Citation Nr: 22051136 Decision Date: 09/08/22 Archive Date: 09/08/22 DOCKET NO. 16-07 706 DATE: September 8, 2022 ORDER Entitlement to service connection for a prostate disability, to include as secondary to a service-connected disability, is denied. FINDING OF FACT The Veteran's prostate disability was not shown in service and is not otherwise etiologically related to service, to include as secondary to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a prostate disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from February 1981 to December 1982. The Board of Veterans' Appeals (Board) remanded this matter in September 2018, December 2021, and, most recently, in May 2022 to obtain medical opinions. The requested development has been completed, and the appeal has returned to the Board for further appellate consideration. Specifically, in June 2022, a VA examiner provided an addendum opinion stating that the Veteran's prostate disorder is not aggravated by diabetes mellitus and provided thorough supporting rationale. The Board is now satisfied there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. Entitlement to service connection for a prostate disability, to include as secondary to a service-connected disability The Veteran contends that he has a prostate disorder that is either directly related to active duty service or caused or aggravated by his service-connected disabilities, to include diabetes mellitus, obstructive sleep apnea, an acquired psychiatric disability, tinnitus, hypertension, and/or migraine headaches. After a review of all the evidence of record, the Board concludes that, while the Veteran has a current diagnosis of benign prostatic hyperplasia, the weight of the evidence is against finding that this disorder began during service or is otherwise etiologically related to an in-service injury, event, or disease, to include as secondary to a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310; Holton v. Shinseki, 557 F.3d 1363. 1366 (Fed. Cir. 2009). First, there is no evidence of symptoms, treatment for, or a diagnosis of a prostate condition during service. Specifically, while there is no separation examination in the record, in October 1982, two months before separating from service, both a physical examination and a report of medical history failed to demonstrate any evidence of a prostate condition or related symptoms. Next, the record reflects that the Veteran was not diagnosed with benign prostatic hyperplasia until January 2015, which is more than 3 decades after separating from service. Therefore, continuity of symptoms has not been shown based on the clinical evidence. 38 C.F.R. § 3.303. The Board has considered the Veteran's statements that his symptoms have persisted since service. However, the Board is unable to grant service connection purely on lay statements alone. Specifically, while he asserted continuous symptoms, the medical evidence weighs against his testimony. For example, the Veteran regularly sought medical treatment after service for other conditions, but there is no mention of a prostate condition until January 2015. Significantly, the Board also notes that the Veteran submitted service connection claims for headaches, ear conditions, hypertension, diabetes mellitus, acquired psychiatric disorders, and arthritis in November 2009 and February 2014, but did not file a claim for a prostate disorder until August 2015. Thus, the Board can infer that the Veteran had knowledge of VA benefits system at that time and had the opportunity to file a claim for his prostate disorder. See generally, Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring) (discussing the distinction between cases in which there is a complete absence of any evidence to corroborate or contradict the testimony, and cases in which there is evidence that is relevant either because it speaks directly to the issue or allows the Board as factfinder to draw a reasonable inference). Accordingly, service connection for a prostate disorder is not warranted, based on continuity of either the medical evidence or the Veteran's statements. Next, despite the lack of continuous symptoms, service connection may be warranted if the evidence otherwise indicates a relationship between the Veteran's current disorder and his active duty service. However, the competent evidence fails to establish a nexus between active duty and the Veteran's current prostate disorder. First, the Veteran underwent a VA examination in July 2021 and was diagnosed with benign prostatic hyperplasia. The VA examiner opined that it is less likely than not that the Veteran's prostate disorder is related to active duty service because there is no evidence of symptoms of a diagnosis for this disorder during or within one year of separation from active duty service. Additionally, the examiner opined that it is less likely than not that the Veteran's disorder is proximately due to or the result of his service-connected mixed anxiety, obstructive sleep apnea, tinnitus, hypertension, or migraine headaches because there is no medical literature that supports a connection between the Veteran's current prostate disorder and these other disorders. Next, a January 2022 VA examiner opined that the Veteran's prostate disorder is less likely than not caused by or the result of his service-connected diabetes mellitus, type II, because there is no pathophysiological relationship upon review of medical literature. Furthermore, in June 2022, a VA examiner opined that it is less likely than not that the Veteran's prostate disorder is aggravated beyond its natural progression by diabetes mellitus because the medical literature does not support that diabetes could aggravate prostate conditions. Specifically, the examiner stated that "both conditions have different and not related pathophysiologic ways." All the VA examiners examined the evidence of record, considered the Veteran's contentions, and provided supporting rationale for their opinions consistent with medical literature and the medical treatment records, which fail to indicate any connection between the Veteran's prostate disorder and his active duty service or his service-connected disabilities. As such, the Board finds these opinions highly probative. There is no other evidence in the record to indicate that the Veteran's benign prostatic hyperplasia is related to active duty service, to include as secondary to a service-connected disability. As such, service connection is not warranted. In arriving at this conclusion, the Board considered the Veteran's statements stating that his prostate disorder is related to active duty service. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to provide testimony regarding the etiology of such a disorder, because it is not diagnosed by unique and readily identifiable features and does not involve a simple identification that a layperson is competent to make. Therefore, the Veteran's contentions linking his prostate disorder to service are found to lack competency. The Board concludes that the weight of the evidence is persuasively against the claim for service connection, and there is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable. The appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Veltri, Associate Counsel