Citation Nr: 21032061 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 14-16 764 DATE: May 25, 2021 ORDER Service connection for stage IVA papillary thyroid cancer, with lymph node removal, to include as due to ionizing radiation exposure, is denied. Service connection for kidney disease, with dialysis, to include as due to ionizing radiation exposure, is denied. FINDINGS OF FACT 1. The Veteran did not participate in a radiation-risk activity during his active service, and there is evidence of exposure to ionizing radiation of no greater than 1.5 rem. 2. The Veteran is diagnosed with stage IVA papillary thyroid cancer, with lymph node removal, which is subject to presumptive service connection in radiation exposed veterans under 38 C.F.R. § 3.309(d)(2). It is also a radiogenic disease under 38 C.F.R. § 3.311(b)(2). The Veteran's kidney disease, with dialysis, is not a presumptive condition under 38 C.F.R. § 3.309(d)(2), or a radiogenic disease under 38 C.F.R. § 3.311(b)(2). 3. The Veteran's stage IVA papillary thyroid cancer, with lymph node removal, was not present during service or for many years thereafter, and was not caused by any incident of service, including ionizing radiation exposure. 4. The Veteran's kidney disease, with dialysis, was not present during service or for many years thereafter, and was not caused by any incident of service, including ionizing radiation exposure. The Veteran also claims service connection for kidney disease, with dialysis, secondary to stage IVA papillary thyroid cancer, with lymph node removal, but he is not currently service-connected for stage IVA papillary thyroid cancer, with lymph node removal. CONCLUSIONS OF LAW 1. The criteria for service connection for stage IVA papillary thyroid cancer, with lymph node removal, to include as due to ionizing radiation exposure, have not been met. §§ 1101, 1112, 1113, 1131, 1137, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.311. 2. The criteria for service connection for kidney disease, to include as due to ionizing radiation exposure, have not been met. §§ 1101, 1112, 1113, 1131, 1137, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.311. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Marine Corps from September 1983 to August 1986. This matter is before the Board of Veterans' Appeals (Board) on appeal of a January 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for stage IVA papillary thyroid cancer, with lymph node removal, to include as due to ionizing radiation exposure, and kidney disease, with dialysis, to include as due to ionizing radiation exposure. In September 2014, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. In October 2014 and December 2015, the Board remanded this appeal for further development. Stage IVA Papillary Thyroid Cancer, with Lymph Node Removal, and Kidney Disease, with Dialysis 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. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995). Service connection for a disorder which is claimed to be attributable to radiation exposure during service can be accomplished in three different ways. See Ramey v. Brown, 9 Vet. App. 40, 44 (1996), aff'd, 120 F.3d. 1239 (Fed. Cir. 1997). First, there are specific diseases that may be presumptively service connected if manifest in a radiation-exposed Veteran. 38 U.S.C. § 1112(c); 38 C.F.R. § 3.309(d). A "radiation-exposed" Veteran is one who participated in a radiation-risk activity. A "radiation-risk activity" includes the onsite participation in a test involving the atmospheric detonation of a nuclear device, occupation of Hiroshima or Nagasaki during World War II, or presence at certain specified sites. 38 C.F.R. § 3.309(d)(3). In applying this statutory presumption, there is no requirement for documenting the level of radiation exposure. Second, other "radiogenic" diseases, such as any form of cancer listed under 38 C.F.R. § 3.311(b)(2), found five years or more after service in an ionizing radiation-exposed Veteran may also be service-connected if the VA Under Secretary for Benefits determines that they are related to ionizing radiation exposure while in service, or if they are otherwise linked medically to ionizing radiation exposure while in service. Other claimed diseases may be considered radiogenic if the claimant has cited or submitted competent scientific or medical evidence that supports that finding. 38 C.F.R. § 3.311(b)(4). When it has been determined that: (1) a Veteran has been exposed to ionizing radiation as a result of participation in the atmospheric testing of nuclear weapons; (2) the Veteran subsequently develops a specified radiogenic disease; and (3) the disease first becomes manifest five years or more after exposure, the claim will be referred to the Under Secretary for Benefits for further consideration in accordance with 38 C.F.R. § 3.311(c). When such a claim is forwarded for review, the Under Secretary for Benefits shall consider the claim with reference to 38 C.F.R. § 3.311(e) and may request an advisory medical opinion from the Under Secretary of Health. 38 C.F.R. §§ 3.311(b), (c)(1). The medical adviser must determine whether sound scientific and medical evidence supports a conclusion that it is "at least as likely as not" that the disease resulted from in-service radiation exposure or whether there is "no reasonable possibility" that the disease resulted from in-service radiation exposure. 