Citation Nr: 1801780 Decision Date: 01/10/18 Archive Date: 01/23/18 DOCKET NO. 17-13 640 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUE Entitlement to service connection for soft tissue sarcoma, due to contaminated water exposure at Camp Lejeune. REPRESENTATION Appellant represented by: John S. Berry, Attorney ATTORNEY FOR THE BOARD K. D. Cross, Associate Counsel INTRODUCTION The Veteran served on active duty from November 1958 to November 1962. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2017). 38 U.S.C. § 7107(a)(2) (2012). FINDING OF FACT While the Veteran served at Camp Lejeune, a sarcoma was not manifest during active service or within one year following separation from a qualifying period of active service, and is not shown to have developed as a result of an established event, injury, or disease during active service. CONCLUSION OF LAW The criteria for entitlement to service connection for sarcoma, to include as due to contaminated water exposure at Camp Lejeune, have not been met. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d) (2017). Service connection may be presumed for certain chronic diseases, to include cardiovascular-renal disease or hypertension, which develop to a compensable degree within one year after separation from service, even though there is no evidence of the disease during the period of service. That presumption is rebuttable by probative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137 (2012); 38 C.F.R. 3.307, 3.309(a) (2017). Where the evidence, regardless of its date, shows that the Veteran had a chronic condition in service or during an applicable presumption period and still has that chronic disability, service connection can be granted. That does not mean that any manifestations in service will permit service connection. To show chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time as distinguished from merely isolated findings or a diagnosis including the word chronic. When the disease entity is established, there is no requirement of evidentiary showing of continuity. 38 C.F.R. § 3.303(b) (2017). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing a service connection claim. 38 C.F.R. § 3.303(b) (2017). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was noted during service; (2) evidence of post- service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. Continuity of symptomatology applies only to those conditions explicitly recognized as chronic, such as hypertension. 38 C.F.R. § 3.309(a) (2017); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that service connection is warranted for sarcoma, due to exposure to contaminated water while stationed at Camp Lejeune. VA has acknowledged that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1953 through December 1987 were potentially exposed to drinking contaminated water with volatile organic compounds (VOCs). See Veterans Benefits Administration (VBA) Fast Letter 11-03 (January 11, 2011). In sum, in the early 1980s it was discovered that two on-base water-supply systems were contaminated with the VOCs trichloroethylene (TCE), a metal degreaser, and perchloroethylene (PCE), a dry cleaning agent. Benzene, vinyl chloride, and other VOCs were also found to be contaminating the water-supply systems. Until scientific evidence shows otherwise, it will be assumed by VA that any given Veteran-claimant who served at Camp Lejeune was potentially exposed in some manner to the full range of chemicals known to have contaminated the water there between 1957 and 1987. The National Academy of Sciences' National Research Council (NRC) published its report, "Contaminated Water Supplies at Camp Lejeune, Assessing Potential Health Effects," in 2009. This report included a review of studies addressing exposure to TCE and PCE, as well as a mixture of the two, and a discussion of disease manifestations potentially associated with such exposure. Fourteen diseases were identified as having limited/suggestive evidence of an association with TCE, PCE, or a solvent mixture exposure. These include esophageal cancer, lung cancer, breast cancer, bladder cancer, kidney cancer, adult leukemia, multiple myeloma, myelodysplastic syndromes, renal toxicity, hepatic steatosis, female infertility, miscarriage with exposure during pregnancy, scleroderma, and neurobehavioral effects. See VBA Training Letter 11-03 (Revised) (November 29, 2011), Appendix B. The list of 14 diseases in this NRC report is not an exhaustive list, however. The Board notes that is presumed to have been exposed to contaminated water as his personnel records confirm his presence in Camp Lejeune from 1959 to 1960. His service treatment records are negative for complaints of treatment of sarcoma, or any other skin condition. There is no prior record of the Veteran being diagnosed with or treated for sarcoma or any other skin condition, and the Veteran does not contend otherwise. The Veteran was diagnosed with soft tissue sarcoma in 2012. In a December 2014 VA examination, the examiner opined that the Veteran's sarcoma was not related to the Veteran's exposure to contaminated water at Camp Lejeune. The rationale provided was that no clear cause of sarcoma had been determined. The examiner went on to explain that while no clear cause for sarcoma was determined, there was no medical evidence that shows an association or causation between sarcoma and Camp Lejeune contaminated water exposure. The Board acknowledges the statements of the Veteran and finds the Veteran competent to report pain. Kahana v. Shinseki, 24 Vet. App. 428 (2011). To the extent that the Veteran himself suggests that his sarcoma is related to service, the Board finds that the Veteran is not competent to offer that etiological opinion. The evidence does not show that the Veteran has medical training or expertise that would make him competent to provide an opinion on a medical matter such as the etiology of soft tissue sarcoma. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). In any event, the Board finds that the opinions of the VA examiner is more persuasive because of the training and expertise of the examiner, their access to and review of the medical record, and their specific consideration of the issues at hand. Accordingly, the Board finds that the preponderance of the evidence is against a claim for service connection for soft tissue sarcoma, due to contaminated water exposure at Camp Lejeune, and the claim must be denied. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to service connection for soft tissue sarcoma, due to contaminated water exposure at Camp Lejeune is denied. ____________________________________________ M. Tenner Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs