Citation Nr: A25035248 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 200710-98471 DATE: April 16, 2025 ORDER Entitlement to service connection for prostate cancer, including as due to herbicide agent exposure, is denied. Entitlement to service connection for diabetes mellitus, type II, including as due to herbicide agent exposure, is denied. FINDINGS OF FACT 1. The evidence persuasively weighs against a finding of exposure to herbicide agents during service. 2. The evidence is against finding that the Veteran's diabetes mellitus and prostate cancer began during active service; manifested to a compensable degree within one year of discharge; or are otherwise related to an in-service injury or disease, including as due to claimed exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer have not been met. 38 U.S.C. §§ 1110, 5107; 38C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for diabetes mellitus, type II, have not been met. 38 U.S.C. §§ 1110, 5107; 38C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1969 to March 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2019 rating decision issued by the Department of Veterans Affairs (VA), regional office (RO), agency of original jurisdiction (AOJ). In the July 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the July 2019 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. In April 2024 the Board denied the claims for entitlement to service connection for prostate cancer and diabetes mellitus, type II. The Veteran appealed the denial of his claims to the United States Court of Appeals for Veterans Claims (Court). In February 2025, the Court granted a Joint Motion for Remand (JMR), vacating the Board's April 2024 decision and remanding the appeal to the Board for readjudication consistent with the JMR. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1113; 38 C.F.R. § 3.303. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting service, was aggravated therein. 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To establish service connection for a disability, there must be competent evidence of the following: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or "nexus" between the present disability and the disease or injury incurred or aggravated during service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent." However, when a disability may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Service connection for certain chronic diseases may be presumed to have been incurred in service by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307 (a)(3), 3.309 (a). Such a chronic disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307 (a). When a chronic disease is shown in service, sufficient to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303 (b). To be "shown in service," the disease identity must be established, and the diagnosis must not be subject to legitimate question. Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013); see also 38 C.F.R. § 3.303 (b). There is no "nexus" requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease. Walker, 708 F.3d at 1336. As to herbicide exposure, VA laws and regulations provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116 (a)(3); 38 C.F.R. § 3.307 (a)(6)(iii). The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he served in the Republic of Vietnam during the Vietnam war period. 38 C.F.R. § 3.307. For these Vietnam veterans, diseases associated with exposure to certain herbicide agents will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307. The presumption requires a veteran actually stepped foot on land in Vietnam or served in the inland waterways in the interior of the Republic of Vietnam. Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008). It also applies to Veterans who served within the 12-nautical-mile territorial sea of the Republic of Vietnam. See 38U.S.C. §1116A(d); Procopio v. Wilkie, 913 F.3d 1371, 1380-81 (Fed. Cir. 2019). A veteran who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish the veteran was not exposed to any such agent during service. 38 C.F.R. § 3.307(a)(6)(iv). The Department of Defense has also confirmed herbicides were used in Thailand during the Vietnam War. The majority of troops in Thailand during the Vietnam Era were stationed at the Royal Thai Air Force Bases (AFB) of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a veteran served on one of these air bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by military occupational specialty (MOS), performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. This applies only during the Vietnam Era. The PACT Act, among other things, extended the presumption of herbicide exposure to veteran's who served in Thailand, Laos, Cambodia, Guam, American Samoa, and Johnston Atoll during specific periods of time. See Pub. L. 117-168; 38 U.S.C. § 1116 (a)(2). The list of diseases associated with exposure to certain herbicide agents is as follows: AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin's disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), all chronic BCell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin's lymphoma, Parkinson's disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft- tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma), parkinsonism, bladder cancer, and hypothyroidism. 