38 C.F.R. § 3.311(c)(1). Third, direct service connection can be established by showing that the disease or malady was incurred during or aggravated by service, a task which includes the burden of tracing causation to a condition or event during service. See Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Service connection claims based on in-service exposure to radiation may be addressed under 38 C.F.R. § 3.309(d) or § 3.311. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran contends that he has stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, that are related to service, to include as due to ionizing radiation exposure. He specifically maintains that he was exposed to ionizing radiation while serving at the Naval Submarine Base in Bangor, Washington, in support of the Trident Submarine Program. The Veteran states that he lived about a third of the time in the nuclear weapons storage area, which included storage bunkers where the weapons were maintained. He reports that he participated in the movement of nuclear weapons from storage to servicing facilities, and that he performed convoy security and wharf security. He also indicates that he slept in bunkers that had been used for weapon storage in order to provide rapid response security forces. The Veteran further asserts that civilians, who worked in the same areas as he did, wore radiation badges, but that the Marines at the facility did not wear radiation badges. See Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). The Veteran served on active duty in the Marine Corps from September 1983 to August 1986. His DD Form 214 lists his occupational specialty as an antitank assault man for two years and six months. An April 2013 response from National Personnel Records Center, to a request for to furnish a DD Form 1141 and records of exposure to radiation, indicates that the document or information requested is not a matter of record. A December 2013 response from the Department of the Navy, Naval Dosimetry Center, indicates that a review of the exposure registry, by name, service number, and social security number, revealed no reports of occupational exposure pertaining to the Veteran. The Naval Dosimetry Center reported that the information provided reflected the data in the Naval Exposure Registry for the Veteran. It was noted that because the official exposure record (DD 1141, NAVMED 6470/10 or equivalent document) was maintained in the Veteran's medical record, it would be prudent to compare that record with the report. A February 2015 statement from the Director, Post-9/11 Environmental Health Program, indicates that the Veteran was diagnosed with thyroid cancer in 2012. It was noted that a December 2013 letter from the Naval Dosimetry Center states that there were no records of exposure to ionizing radiation for the Veteran on file. The Director, Post-9/11 Environmental Health Program, reported that the Veteran claimed that radiation exposure during his military service from 1983 to 1986 was the cause of his thyroid cancer. The Director, Post-9/11 Environmental Health Program, reported that the Health Physics Society, in a position statement PSO10-2, Radiation Risk in Perspective, revised in July 2016, stated that in accordance with current knowledge of radiation health risks, the Health Physics Society recommended against quantitative estimation of health risk below an individual dose of 5 rem in one year, or a lifetime does of 10 rem above that received from natural sources. It was noted that there was substantial and convincing scientific evidence for health risks following high-dose exposures, but that below 5 to 10 rem, which included occupational and environmental exposures, the risks of health effects were either too small to be observed or nonexistent. The Director, Post-9/11 Environmental Health Program, found that since there was no dose for the Veteran, it was their opinion that it was unlikely that the Veteran's thyroid cancer could be attributed to radiation exposure during his military service. A statement from the Veterans Benefits Administration, received in March 2015, notes that in February 2015, records were referred to the Under Secretary for Health, for an opinion as to whether it was likely, unlikely, or as likely as not, that the Veteran's thyroid cancer was the result of exposure to ionizing radiation in service. The Veterans Benefits Administration reported that a February 2015 memorandum from the Director, Post-9/11 Environmental Health Program, written for the Under Secretary, concludes that it was unlikely that the Veteran's thyroid cancer was the result of exposure to ionizing radiation during service. It was noted that the Director, Post-9/11 Environmental Health Program, stated that, in a December 2013 letter, the Naval Dosimetry Center indicates that there was no record of exposure to ionizing radiation for the Veteran. The Veteran's Benefits Administration referred to the discussion by the Director, Post-9/11 Environmental Health Program, regarding findings from the Health Physics Society, in a position statement PSO10-2, Radiation Risk Perspective, revised