Citation Nr: 22016010 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 17-01 999 DATE: March 21, 2022 ORDER Service connection for prostate cancer is denied. FINDINGS OF FACT 1. The Veteran served on active duty from January 1989 to November 1993. 2. Prostate cancer was not shown in service, is not causally or etiologically related to service, and weas not caused by or worsened beyond its natural course by a service-connected disability. CONCLUSION OF LAW Prostate cancer is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.310 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION As a procedural matter, the Veteran testified before the Board in August 2019. Unfortunately, due to transcription errors, no transcript could be associated with the claims file. In an August 2020 letter, he was offered several options to include a new hearing. Apparently, he requested another hearing in September 2020; however, at the time of an October 2021 Board remand, it does not appear that the letter had been associated with the record. Following the October 2021 remand development, the Board sent another letter to the Veteran in January 2022 explaining that the Veterans Law Judge who conducted the August 2019 hearing was no longer at the Board. He was provided with several options to include requesting a new hearing or to continue the appeal. The letter indicated that if there was no response in 30 days, the Board would make a decision on his appeal. He did not respond to the letter in either the allocated 30 days or as of the date of this decision. Although a hearing request was pending at the time of the October 2021 Board remand, the January 2022 clarification letter provided the Veteran with an opportunity for another hearing but he did not respond. As such, the Board will decide the issue based on the evidence of record. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Turning to the evidence, the first element of service connection a current disability is met, as an October 2015 VA examination confirmed a diagnosis of prostate cancer dated in January 2015. VA medical records similarly reflect a diagnosis of and treatment for prostate cancer beginning in January 2015. As such, the first element is met. Next, the second element an in-service incurrence is not met, as a review of the service treatment records (STRs) fail to show a diagnosis of, treatment for, or complaints of prostate cancer or any prostate disorder. He has not alleged, nor has evidence shown, any in-service incurrence regarding prostate cancer. As such, the second element is not met, and the medical evidence does not support service connection on a direct basis. Rather, the Veteran's primary contention is that prostate cancer was proximately due to or aggravated by service-connected status/post endopyelotomy for right kidney ureter pelvic junction obstruction with hydronephrosis. As prostate cancer has been diagnosed and he is service connected for the right kidney disorder, the first element (a current disability) and second element (a service-connected disability) of secondary service connection are met. However, the third element a medical nexus between the two disabilities is not supported by the evidence. To that end, the Veteran related to the October 2015 VA examiner that he believed his kidney disease caused prostate cancer. Nonetheless, the examiner found that the Veteran's kidney disorder was often congenital and if a blockage was present for a long time, it could cause permanent kidney damage; however, the examiner noted that there was no evidence of any kidney damage and there was normal renal function. Further, the examiner noted that a chronic obstruction does not relay increased risk of developing any type of urogenital cancer, including cladder, urethral, or prostate. Thus, the examiner concluded, prostate cancer was a separate issue from the service-connected kidney disability. In an October 2021 follow-up medical opinion, the examiner specifically noted that in May 1993, the Veteran underwent intravenous pyelogram with tomogram which showed a partial right kidney ureter pelvic junction obstruction causing moderate to marked hydronephrosis and decreased parenchyma of the right kidney, and the Veteran underwent multiple stents and endopyelotomy, with the last surgery in September 1993. The examiner noted that years later, November 2014 VA medical records showed that the Veteran was negative for dysuria, frequency, nocturia urgency, hematuria, incontinence, impotence, testicular pain/swelling, or flank pain, and that his prostate appeared normal. January 2015 VA medical records included biopsy results showing prostatic adenocarcinoma. Given that treatment records showed that the prostate as normal as late as November 2014, despite the symptomatic kidney disorder with procedures occurring many years before, the examiner found that the current prostate cancer was not aggravated by the service-connected kidney disability. A review of the remainder of the VA medical records similarly fails to show any medical opinion establishing a relationship of any kind between prostate cancer and service connection kidney disease. Given that the two competent medical opinions of record regarding proximate cause and aggravation weight persuasively against the claim, and there is no positive medical nexus opinion regarding secondary service connection, the third element is not met. Therefore, the medical evidence fails to support service connection on a secondary basis. The Board has considered the Veteran's lay statements that that his disorder was caused or aggravated by service or a service connected disability. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings and VA examinations and opinions than to his statements. In light of the above, the evidence weighs against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brendan Evans, 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.