38 C.F.R. § 3.309 (e). The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a Veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 999 F.3d 1391, 1395 (Fed. Cir. 2021). 1. Entitlement to service connection for prostate cancer. 2. Entitlement to service connection for diabetes mellitus, type II. The Veteran contends that his prostate cancer and diabetes mellitus, type II (hereinafter, "diabetes"), are due to herbicide agent exposure while serving in Germany during the Vietnam War more than one-half century ago. The Veteran has provided no evidence to support this claim. Initially, the Board will address the Veteran's presumptive service connection on the basis of in-service herbicide exposure. Next, the Board notes that for any service connection, the Veteran must have a current disability. Under the AMA, the Board is bound by favorable findings by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104 (c). In the July 2019 rating decision, the AOJ found that the Veteran had a current disability of prostate cancer and diabetes mellitus, type II. See July 2019 Rating Decision. Concerning presumptive service connection due to Agent Orange exposure, the Veteran's conditions of prostate cancer and diabetes are both diseases that are listed as those which can be presumptively service connected. The question for the Board is whether the evidence is at least in approximate balance on the issue of whether the Veteran was actually exposed to "herbicide agents," as that phrase is defined in 38 C.F.R. § 3.307 (a)(6)(i). As noted above, the Veteran does not claim, nor does the evidence show, that he served in Vietnam, or in any other area subject to certain presumptions of exposure as discussed above, including Korea, Thailand, Laos, Cambodia, Guam, American Samoa, or Johnston Atoll. Instead, in a statement received on July 21, 2019, the Veteran alleged that while stationed in Hanau, Germany, his military occupational specialty (MOS) as a fuel and electric repairman exposed him to damaged fuel and electric products, which he asserts traveled from Vietnam and were thus presumably sprayed with herbicides, which, in turn, put him in contact with products contaminated by Agent Orange, which then caused him to develop the diabetes and prostate cancer more than three decades after service discharge. The Veteran has supplied the Board with no evidence to support his theory. This case has been to the Veteran's Court, and the Board believes it must be explicit as to the Veteran's contentions and the copious presumptions he is making in this case. Specifically, first, he makes the presumption that damaged fuel and electric products were sprayed with Agent Orange while in Vietnam. The Veteran's second presumption is that these "contaminated" parts were then shipped to Germany, rather than the United States. The Veteran's third presumption is that he worked on those parts, repairing them, as opposed to simply damaged fuel and electric products that were never in Vietnam but were damaged in Germany. The Veteran's fourth presumption is that (even if the Board assumes that the three other presumptions were correct, which it does not) is that these parts, that were in Vietnam, sprayed with Agent Orange, and then shipped to Germany, were never cleaned before he worked on them. The Veteran's fifth presumption (even if the Board assumes that the four other presumptions were correct, which it does not) is that this, at very best, highly limited exposure caused the disabilities at issue years later. As the Veteran can see from the above, it is deeply doubtful as to how this theory can be said to be at least as likely as not (generally speaking, a 50% or greater chance) to be the cause of the Veteran's disability. The Board will first address the February 2025 JMR concerns regarding the duty to assist. The parties to the JMR found that the Board should address whether the duty to assist was satisfied in verifying the veteran's reports of herbicide exposure while serving in Germany more than one-half century ago. In this regard, it is unclear as to how the VA could do this. Overall, it appears that the VA is being asked to prove a negative. How can the Board find that the Veteran was never in contact with a piece of equipment that was in Vietnam, that had not been cleaned before the Veteran was in contact with the equipment, and that this equipment had been exposed to herbicides more than 50 years ago? In making any a determination regarding whether the duty to assist has been satisfied is a review of the validity and plausibility of the Veteran's contention. In this regard, the parties noted that the only development to verify herbicide exposure was a June 7, 2019, letter from VA asking for Appellant to provide information regarding service in the Republic of Vietnam, despite the fact that the Veteran had never alleged Vietnam service. Pertinent to this point, the parties noted that VA's Adjudication Procedures Manual ("M21-1"), Part VIII, Subpart i, Chapter 1, Section A. 6. a. provided explicit steps for adjudicators to follow to verify potential herbicide exposure on a factual basis when a veteran alleged exposure in locations other than the Republic of Vietnam ("RVN" or "Vietnam"), Korean demilitarized zone ("DMZ"), or Thailand. The M21-1 (which does not apply to the Board) provides a procedure for verifying exposure to herbicides in locations other than the Republic of Vietnam or along