in July 2016. The Veteran's Benefits Administration reported that the Veteran was eighteen to twenty years sold when he was exposed to ionizing radiation. It was noted that the Veteran's thyroid cancer was diagnosed twenty-eight to thirty years after his alleged exposure to ionizing radiation. The Veterans Benefits Administration stated that the Veteran was a lifetime non-smoker, and that his post-service employment was as a police office. It was noted that a reported of medical examination, in the Veteran's service treatment records, shows that he was 69 and 14 inches in height, that he weighed 157 pounds, and that he had a medium build. The Veterans Benefits Administration related that the Veteran's family history was positive for a grandmother with lung cancer. The Veterans Benefits Administration indicated that in their opinion, there was no reasonable possibility that the Veteran's "MDS" was the result of exposure to ionizing radiation. An April 2017 response from the Department of the Navy, Naval Dosimetry Center, indicates that a review of the exposure registry by name, command, and social security number, revealed no occupational exposure to ionizing radiation pertaining to the Veteran. It was noted that a search was performed for any exposure records submitted through the Naval Submarine Base in Bangor, Washington. The Naval Dosimetry Center indicated that no exposure records were submitted from the Naval Submarine Base in Bangor, Washington, during the Veteran's periods of service. The Naval Dosimetry Center maintained that in the absence of any exposure records for the time period in question, their office did not have the data necessary to perform the requested dose estimate. It was noted that the Strategic Systems Programs may have further information in regard to service-incurred occupational exposure to ionizing radiation. A July 2017 response from the Department of the Navy, Naval Dosimetry Center indicates that a review of the exposure registry by name, command, and social security number, revealed no occupational exposure to ionizing radiation pertaining to the Veteran. It was noted that such results were sent in an April 2017 letter. The Naval Dosimetry Center reported that the Strategic Systems Programs was contacted because the Veteran's claim included exposure from guarding nuclear weapons. The Naval Dosimetry Center indicated that the Strategic Systems Programs reviewed their records and found no records pertaining to the Veteran. A January 2018 statement from the Director, Post-9/11 Environmental Health Program, reflects that the Veteran was born in December 1965, and that he had honorable service in the Marine Corps from September 1983 to August 1986. It was noted that the record showed that the Veteran claimed exposure to radiation while guarding nuclear weapons at the Marine Barracks, Naval Submarine Base, in Bangor Washington, from 1984 to 1986. The Director, Post-9/11 Environmental Health Program, stated that a July 2017 letter from the Naval Dosimetry Center indicates that no there was no recorded evidence of exposure to radiation. It was noted that the Veteran was nineteen years old at the time of exposure. The Director, Post-9/11 Environmental Health Program, reported that medical reports show that the Veteran had diagnoses of thyroid cancer and kidney disease in October 2012, twenty-eight years after his claimed exposure to radiation. The Director, Post-9/11 Environmental Health Program, stated that the Veteran's family history was positive for a grandmother with lung cancer, and that his post-military occupations included computer games sales, work as a computer operator, and work in law enforcement. It was noted that the Veteran's smoking habits were unknown. The Director, Post-9/11 Environmental Health Program, indicated that thyroid cancer was a disease listed under 38 C.F.R. § 3.309(d). The Director, Post-9/11 Environmental Health Program, maintained that the Veteran's military service did not include participation in a "radiation-risk activity." The Director, Post-9/11 Environmental Health Program, reported that since there were no records of a dose, a dose would be assigned to the Veteran based on the facts of the claim and the regulations in effect at the time of exposure. It was noted that when an occupationally exposed worker was not expected to receive a radiation dose exceeding 1/10 of the annual limit of 5 rem per year (0.5 rem), monitoring was not required. The Director, Post-9/11 Environmental Health Program, indicated that a dose of 1.5 rem (total effective dose equivalent) would be assigned to the Veteran (0.5 rem per year times three calendar years of service at the Naval Submarine Base in Bangor, Washington). The Director, Post-9/11 Environmental Health Program, reported that the Health Physics Society, in a position statement PSO10-3, Radiation Risk in Perspective, revised in May 2016, stated that the average annual equivalent dose from natural background radiation in the United States was about 3 mSv (0.3 rem). It was noted that a person might accumulate an equivalent dose from natural background radiation of about 30 mSv (5 rem) in the first seventeen years of life and about 250 mSv (25 rem) during and average eighty-year life. The