Citation Nr: 18157123 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 17-01 004 DATE: December 11, 2018 ORDER Entitlement to service connection for prostate cancer, to include as due to exposure to contaminated water at Camp Lejeune is denied. FINDING OF FACT The Veteran’s prostate cancer was not manifested in service or within a year following his discharge from active duty, and the preponderance of the evidence is against a finding that it is related to his service, to include as due to exposure to contaminated drinking water therein. CONCLUSION OF LAW Service connection for prostate cancer is not warranted. 38 U.S.C. §§ 1110; 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from October 1974 to October 1978 and from July 2003 to May 2005. This matter is before the Board of Veterans’ Appeal (Board) on appeal of a February 2013 Department of Veterans Affairs (VA) rating decision. Service connection may be granted for a disability resulting from a disease or injury incurred or aggravated by active service. See 38 U.S.C. § 1110, 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury; and (3) a nexus between the disease or injury in service and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases (to include malignant tumors) may be service connected on a presumptive basis if manifested to a compensable degree within a specified period following separation from service (one year for malignant tumors). 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303 (d). During the pendency of this appeal, effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 to provide a presumption of service connection for certain diseases based on exposure to contaminants in the water supply at Camp Lejeune. Two of the eight water treatment facilities supplying water to the base were contaminated with trichloroethylene (TCE), tetrachloroethylene (PERC), or perchloroethylene (PCE) from an off-base dry-cleaning facility. Essentially, as amended, 38 C.F.R. §§ 3.307 and 3.309 establish a presumption of service connection for veterans who served at Camp Lejeune for no less than 30 days (consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987, and have a diagnosis of any of the following eight diseases, even though there is no record of such disease during service: kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. §§ 3.307 (a), 3.309(f). Such listed diseases shall have to become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(7)(ii). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, where the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. The Veteran’s service personnel records indicate he was stationed at Camp Lejeune from April 15, 1975 to May 15, 1975. His service treatment records (STRs) are silent for complaints, treatment, or diagnoses related to prostate cancer. VA treatment records show the Veteran received a diagnosis of prostate cancer in September 2011, and underwent a robotic radical prostatectomy later that month. The Veteran alleges his prostate cancer is due to exposure to contaminated drinking water at Camp Lejeune. On a December 2012 VA examination, the examiner opined his prostate cancer is not due to or aggravated by exposure to contaminated water at Camp Lejeune. The examiner noted the Veteran was 57 years old and had a history of obesity. The examiner noted the most important risk factors for prostate factors include age (40 and over), ethnicity, genetic factors, and possible dietary factors. The examiner reviewed several studies (including the National Academy of Sciences’ (NAS) National Research Council (NRC)’s report, “Contaminated Water Supplies at Camp Lejeune, Assessing Potential Health Effects”) regarding the possible connection between solvents (including trichloroethylene, tetrachloroethylene, and mixed solvents) and prostate cancer, and indicated the literature revealed no definite medical evidence to suggest an association exists between chronic exposure to solvents and prostate cancer. On June 2016 VA examination, the examiner identified advanced age, family history of cancer, dietary factors, obesity, and smoking as risk factors for prostate cancer. The examiner discussed the scientific studies and medical literature regarding the impact of chemical contaminants on the development of prostate cancer, noting that substantial exposure to PERC or TCE for five years or more may be associated with an increased risk for developing prostate cancer, but that the Veteran’s exposure to CLCW was low and lasted 30 days. The examiner also reviewed an Agency for Toxic Substances and Diseases Registry, which lists prostate cancer as a health outcome associated with working with TCE and PCE but does not identify prostate cancer as a reported problem in people from drinking contaminated water. The examiner noted the Veteran’s prostate cancer was diagnosed at age 55, and that he had a history of heavy alcohol use, was morbidly obese, and his father had pancreatic cancer. Given these other risk factors and the limited exposure at Camp Lejeune, the examiner opined that the prostate cancer is not related to exposure to contaminated water at Camp Lejeune. The record does not contain any further medical opinion regarding the etiology of the Veteran’s prostate cancer. It is not in dispute that the Veteran now has had prostate cancer. His service personnel records show he served at Camp Lejeune from April 15, 1975 to May 15, 1975. Accordingly, his exposure to contaminated drinking water at Camp Lejeune is conceded. The critical question remaining is whether there is competent evidence of a nexus between his service, to include his exposure to contaminated drinking water therein, and the prostate cancer. There is no evidence, or allegation, that prostate cancer was manifested in service or in the first postservice year. Prostate cancer was not diagnosed until 2011, more than 6 years following the Veteran’s separation from service. Consequently, service connection on the basis that the prostate cancer became manifest in service and persisted or on a presumptive basis (for the cancer as a chronic disease under 38 U.S.C. § 1112) is not warranted. There is also no evidence of postservice continuity of prostate cancer symptoms that would warrant service connection base on continuity (under 38 C.F.R. § 3.303(b)). What remains then is whether, in the absence of a showing of onset in service and continuity since, the Veteran’s prostate cancer is otherwise shown to be etiologically related to his service. The only competent (medical) evidence in the record regarding a nexus between the Veteran’s prostate cancer and his service is in the opinions of the December 2012 and June 2016 VA examiners, who opined that the Veteran’s prostate cancer is not related to his service, including as due to exposure to contaminated water at Camp Lejeune. The December 2012 examiner opined that it is “more likely than not the diagnosis of prostate cancer is NOT due to or aggravated by exposure to Camp Lejeune contaminated water.” The June 2016 examiner clearly opined that the Veteran’s prostate cancer is not related to exposure to contaminated water at Camp Lejeune. Both of the VA examiners are medical professionals competent to offer their opinions, and the opinions reflect a familiarity with the Veteran’s entire record and include rationale with citation to supporting factual data and scientific studies. The opinions are probative evidence and, without competent evidence to the contrary, are persuasive. The Board has considered the Veteran’s own assertions that his prostate cancer is due to exposure to contaminated water at Camp Lejeune (where he served for a month in 1975). Because he is a layperson, he is not competent to opine regarding the etiology of his prostate cancer, as that is a medical question that requires medical expertise. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (2007). Accordingly, the Board concludes the preponderance of the evidence is against the claim of service connection for prostate cancer, and that the appeal in this matter must be denied. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Naumovich, Associate Counsel