the demilitarized zone (DMZ) in Korea, or Thailand, which requires: (1) asking the appellant for the approximate dates, location, and nature of the Veteran's alleged exposure; (2) researching the dates, locations, and circumstances of the claimed exposure with the Herbicide Tests and Storage Outside Vietnam lists provided by DoD; and (3) if this review does not confirm that herbicides were used as alleged, sending a request to Military Records Research Center (MRRC) (formerly known the Joint Services Records Research Center (JSRRC)) for verification of exposure to herbicides. See M21-1 MR, Part VIII, Subpart i, Chapter 1, Section A, Subsection 6. While the Board is not bound by the M21-1, it must nonetheless consider and address the relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims therein. Chavis v. McDonough, 34 Vet. App. 1 (2021) (citing Healey v. McDonough, 33 Vet. App. 312, 321 (2021)); see also Overton v. Wilkie,30 Vet. App. 257, 264 (2018). The Board notes, however, that in connection with the current appeal, in correspondence dated January 25, 2019 VA asked the Veteran for information regarding when, where, and how he was exposed to Agent Orange, to include other than service in the Republic of Vietnam. The letter specifically stated: "In order for VA to acknowledge that you were exposed to Agent Orange, please send evidence that: (1) you physically served within or visited the country of Vietnam, or its inland waterways, between January 9, 1962 and May 7, 1975. If you were stationed aboard a ship, we need the ship's name and evidence that it entered Vietnam's inland waterways or that you went ashore; (2) you served in a unit stationed along the Korean demilitarized zone between April 1, 1968 and August 31, 1971; or (3) you were exposed to Agent Orange in some other manner, with an explanation of when, where, and how you were exposed." On June 7, 2019, VA sent the Veteran a second letter that requested additional evidence to substantiate the Veteran's claimed exposure to Agen Orange. Therefore, while the June 7, 2019 correspondence limited the inquiry regarding the Veteran's alleged exposure to herbicides to service in the Republic of Vietnam, the January 25, 2019 correspondence expanded the inquiry to include any exposure outside of service in the Republic of Vietnam. No response with the requested information was received. Simply stated, the Veteran has never provided any proof that he was exposed to hebrides during military service more than one-half century ago. In a rating decisions in July 2019 and September 2019, the RO informed the Veteran that without additional information from him regarding his claimed exposure to herbicide agents, his claim could not be investigated. This is correct. The Board finds no basis to launch an investigation into whether, or if, the Veteran was somehow exposed to (for example purposes only) damaged fuel and electric products that, for some reason, where moved from Vietnam to Germany without being cleaned. First - there is simply nothing to investigate - the Board must assume that some limited damaged fuel and electric products were, at some point, moved from Vietnam to Germany. This fact does not suggest that the Veteran was ever exposed to such equipment or that the equipment was someone "contaminated" with Agent Orange. The Board finds that the VA has fulfilled its duty to assist the Veteran in attempts to verify his claimed exposure to herbicide agents, notwithstanding the limited evidence of record that supports the contention that any electric equipment handled by the Veteran traveled from Vietnam to Germany and, somehow, contaminated the Veteran. The context of the contention must be addressed within the facts of this case to address whether the duty to assist has been met in this case and, simply stated, the contentions lack of great deal of reasonableness. To address the Court's concerns, the Board must address the Veteran's contention in this case judiciously. For the Veteran's contention to be accepted, the Board must assume that the Veteran worked on electric equipment that came from Vietnam one-half century ago, that the electric equipment from Vietnam was sprayed with herbicide agents in Vietnam, that the herbicides persisted through the equipment's' travels and was never removed, and that, at that point, the Veteran was exposed to the Vietnam electrical equipment in Germany and that this, in turn, years later, led to the Veteran's diabetes (ignoring such other facts that typically cause diabetes in the United Sa, including a family history of diabetes and a history of smoking) and prostate cancer. It is difficult to find that, at any point, it could be said that this is at least as likely or not (very generally a 50% or greater chance) that this was the cause of the Veteran's disabilities. Notwithstanding, this has been the subject of extensive litigation. The Board must note for the record that it is difficult for VA personnel to determine what did, or did not, occur 50 years ago. The Veteran's contention, raised decades after service with no credible evidence that supports this contention, must be considered in any coherent review of whether the VA has fulfilled to duty to assist. As previously noted, none of the presumptions pertaining to exposure to herbicide agents during the Vietnam War noted above apply to Germany. As for secondary exposure from