Director, Post-9/11 Environmental Health Program, stated that substantial and convincing scientific data shows evidence of health effects following high-dose exposures (many multiples of natural background), but below levels of about 100 mSv (10 rem) above background from all sources combined, the observed radiation effects were not statistically different from zero. The Director, Post-9/11 Environmental Health Program, indicated that since the Veteran's lifetime total radiation dose did not exceed 100 mSv (10 rem) above natural background, it was their opinion that it was unlikely that thyroid cancer and/or kidney disease were caused by exposure to ionizing radiation during military service. A January 2018 statement from the Director, Compensation Service, indicates that the Veteran's claims folder was reviewed. It was noted that the January 2018 statement from the Director, Post-9/11 Environmental Health Program, advises that it was unlikely that the Veteran's thyroid cancer and/or kidney disease could be attributed to ionizing radiation exposure during his military service. The Director, Compensation Service, stated the record showed no evidence of exposure to radiation, and that the Veteran was nineteen years old at the time of his claimed exposure. The Director, Compensation Service, indicated that the Health Physics Society, in a position statement PSO10-3, Radiation Risk in Perspective, revised in May 2016, stated that the average annual equivalent dose from natural background radiation in the United States was about 3 mSv (0.3 rem). It was noted that a person might accumulate an equivalent dose from natural background radiation of about 30 mSv (5 rem) in the first seventeen years of life and about 250 mSv (25 rem) during and average eighty-year life. The Director, Post-9/11 Environmental Health Program, stated that substantial and convincing scientific data shows evidence of health effects following high-dose exposures (many multiples of natural background), but below levels of about 100 mSv (10 rem) above background from all sources combined, the observed radiation effects were not statistically different from zero. The Director, Compensation Service, reported that the medical evidence shows that the Veteran had diagnoses of thyroid cancer and kidney disease twenty-eight years after his claimed exposure to radiation. It was noted that the Veteran's family history was positive for a grandmother with lung cancer. The Director, Compensation Service, stated that the Veteran's post-military occupations included computer games sales, work as a computer operator, and work in law enforcement. It was noted that the Veteran's smoking habits were unknown. The Director, Compensation Service indicated that there was no reasonable possibility that the Veteran's thyroid cancer and/or kidney disease were the result of exposure to ionizing radiation during service. The service treatment records do not show treatment for thyroid problems, to include thyroid cancer, and/or for kidney problems, to include kidney disease. Post-service private and VA treatment records show that the Veteran was treated for stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis. The first question before the Board is whether the Veteran meets the criteria for qualification as a "radiation-exposed" Veteran. His service records do not reflect any exposure to radiation monitored by dosimetry badge or that he participated in atmospheric nuclear weapon testing or any other radiation risk activity, as defined by 38 C.F.R. § 3.309 (d)(3). As there is no evidence demonstrating participation in a "radiation-risk activity," he does not meet the criteria for qualification as a "radiation-exposed" Veteran. The Board observes that stage IVA papillary thyroid cancer, with lymph node removal, is among the types of diseases listed at 38 C.F.R. § 3.309 (d)(2) subject to presumptive service connection in radiation-exposed veterans. It is also listed under 38 C.F.R. § 3.311 (b)(2) as a radiogenic disease. As the Veteran is not a radiation-exposed Veteran, presumptive service connection under 38 C.F.R. § 3.309(d) is not available. The Board notes that the Veteran's kidney disease, with dialysis, is not a presumptive condition under 38 C.F.R. § 3.309(d)(2), or a radiogenic disease under 38 C.F.R. § 3.311(b)(2), and, therefore, presumptive service connection under 38 C.F.R. § 3.309(d), is also not available for that disorder. As the Veteran's participation in a radiation-risk activity has not been confirmed, in order to qualify for service connection for that stage IVA papillary thyroid cancer, with lymph node removal, as a result of exposure to ionizing radiation, there must be evidence documenting the level of his radiation exposure, and his stage IVA papillary thyroid cancer, with lymph node removal, as a "radiogenic" disease, must be determined by the VA Under Secretary of Health to be related to ionizing radiation exposure while in service, or otherwise be linked medically to ionizing radiation exposure while in service. The Board notes that although presumptive service connection cannot be established for stage IVA papillary thyroid cancer, with lymph node removal, under 38 U.S.C. § 1112(c) and 38 C.F.R. § 3.309(d), it is a "radiogenic" disease under 38 