Citation Nr: 21005609 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 13-33 630 DATE: February 2, 2021 ORDER Service connection for a prostate disability is denied. FINDING OF FACT The Veteran’s prostate disability was not incurred in service, and it is not etiologically related to herbicide agent exposure or any other in-service cause. CONCLUSION OF LAW The criteria for service connection for a prostate disability have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1964 to October 1966. This case returns to the Board of Veterans’ Appeals (Board) after a remand to the agency of original jurisdiction (AOJ) in July 2020. Prior to that, the Board remanded the appeal in June 2015, October 2017, and November 2018. The AOJ has substantially complied with the Board’s remand instructions, and the claim is ready for further review. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection for a Prostate Disability The Veteran attributes his prostate and urinary tract issues, including chronic prostatitis and benign prostatic hyperplasia (BPH), to herbicide agent exposure in Vietnam. He contends that he began experiencing painful urination, groin pain, and other symptoms in 1967, shortly after separation from service. After careful review, the Board finds that service connection is not warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Service connection is also available on a presumptive basis for certain diseases, including prostate cancer, which are associated with exposure to Agent Orange or other herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). VA regulations provide that veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975 are presumed to have been exposed to herbicide agents. 38 C.F.R. §§ 3.307(a)(6). Only the specific diseases listed under 38 C.F.R. § 3.309(e) are subject to presumptive service connection on this basis. Nevertheless, a claimant may establish service connection for an unlisted disability on a direct basis by showing proof of causation through competent evidence. Combee v. Brown, 34 F.3d 1039, 1042 (1994). At the outset, the Board notes that the Veteran is presumed to have been exposed to herbicide agents, based on his Vietnam service. However, there is no evidence that he has been diagnosed with prostate cancer, which is the only prostate disability listed under § 3.309(e). He does not argue otherwise. Thus, there is no basis to grant presumptive service connection in this case. By the Veteran’s own account, he did not develop any prostate or urinary symptoms prior to separation. Service treatment records likewise show that he denied a history of frequent or painful urination at his separation physical in October 1966. In January 2014, he testified that his prostate problems started in college sometime in 1967. See also February 2019 statement in support of claim. The Board finds his testimony about the onset and progression of his symptoms to be competent and credible. This testimony is generally consistent with the available private medical records, which document treatment for recurrent prostatitis since 1970. The medical records also document BPH since at least 1998. The Veteran has submitted two statements from “Dr. F.D.G.,” his longtime urologist, in support of the claim. In July 2010, Dr. F.D.G. stated that he could not prove the Veteran’s chronic prostatitis is not due to Agent Orange. Dr. F.D.G. did not offer any medical reasoning in support of this conclusion. Nor did he provide an opinion on the etiology of the Veteran’s BPH. In December 2018, Dr. F.D.G. wrote that the Veteran’s only risk factor for prostatitis is his exposure to Agent Orange in Vietnam in 1966. He did not elaborate on this point, or cite relevant medical literature or any other evidence that herbicide agent exposure is a risk factor for prostatitis. Although he noted that patients exposed to Agent Orange have a higher prostate cancer risk, Dr. F.D.G. offered no clear medical explanation as to how the Veteran’s current disability is related to Agent Orange. The Board does not find Dr. F.D.G.’s conclusory statements probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (an opinion is probative when it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data). The Veteran also identified a study from researchers at the University of Texas on the relationship between the dioxin in Agent Orange (TCDD) and the development of BPH. See correspondence received in November 2014 & January 2019. These researchers concluded that the risk of BPH “decreases with increasing TCDD exposure but may increase at higher doses.” The Board finds this evidence, by itself, does not provide the “degree of certainty of causality” necessary to establish a nexus between the Veteran’s service and BPH. Wallin v. West, 11 Vet. App. 509, 513 (1998); see also Mattern v. West, 12 Vet. App. 222, 228 (1999) (generally, medical journal or treatise evidence alone is too general and too inconclusive to establish a nexus). The Board also notes that the dioxin study does not purport to show a causal link between dioxin exposure and chronic prostatitis. Therefore, it does not strengthen Dr. F.D.G.’s opinions, which only discuss prostatitis. See id. at 228 (a medical article or treatise “can provide important support when combined with an opinion of a medical professional”). On the other hand, multiple VA examiners have opined that the Veteran’s prostate disability is less likely than not related to herbicide agent exposure. In July 2020, the Board remanded for an addendum opinion that addresses the lay and medical evidence summarized above. The AOJ obtained one in October 2020. The October 2020 examiner specifically considered the Veteran’s lay statements about the onset and progression of his symptoms, Dr. F.D.G.’s 2018 opinion, and the dioxin study. The examiner noted that the Veteran was first treated for prostatitis in college, and explained that sexually transmitted disease would have been the most likely cause of prostatitis for his age group at that time. The examiner also explained that the most common cause of chronic prostatitis is chronic or recurrent infections, whereas BPH is thought to be due to hormonal changes as males age. According to the 2020 opinion, the current, widely-accepted, peer-reviewed medical literature has not established Agent Orange as a cause for either chronic prostatitis or BPH. In contrast, the results of the dioxin study “suggest a link … without establishing cause and effect.” The examiner also noted that Dr. F.D.G.’s opinion did not cite any medical literature. Ultimately, the examiner concluded it is less likely than not that the Veteran’s BPH and chronic prostatitis are due to service or in-service exposures, including Agent Orange. This opinion is consistent with the various earlier VA opinions of record. The Board finds the October 2020 VA opinion highly probative. Nieves-Rodriguez, 22 Vet. App. at 304. It is well-reasoned and based on an accurate medical history, as related by the Veteran. It provides a coherent alternative explanation for his prostate disability consistent with all of the available lay and medical evidence. Accordingly, the Board finds that the preponderance of evidence is against service connection for chronic prostatitis or BPH. As such, the benefit-of-the-doubt rule is not applicable in this instance. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, 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.