equipment used in Vietnam, there is no VA presumption or acknowledgement of exposure for such remote or secondary contact and no evidence of long-term health effects from any such contact. A request was not sent to JSRRC due to insufficient evidence. Nonetheless, it is unclear what evidence could possibly be provided to the JSRRC that could corroborate the Veteran's contentions regarding his claimed secondary exposure to herbicides from equipment while stationed in Germany. The Board finds remanding the Veteran's claims for additional development would serve no useful or meaningful purpose and instead result in unnecessarily imposing additional burdens on VA with no potential benefit flowing to the Veteran. See, e.g., Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). It is doomed to failure based on the facts of this case. Overall, the Board again finds the Veteran's claim of exposure to herbicide agents to be implausible in the extreme to assume that herbicide agents would travel on equipment from Vietnam to Germany and then, somehow, caused the Veteran's diabetes and prostate cancer more than three decades later. The contention is, at best, highly speculative. While is can never be said that it is "impossible" this is not a standard that the Board uses. There is simply no presumption to show the Veteran was exposed to herbicide agents. On this basis alone, the claim has failed. It also is clear that the Veteran did not serve in Vietnam, or anywhere near Vietnam, or in an area in which herbicides are known to have been applied during the Vietnam War. The Veteran's honorable service in Germany is not in dispute. The Veteran served in Hanau, Germany, which is roughly 5,920 miles from Vietnam, and nowhere near any areas associated with conceded herbicide exposure. As exposure to herbicide agents cannot be conceded, the Board must determine whether the Veteran was "actually exposed" to herbicide agents (i.e., exposure in fact). The Veteran has provided no information to support the claim that he was exposed to herbicide agents in Germany. Therefore, the Board finds that it is less likely than not that the Veteran was actually exposed to herbicide agents. To suggest the Veteran was exposed to herbicide agents based on his contentions and this evidence amounts to gross speculation, and an unwillingness to accept the fact that there are far more likely causes of these disabilities, particularly, unfortunately, for men living in the United States (and particularly this Veteran), to a point at which it becomes deeply indeterminate, respectfully, as to why this case was returned to the Board on this basis. Accordingly, the remaining issue is whether the Veteran's current disabilities are related to active service. The Veteran does not assert, nor does the record reflect an in-service onset of prostate cancer or diabetes. The Veteran's service treatment records reflect there were no complaints of prostate cancer or diabetes, and on separation from service the Veteran's urinalysis was negative for sugar and albumin. See July 1969 and February 1972 Report of Medical Examination. After service, treatment records since 2003, approximately three decades after discharge from service document treatment for diabetes, along with a family history of diabetes, a history of smoking and hypertension. Concerning prostate cancer, treatment records since 2011, more than 38 years after service discharge, noted a diagnosis of adenocarcinoma of the prostate. Second, for direct service connection, the Board finds that there was not an in-service disease of prostate cancer or diabetes. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). After service, VA treatment records since 2003, approximately three decades after discharge from service document treatment for diabetes, along with a family history of diabetes, a history of smoking and hypertension. Concerning the Veteran's prostate cancer, treatment records since 2011, more than 38 years after service discharge, noted a diagnosis of adenocarcinoma of the prostate. There is no evidence contemporaneous with the Veteran's period of active duty service showing any complaints, history or findings consistent with or diabetes or prostate cancer. Additionally, neither diabetes or a malignant tumor, was not shown in service or within one year following discharge from active-duty service, as such, service connection cannot be established for diabetes on a presumptive basis. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. At this point, the service medical records and the post-service medical evidence provides evidence against the claims. In fact, it does not even appear that the Veteran has alleged such continuity of symptomatology from his time in service. Simply stated, the facts of this case are not in dispute: There is no medical record made during service, or after service, that would support the Veteran's claims. Therefore, the Board finds that the most probative evidence of record shows that the Veteran did not have a continued problem with diabetes or prostate cancer in and since service and that his diabetes and prostate cancer are not otherwise related to an in-service injury or disease. Additionally, there is nothing in the service or post-service medical evidence to relate prostate cancer or diabetes to active service. The Board is highly sympathetic towards the Veteran's