C.F.R. § 3.311(b). See 38 C.F.R. § 3.311(b)(2). The Board observes that, in such cases, special development procedures are required, including referral to the VA Undersecretary for Benefits to determine whether a relationship in fact exists between the disease and a Veteran's exposure in service. The Board must consider all relevant factors, including the amount of radiation exposure, in determining whether the record supports the contended etiologic relationship. See 38 C.F.R. § 3.311. The Veteran's kidney disease, with dialysis, is not a "radiogenic disease" under 38 C.F.R. § 3.311(b). In this case, the Board notes that the in a January 2018 statement, the Director, Post-9/11 Environmental Health Program, indicated that a dose of 1.5 rem (total effective dose equivalent) would be assigned to the Veteran (0.5 rem per year times three calendar years of service at the Naval Submarine Base in Bangor, Washington). The Director, Post-9/11 Environmental Health Program, indicated that since the Veteran's lifetime total radiation dose did not exceed 100 mSv (10 rem) above natural background, it was their opinion that it was unlikely that thyroid cancer and/or kidney disease were caused by exposure to ionizing radiation during military service. Additionally, in a January 2018 statement, the Board notes that the Director, Compensation Service, also specifically maintained that there was no reasonable possibility that the Veteran's thyroid cancer and/or kidney disease were the result of exposure to ionizing radiation during service. In light of above, service connection is not warranted for stage IVA papillary thyroid cancer, with lymph node removal, as a radiogenic disease, under 38 C.F.R. § 3.311. The Board also observes that service connection is also not warranted for kidney disease, with dialysis, which is not a radiogenic disease, under 38 C.F.R. § 3.311. Notwithstanding the development procedures of 38 C.F.R. § 3.311, service connection may also be established by competent evidence establishing the existence of a medical nexus between a claimed disability and exposure to ionizing radiation during active service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Board observes that the probative medical evidence does not suggest that Veteran's stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, are related to his period of service. In fact, the probative medical evidence provides negative evidence against this finding, indicating that the Veteran's stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, began many years after service, without relationship to service. The Director, Post-9/11 Environmental Health Program, as well as the Director, Compensation Service, respectively, in January 2018 statements, concluded that the Veteran's thyroid cancer and/or kidney disease were not caused by radiation exposure during his military service. The Board notes that there are no positive medical opinions of record regarding the etiology of the Veteran's claimed stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis. The Veteran has asserted that his stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, had their onset during his period of service. While the Veteran is competent to report that he had problems that he thought were due to his claimed stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, during service or since service, he is not competent to diagnose his currently claimed stage IVA papillary thyroid cancer, with lymph node removal, and kidney disease, with dialysis, as due to exposure to ionizing radiation exposure. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional); Buchanan v. Nicholson, 451 F.3d. 1331 (Fed. Cir. 2006) (lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself). In the Veteran's case, such a nexus opinion requires a certain level of expertise given the medically complex question. A lay opinion is not sufficient in this case to prove nexus. Additionally, the Veteran is also attempting to establish service connection for kidney disease, with dialysis, as secondary to stage IVA papillary thyroid cancer, with lymph node removal. However, secondary service connection presupposes the existence of an established service-connected disability. The Board notes that stage IVA papillary thyroid cancer, with lymph node removal, is not service-connected, and thus, secondary service connection for any condition allegedly due to stage IVA papillary thyroid cancer, with lymph node removal, is not warranted. The Board notes that a lay statement from M. L., received in February 2013, refers to asbestos exposure. The Board observes that the Veteran is not contending that his claimed disorders are due to asbestos exposure. Therefore, the preponderance of the evidence is against the claims for entitlement to service connection for stage IVA papillary thyroid cancer, with lymph node removal, and for kidney disease, with dialysis, both to include as due to exposure to ionizing radiation; there is no doubt to be resolved; and service connection for stage IVA papillary thyroid cancer, with lymph node removal, and for kidney disease, with dialysis, both to include as due to exposure to ionizing radiation, is not warranted. 38 U.S.C.A. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.