Citation Nr: 22008056 Decision Date: 02/11/22 Archive Date: 02/11/22 DOCKET NO. 17-12 300 DATE: February 11, 2022 ORDER Service connection for a prostate disorder, to include benign prostatic hyperplasia, chronic prostatitis, and high grade prostatic intraepithelial neoplasia (PIN), to include as secondary to service-connected left epididymitis and as due to exposure to herbicide agents, is denied. FINDINGS OF FACT 1. The Veteran's in-service exposure to herbicide agents is acknowledged. 2. The Veteran has not had, and does not have, a diagnosis of prostate cancer. 3. The Veteran's elevated prostate-specific antigen (PSA) is a laboratory finding, not a disease or injury, or a disability resulting from a disease or injury. 4. The Veteran's benign prostatic hyperplasia, chronic prostatitis, and high grade PIN are neither etiologically related to his active military service, to include exposure to herbicide agents, nor caused or aggravated by his service-connected left epididymitis. CONCLUSION OF LAW The criteria for service connection for a prostate disorder, to include benign prostatic hyperplasia, chronic prostatitis, and high grade PIN, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1966 to June 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in January 2019, December 2020, and July 2021 for further development. The appeal has been returned to the Board for further adjudication and consideration. The Board notes that, according to the United States Court of Appeals for Veterans Claims, when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Clemmons v. Shinseki, 23 Vet. App. 1 (2009). The record shows diagnoses of benign prostatic hyperplasia, chronic prostatitis, and high grade PIN. Based on the record, the Board will recharacterize the Veteran's service connection claim pursuant to Clemmons as entitlement to service connection for a prostate disability, to include benign prostatic hyperplasia, chronic prostatitis, and high grade PIN. This issue so characterized is reflected above. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). In short, establishing service connection on a direct basis requires evidence of (1) a current disability; (2) 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 disease or injury. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Establishing service connection on a secondary basis requires evidence (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Alternatively, VA laws and regulations provide that if a veteran was exposed to herbicide agents during active military service, certain listed diseases, including prostate cancer, are presumptively service connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). Where, as is the case here, a veteran "served in the Republic of Vietnam" between January 9, 1962 and May 7, 1975, the veteran is presumed to have been exposed during such service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). Service connection for a prostate disorder, to include benign prostatic hyperplasia, chronic prostatitis, and high grade PIN The Veteran contends that his prostate disorder is related to his active duty service, to include exposure to herbicide agents. See March 2017 VA Form 9. Additionally, the theory of secondary service connection has been raised by the record, specifically, that the Veteran's prostate disability was caused or aggravated by his service-connected left epididymitis. At the outset the Board notes that elevated PSA is not recognized as a disability for VA benefits purposes. See 38 U.S.C. § 1701(1); Allen, 7 Vet. App. at 444-45 (applying definition of disability in § 1701(1) to statutes describing "eligibility for disability compensation for service-connected disabilities"). Instead, elevated PSA is a laboratory finding, not a disease or injury, or a disability resulting from a disease or injury. Moreover, the term "disability" as used for VA purposes refers to impairment of earning capacity. See Allen, 7 Vet. App. at 439. In this case, there is no evidence of record suggesting that elevated PSA, on its own, has caused any impairment of earning capacity or other disease or injury for which service connection may be granted. Because an elevated PSA is not a "disability" for which VA compensation benefits may be awarded, service connection for in this regard is not warranted. Also, the Veteran's exposure to herbicide agents is acknowledged as a result of his documented service in the Republic of Vietnam. While the Board recognizes that prostate cancer is a disease for which presumptive service connection is granted, and acknowledges the Veteran's contention that elevated PSA is a precursor to prostate cancer, there is no diagnosis of prostate cancer of record; therefore, service connection on a presumptive basis is not warranted. As discussed below, it is acknowledged that this does not preclude service connection for a prostate disability as secondary to herbicide exposure on a direct basis if a medical nexus can be established. Diagnoses of benign prostatic hyperplasia, chronic prostatitis, and high grade PIN are of record. See March 2021 Medical Opinion Disability Benefits Questionnaire. Over the course of the appeal, the Veteran has been afforded VA prostate examinations in March 2016 and January 2020, with associated opinions, and addendum opinions were rendered in March 2021, April 2021, and November 2021. However, the March 2016, January 2020, March 2021, and April 2021 examinations, associated opinions, and addendum opinions have previously been found inadequate by the Board. The Board notes that the November 2021 VA examiner rendered three opinions earlier in the month and an addendum opinion later in the month. In the addendum opinion, the examiner opined that the Veteran's prostate disorders are not related to exposure to herbicide agents, and were also not caused or aggravated by his service-connected left epididymitis. The examiner also explained that the epididymis and the prostate are anatomically separate structures and that there is no evidence in medical literature of a causal relationship between exposure to herbicide agents and the Veteran's prostate disorders. The examiner reviewed the Veteran's e-folder and based his opinions on medical literature and knowledge. The November 2021 examiner's negative nexus opinion is consistent with the other objective evidence of record. In this regard, the Veteran's service treatment records (STRs) show groin, abdominal, and testicular pain, but reflect that these complaints were assessed as left testicular epididymitis, for which the Veteran is service connected. See January and April 1968 STRs. There is one reference in the STRs to a slightly boggy, small prostate in April 1968. However, later that same month, his April 1968 Separation Report of Medical Examination notes "[n]o urological problem at this time" and a May 1968 genitourinary consultation report notes the examination was negative. The Board also notes that in a December 1968 application for compensation, the Veteran claimed service connection for "infection in testicle (left) 1968; pus in prostate gland." The December 1968 application further shows that the Veteran noted both in-service and private post-service treatment for his testicle infection, but there is nothing further in the application about his prostate. Moreover, neither the private treatment records nor the VA treatment records demonstrate a nexus between his prostate disorder and service, or between his prostate disorder and his left epididymitis. The Board therefore finds the November 2021 negative medical nexus opinions probative, and notes that there is no competent medical opinion to the contrary or in support of a nexus between his prostate disorder and his active military service or between his prostate disorder and his left epididymitis. The Board also acknowledges the Veteran's appellate assertions, wherein he maintains that his disorders are related to service. However, given the medical complexity of the disorder involved, the Veteran is not competent to etiologically relate any prostate disorder to service or any event of service. His statements in this regard are not probative. As noted, the November 2021 medical opinion is probative. In consideration of the above, the Board finds that the evidence of record does not show that the Veteran's prostate disorder is associated with service or is in any way associated with or aggravated by his service-connected left epididymitis. The persuasive evidence is against the Veteran's claim. The appeal is denied. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Battaile 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.