Citation Nr: A25035110 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240819-468824 DATE: April 16, 2025 ORDER Entitlement to service connection for a prostate disorder is denied. Entitlement to service connection for a gallbladder disorder is denied. Entitlement to service connection for Crohn's disease is denied. Entitlement to service connection for hemorrhoids is denied. REMANDED The claim of entitlement to service connection for a lung disorder is remanded. FINDINGS OF FACT 1. The evidence demonstrates that a prostate disorder was not incurred in service. 2. The evidence demonstrates that a gallbladder disorder was not incurred in service. 3. The evidence demonstrates that Crohn's disease was not incurred in service. 4. The evidence demonstrates that hemorrhoids were not incurred in service. CONCLUSIONS OF LAW 1. The criteria for service connection for a prostate disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for service connection for a gallbladder disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 3. The criteria for service connection for Crohn's disease are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 4. The criteria for service connection for hemorrhoids are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1967 until October 1971. This matter comes to the Board of Veterans' Appeals (Board) on appeal of an October 2023 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In August 2024, the Veteran filed a VA Form 10182, notice of disagreement, against the decision. He elected to appear before a Board hearing, which was held in December 2024. A transcript of the hearing is included in the claims file and has been reviewed. See 38 C.F.R. § 20.302. In this decision, the Board may only consider the evidence of record at the time of the rating decision on appeal, the evidence submitted during the hearing, and the evidence submitted within the 90 days following the hearing. 38 C.F.R. § 20.302. If the Veteran wishes to pursue this matter further, information for doing so is included with this decision. Service Connection The Veteran asserts that he developed multiple disorders during service as the result of exposure to toxins such as herbicides and contaminated water. Law and regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran 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 active service. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may be established based on toxic exposure risk activity (TERA) during service. See, e.g., 38 U.S.C. § 1116. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. To deny a claim, the evidence must clearly weigh against the claim. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Evidence and analysis The evidence in this matter consists of lay assertions, service treatment records (STRs), service personnel records (SPRs), VA treatment records, and VA compensation examination reports dated in September 2023. This evidence documents that the Veteran has prostate enlargement, residuals of gallbladder cholecystectomy, Crohn's disease, and hemorrhoids. These diagnoses are noted in the VA reports and treatment records. The record also shows that the Veteran was exposed to herbicides and contaminated water during service. The Veteran served in Vietnam in the early 1970s and was presumably exposed to herbicides there. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307. And the Veteran served for several weeks at Camp Lejeune, North Carolina and was presumably exposed to contaminated water there. See 38 C.F.R. § 3.307 (a)(7)(i). The evidence indicates, however, that the claimed disorders are not related to service to include any TERA. None of the claimed disorders can be presumed related to either herbicides or to contaminated water. See 38 C.F.R. § 3.309 (e) or (f). The STRs and SPRs are negative for digestive or genitourinary complaints, treatment, or diagnoses. The earliest medical evidence of record of either of these disorders is dated in the mid-2010s, over four decades after service. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012). Further, the VA reports counter the assertion that the disorders developed as the result of exposure to herbicides and contaminated water. The examiner who reviewed the claims stated that it was unlikely the digestive and prostate disorders at issue here related to service, finding no support for the notion that herbicides or contaminated water would cause such disorders. The reports are probative because they are based on a review of the claims file and on examinations of the Veteran, and specifically cite to evidence in the claims file in support of their conclusions. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician's statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). Further, the VA reports are more probative than the Veteran's assertions regarding causation. Laypersons are competent to report observable symptoms such as pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, laypersons are not competent to determine matters such as diagnosis and etiology, particularly concerning the pathologies in this case. The question of whether the Veteran incurred digestive or genitourinary disorders during service as the result of TERA is a complex medical issue. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). For this reason, the probative VA opinions outweigh the lay theories offered by the Veteran. Indeed, the VA opinions are more credible with regard to the issues before the Board. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder). In sum, the evidence demonstrates that at discharge from service, and for years after service, the Veteran did not have the characteristic manifestations sufficient to identify chronic digestive or genitourinary disorders. Further, the probative evidence indicates that these disorders are not due to TERA. See 38 C.F.R. §§ 3.303, 3.307, 3.309. As such, the benefit-of-the-doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND A remand is warranted based on a duty to assist error. The Veteran claims that he developed chronic obstructive pulmonary disease (COPD) as the result of TERA. In particular, he states that exposure to asbestos while serving aboard a naval vessel caused his respiratory problems. A VA examiner discussed this briefly in a September 2023 VA report, but did not provide a medical opinion into the claim. The matter is REMANDED for the following action: Return the case to the VA examiner who conducted the September 2023 examinations, or to a suitable substitute, for issuance of an addendum medical opinion. After reviewing the claims file, the examiner should address the following question: Is it approximately at least as likely as not (i.e., probability of approximately 50 percent or more) that COPD or restrictive lung disease had its onset during service or is related to an event, disease, or injury during service? In answering this question, the examiner should discuss the Veteran's exposure to herbicides in Vietnam and his exposure to contaminated water at Camp Lejeune, North Carolina, as well as his potential exposure to asbestos while serving aboard a ship in the late 1960s, early 1970s. In rendering the requested report, the examiner should note that laypersons are competent to attest to matters of which they have first-hand knowledge, including observable symptomatology. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The evidentiary standard "at least as likely as not" is defined as the "likelihood is at least approximately balanced or nearly equal, if not higher." Conversely, "less likely than not" is defined as the "likelihood is less than approximately balanced or nearly equal." Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee 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.