Citation Nr: 21014809 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 16-11 893 DATE: March 15, 2021 ORDER Entitlement to service connection for prostate cancer is denied. FINDING OF FACT Prostate cancer was not incurred during service and is not due to environmental exposures therein. CONCLUSION OF LAW The criteria for entitlement to service connection for prostate cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from June 1977 to June 2003. The Board has considered the Veteran’s claim and decided entitlement based on the evidence or record. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Entitlement to service connection for prostate cancer The Veteran contends that his prostate cancer was incurred as a result of in-service exposure to Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid (PFOA) at military bases. Service connection may be established for a disability resulting from disease or injury which was clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). After thorough review of the evidence of record, the Board concludes that, while the Veteran has a diagnosis of prostate cancer and was exposed to PFOS and PFOA during military service, the preponderance of the evidence weighs against finding that the Veteran’ prostate cancer was caused by or incurred as a result of the exposures. The record establishes a current diagnosis of “neoplasm of uncertain behavior of prostate.” See September 2013 private treatment records from T.P., M.D. Thus, a current disability is demonstrated. However, the record does not establish in-service incurrence of this disability. Service treatment records are negative for any indication of elevated prostate specific antigen (PSA) or other prostate problems. Laboratory testing reflects that the Veteran’s PSA level was 1.47 in both April 2001 and May 2002. The medical evidence of record shows that the Veteran’s PSA was first found to be elevated in October 2011, when laboratory testing showed a PSA level of 5.87. The Veteran underwent a prostate biopsy in December 2011 which revealed focal high grade prostatic intraepithelial neoplasia. Another biopsy, performed in April 2013, also showed focal high grade prostatic intraepithelial neoplasia in various locations of the prostate. The Veteran underwent cryotherapy treatment in 2014. The Veteran has submitted evidence showing that he served on military bases were PFOS and PFOA were likely present. He submitted an internet article noting that harmful chemicals found in firefighting foam were used at the Cannon Air Force Base from the 1970’s until 2017, and that PFAS was found in the groundwater below Cannon Air Force Base and in the wells. He also submitted a “fact sheet” which indicates that the Air Force was working with the Environmental Protection Agency (EPA) to identify locations at the former Reese Air Force Base where PFAS may have been released and a newspaper article noting that well water contaminated with PFOA and PFOS was found to be present at Reese Air Force Base. Additionally, the Veteran provided a Department of Defense list of bases with contaminated groundwater sites, which identifies Eglin Air Force Base and McChord Air Force Base. The Veteran’s service personnel records show that he served at the Reese Air Force Base from June 1981 through May 1984, at the Eglin Air Force Base from April 1986 to April 1989, at the McChord Air Force Base from July 1993 to July 1994, at the Cannon Air Force Base from July 1994 to May 1997. However, even conceding for purposes of this decision in-service exposure to environmental toxins such as PFOS and PFAS, the Board finds that the weight of the probative evidence does not show that the Veteran’s prostate cancer is related to his active duty service, to include such exposure to environmental toxins. In that regard, after reviewing the Veteran’s claim file, including the medical treatise evidence, a January 2021 VA examiner opined that the Veteran’s prostate cancer was less likely than not related to his active duty service. The examiner explained that the current, widely accepted, peer-reviewed literature has not established PFOS and PFOA as a cause of prostate cancer. The January 2021 VA opinion is probative because it is based on consideration of the evidence in the Veteran’s claims file as well as a review of Up to Date, “a respected, professional medical resource,” and cites to a Mayo Clinic website for a discussion of the symptoms and causes of prostate cancer. Additionally, the VA examiner provided sufficient supporting rationale for the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that, in a July 2018 treatment record, the Veteran’s treating physician remarked that it was “uncertain” whether the Veteran’s in-service exposure to contaminated water and environmental toxins during service was “directly related to his prostate cancer” but noted that it “may be.” The Board finds the July 2018 statement to be speculative, as it does not provide a conclusive opinion with supporting rationale. Medical opinions that are speculative, general, or inconclusive in nature cannot support a claim. See Morris v. West, 13 Vet. App. 94, 97 (1999) (diagnosis that appellant was “possibly” suffering from schizophrenia deemed speculative); Hogan v. Peake, 544 F.3d 1295, 1298 (Fed. Cir. 2008) (the Board may discount the value of competent medical evidence based on factors including the lack of a definitive statement as to etiology); Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997) (the Board has authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). Accordingly, the July 2018 opinion is not afforded significant probative value. Additionally, the Board recognizes the March 2018 report by the Deputy Assistant Secretary of Defense of Environment, Safety & Occupational Health, which notes that “[l]imited human studies how PFOS/PFOA may be associated with . . . prostate, kidney, and testicular cancer.” This statement only indicates a potential link to prostate cancer. Such a conclusion is too equivocal and speculative to have more than minimal probative value. See Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2009); see also Obert v. Brown, 5 Vet. App. 30, 33 (1993) (“as appellant “may” have been showing symptoms, the implication is he “may not have” been showing symptoms.”). Thus, this report is not sufficiently probative to indicate more than a remote possibility that the Veteran’s prostate cancer might be related to his exposures, and is not sufficiently probative to outweigh the January 2021 VA opinion. While the Veteran believes his prostate cancer is related to service, including the toxic substances, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires knowledge of the risk factors for and development of cancer. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Consequently, the Board gives more probative weight to the January 2021 VA opinion. The Board is grateful for the Veteran’s honorable service. However, given the record before it, the Board finds that evidence in this case does not reach the level of equipoise. See 38 U.S.C. § 5107 (a) (“[A] claimant has the responsibility to present and support a claim for benefits....”); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009) (stating that the claimant has the burden to “present and support a claim for benefits” and noting that the benefit of the doubt standard in section 5107(b) is not applicable based on pure speculation or remote possibility); Skoczen v. Shinseki, 564 F.3d 1319, 1323-29 (Fed. Cir. 2009) (interpreting section 5107(a) to obligate a claimant to provide an evidentiary basis for his or her benefits claim, consistent with VA’s duty to assist, and recognizing that “[w]hether submitted by the claimant or VA... the evidence must rise to the requisite level set forth in section 5107(b),” requiring an approximate balance of positive and negative evidence regarding any issue material to the determination). ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Katz, 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.