Citation Nr: A21020025 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 200722-99150 DATE: December 15, 2021 ORDER Service connection for pancreas cancer is denied. FINDING OF FACT The preponderance of the evidence is against finding that pancreas cancer began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for pancreas cancer are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the United States Army from February 1966 to February 1968. His decorations include the Vietnam Service Medal and Vietnam Campaign Medal. The rating decision on appeal was issued in December 2019 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the July 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Pancreas Cancer 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; 38 C.F.R. § 3.303. To establish service connection for a 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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). In the December 2019 rating decision, the AOJ found that the Veteran has a diagnosis of pancreas cancer and that he was exposed to herbicide agents. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). The Veteran contends that his pancreas cancer is due to exposure to Agent Orange. For the following reasons the Board disagrees and finds that service connection is not warranted. If a Veteran was exposed to an herbicide agent during active military, naval, or air service, then certain diseases shall be service connected even though there is no record of such disease during service. For the purpose of this section, the term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operation in the Republic of Vietnam during the Vietnam era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.313. However, pancreas cancer is not included as a disease where presumptive service connection is available. As such, presumptive service connection is not applicable to the Veteran's claim. Though service connection cannot be granted on a presumptive basis, service connection is still available on a direct basis. The evidence concerning the third element for direct service connection, medical nexus, consists of an opinion from the Veteran's treating oncologist, and an opinion from a VA examiner. The Veteran submitted a September 2019 letter from his treating oncologist. In this letter, his oncologist states that they cannot attest that the Veteran's pancreatic cancer was caused by Agent Orange. They do clarify that they also cannot say that there is no relation. They continue to state that the Veteran's pancreas cancer may be related to his exposure to Agent Orange reasoning that the gastrointestinal track and respiratory track have similar origins. The oncologist says that there is an association between Agent Orange and cancers in general that seems strong and finds that there may be a connection between Agent Orange and the Veteran's cancer. The Board finds that the oncologist's finding that exposure to Agent Orange may have caused the Veteran's pancreas cancer to provide little probative weight in support of the Veteran's claim. The use of the clarifier "may" makes the opinion speculative. As such, the submitted opinion by the Veteran is afforded little probative weight in support of his claim. In August 2019, the Veteran underwent a VA examination for his claim. The examiner found that it was less likely than not that the Veteran's pancreas cancer is connected to Agent Orange exposure. Their rationale was based a review of medical literature which states "cancers of the esophagus, stomach, pancreas, colon, and rectum have been extensively studied in Vietnam veterans, occupational groups with herbicide exposure, and people exposed to dioxins. These studies have yielded a fairly consistent pattern of no association between these exposures and GI cancer." The Board finds this opinion to be based on a sound rationale with no speculation. As such, the Board affords great probative weight to the VA examiner's opinion. The Board acknowledges the Veteran's contention that his pancreas cancer is due to exposure to Agent Orange. Though the Veteran is competent to describe the circumstances of his service, the Veteran has not shown that he has the requisite medical knowledge to provide a medical nexus opinion for his disability. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board affords the Veteran's lay statement less probative weight and affords more probative weight to the August 2019 VA examiner's opinion. Accordingly, the preponderance of the evidence is against a finding that the Veteran's pancreas cancer is related to service. Because the preponderance of the evidence weighs against this claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As such, service connection for pancreas cancer is denied. ALEXIS M. PARRISH Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Chandeck, 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.