due to exposure to herbicide agents, is denied. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam and is presumed to have been exposed to herbicides. 2. The Veteran's prostate disorder was not incurred in service and is not otherwise related to service, to include in-service herbicide exposure. 3. The Veteran's prostate disorder was not caused or aggravated by his service-connected diabetes disability. CONCLUSION OF LAW The criteria for service connection for BPH with polyuria, to include as secondary to the service-connected diabetes mellitus disability or as due to exposure to herbicide agents, are not met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from November 1965 to October 1967, which includes service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The issue on appeal was previously remanded by the Board in January 2021 and August 2021 for further development. The requested development has been completed and the case has been returned to the Board for adjudication. Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57(1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Prostate Disorder The Veteran maintains that his prostate disorder is etiologically related to herbicide exposure during service, or alternatively, to his service-connected diabetes mellitus disability. Initially, the Board finds that the Veteran has a diagnosed prostate condition. Specifically, a June 2021 VA examiner confirmed a diagnosis of prostate hyperplasia (BPH). The Veteran's polyuria (i. e., a condition where the body urinates more than usual) has been found to be a symptom associated with the Veteran's BPH. See August 2020 VA medical opinion. Next, the Board finds that the Veteran served in the Republic of Vietnam; as such, he is presumed to have been exposed to herbicides, including Agent Orange. Although the Board finds that the Veteran served in Vietnam during the Vietnam War era, and is presumed to have been exposed to herbicide agents during service, BPH is not among the diseases listed under 38 C.F.R. § 3.309 (e) 5), for which presumptive service connection based on herbicide exposure is available. As such, the Board finds that presumptive service connection for the Veteran's prostate disorder, diagnosed as BPH, based on exposure to herbicides in service is not warranted. Notwithstanding the inapplicability of the Agent Orange presumptive service connection regulations, the Board is obligated to fully consider the Veteran's service connection claim on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994) (where the Federal Circuit determined that an appellant is not precluded from establishing service connection with proof of actual direct causation). In this regard, the Board finds that the Veteran's prostate disorder is not etiologically related to service, to include the in-service herbicide exposure or as secondary to his service-connected diabetes disability. Service treatment records contain no complaints, diagnoses, or treatment related to a prostate disorder in service. An October 1967 report of medical examination, conducted at service separation, does not show that a prostate disorder was indicated. Moreover, during the June 2021 VA examination, the Veteran indicated that he was first diagnosed with a prostate disorder "about ten years ago," i. e., more than 40 years following service separation. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (explaining that the Board may consider "evidence of a prolonged period without medical complaint," along with other factors in resolving a claim). Regarding the etiology of the Veteran's BPH, VA obtained a medical opinion in August 2020. At that time, the examiner stated that the Veteran's prostate problem, BPH was not related to service as BPH was considered a normal condition of male aging, and many men older than 80 years had BPH symptoms. Although the exact cause of BPH was unknown, changes in male sex hormones that arose with aging were noted to be a possible factor. Therefore, the examiner opined that the Veteran's diagnosed BPH and subsequent polyuria were less likely than not incurred in or caused by the presumed exposure to herbicide agents during service. The examiner also indicated that diabetes mellitus was not related to BPH as there was no known link between BPH and polyuria and diabetes. Pursuant to the Board's remand directive, a June 2021 VA examiner reviewed the claims file and provided an additional opinion as to secondary service connection. Specifically, the examiner stated that type two diabetes mellitus occurred due to dysregulation of blood glucose levels. It was not accepted in the general medical community that increased glucose levels in the blood would cause the prostate to enlarge, leading to BPH. BPH was a condition that is common among older men, especially after age 65. Diabetes did not typically aggravate or accelerate the growth of the prostate, leading to BPH. The Board finds the August 2020 VA medical opinion to be highly probative as to whether the Veteran's prostate disorder is etiologically related to the in-service herbicide exposure on a direct basis. The Board further finds that the June 2021 opinion is highly probative as to whether the Veteran's prostate disorder is secondary to his service-connected diabetes disability. The examiners reviewed the evidence of record, discussed the relevant medical evidence, and provided medical opinions support by a well-reasoned rationale. See Bloom, 12 Vet. App. 187; Hernandez-Toyens, 11 Vet. App. 382; see also Claiborne, 19 Vet. App. 181, 186. The Veteran's statements asserting a nexus between his prostate disorder and the in-service herbicide exposure or his service-connected diabetes mellitus are not competent evidence. As a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the medically complex disorder of prostate disorder. Prostate disorders are complex disease processes because of their multiple possible etiologies. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). For the reasons discussed above, the Board finds based on the competent, credible, and probative evidence of record, the Veteran's prostate disorder was not incurred in service, was not etiologically related to the in-service herbicide exposure, and is not proximately due to or aggravated by service-connected diabetes mellitus. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.