disabilities. However, the evidence is against finding that his prostate cancer or diabetes began during active service, or are otherwise related to an in-service injury, event, or disease, to include any claimed in-service herbicide exposure. The Veteran himself must, at this point, be aware of the exceedingly speculative nature of his claims regarding exposure to herbicides in Germany 50 years ago. It light of the litigation in this case, the Board must be explicit regarding the Veteran's statements. The Board has reviewed the Veteran's statements in some detail. At no point, it appears, does the Veteran state that he saw herbicides on any equipment that was in Vietnam, in Germany. The Veteran's statements, overall, at best, are based on secondhand information of highly limited probative value. Remanding this case for more development of events that occurred one-half-century ago would serve no constructive purpose. Sporadically, the Board must use common sense based on the facts of the case in any rational determination of whether the duty to assist has been met in this case. A remand would be waste for both the Veteran, the Board, and the Veteran's Court. As noted, there is simply no evidence of electric equipment exposed to herbicides in Vietnam being sent thousands of miles away to Germany and, exposing a person to herbicides, and then causing his diabetes and prostate cancer more than 30 years later. The contention lacks all foundation. He has provided no evidence to support this theory based on a set of facts that are simply deeply tentative. It can never be said that it is as least as likely as not (a 50% or greater chance, generally) that this is the way in which the Veteran's problems began. There are unmistakably more likely reasons for these problems to have occurred. We cannot say what caused the Veteran's disabilities, but we can clearly say the Veteran's service one-half century ago, is less likely than not (less than 50% chance) the cause of this problem. The Board has considered the statements from the Veteran asserting that his diabetes and prostate cancer were due to service, as well as his reported exposure to herbicide agents. The Veteran is certainly competent to report as to the observable symptoms he experiences and their history, but he cannot diagnose diabetes or prostate cancer because of the medically complex nature of such diagnoses. Even if the Board finds the Veteran's report of being exposed to herbicides during service to be credible, which it does not, while the Veteran is competent to report on his own symptomatology, he is not competent to offer an opinion on whether any of the claimed disability is related to these exposures. Layno v. Brown, 6 Vet. App. 465 (1994); See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The ultimate questions in this case are related to an internal medical process which extends beyond an immediately observable cause and effect relationship. Id. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his claimed in-service exposures is a matter that requires medical expertise to determine. Finally, the Veteran has not been shown to have specialized knowledge to identify herbicide agents. Specifically, he has not shown how he knew the equipment he handled was contaminated with any chemicals. As there is no indication that the Veteran's diabetes and prostate cancer are due to service, an examination is not required for the purposes of adjudication. While the McLendon factors set a low bar to trigger an examination pursuant to VA's duty to assist, an examination is not required every time a claim is filed. McLendon v. Nicholson, 20 Vet. App. 79 (2006). A VA examination is only required when necessary to decide a claim. Despite the permissive language of VA's duty to assist, the Court has stated that "[i]f Congress had wanted the Secretary to automatically provide an examination on all possible theories, then section 5103A would not read the way it does." Robinson v. Peake, 21 Vet. App. 545, 553 (2008). See also Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (a claimant's mere "conclusory generalized statement" that an in-service illness caused his current disability did not trigger VA's requirement to obtain an examination, and it rejected the theory "that medical examinations are to be routinely and virtually automatically provided to all Veterans in disability cases involving nexus issues"). Here, the Veteran has provided nothing beyond a bare assertion to trigger VA's duty to assist. Private and VA treatment records do not in any way suggest or indicate that his diabetes and prostate cancer are etiologically related to service. 38 C.F.R. § 3.159(c)(4); See McClendon, 20 Vet. App. at 81-82. Hence, a VA medical opinion or examination regarding a nexus is not required to adjudicate these claims on a direct basis. Both the best medical evidence in this case, and the facts of this case, provide highly probative evidence against the claim, indicating problems that began many years after service with no connection to service. Given the foregoing, the Board finds that the most persuasive evidence is against the claims for service connection for diabetes and prostate cancer and the claims must be denied. See 38 U.S.C. § 5107(b); Lynch, 1 Vet. App. at 55-56. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Azizi, T. 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.