Citation Nr: 18150550 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 15-25 046 DATE: November 15, 2018 ORDER Entitlement to service connection for bladder cancer, to include as due to exposure to contaminated water at Camp Lejeune is denied. Entitlement to service connection for stomach cancer is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of bladder cancer. 2. Stomach cancer did not manifest in service or within one year. The disability is not otherwise related to service. CONCLUSIONS OF LAW 1. Bladder cancer was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. Duodenal/gastric adenocarcinoma was not incurred in or aggravated by service, and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 7, 1978 to December 15, 1978. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. Service Connection Generally, to establish service connection 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 service.” Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also 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). 1. Entitlement to service connection for bladder cancer, to include as due to exposure to contaminated water at Camp Lejeune The Veteran seeks service connection for bladder cancer, which he contends is due to exposure to contaminated water at Camp Lejeune. The issue for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease. As the Veteran’s service at Camp Lejeune in 1978 is confirmed, exposure to contaminated water is presumed. However, the Board concludes that the Veteran does not have a current diagnosis of bladder cancer and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The June 2013 VA examiner reviewed the Veteran’s file and medical records and determined that there was no diagnosis or history of bladder cancer. Further, private treatment records do not contain any record of treatment or diagnosis of bladder cancer. While the Veteran believes he has a current diagnosis of bladder cancer, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Without a current disability, service connection is not warranted under any theory of entitlement. 2. Entitlement to service connection for stomach cancer The Veteran seeks service connection for stomach cancer, which he believes is secondary to bladder cancer. As noted above, medical records do not contain a diagnosis of bladder cancer or evidence of treatment for bladder cancer. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that, while the Veteran has duodenal and gastric adenocarcinoma, which is a chronic disease under 38 C.F.R. § 3.309(a), it was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. Private treatment records show the Veteran was not diagnosed with duodenal and gastric adenocarcinoma until 2010, more than 30 years after his separation from service and well outside of the applicable one-year presumptive period. Service connection for duodenal and gastric adenocarcinoma may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s duodenal and gastric adenocarcinoma and an in-service injury or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service treatment records contain no record of complaints or treatment related to duodenal and gastric adenocarcinoma. The June 2013 VA examiner opined that the Veteran’s duodenal and gastric adenocarcinoma is not at least as likely as not related to an in-service injury, event, or disease, including exposure to contaminated water at Camp Lejeune. The rationale was that the Veteran was stationed at Camp Lejeune for a short time, and his estimated exposure is well below the lowest amount shown to cause disease in humans and animals. Further, medical literature does not support a link between the exposure and duodenal and gastric adenocarcinoma. While the Veteran believes his duodenal and gastric adenocarcinoma is related to his exposure to contaminated water at Camp Lejeune, he is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Therefore, service connection on a direct basis is not warranted. There is no evidence of duodenal and gastric adenocarcinoma in service, and the most probative evidence of record weighs against a finding that duodenal and gastric adenocarcinoma was caused by exposure to contaminated water at Camp Lejeune or otherwise related to service. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Creegan, Associate Counsel