Citation Nr: 18160014 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 17-06 306 DATE: December 20, 2018 ORDER Entitlement to service connection for chronic prostatitis is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s chronic prostatitis is related to service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for chronic prostatitis are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307(a)(7). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1975 to July 1977. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2016 rating decision. Entitlement to service connection for chronic prostatitis Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran contends that he has current prostate disability which is related to his exposure to contaminated water at Camp Lejeune in service. The Board concludes, for the following reasons, that the Veteran has a current diagnosis of chronic prostatitis and that the evidence is at least evenly balanced as to whether this disability is related to service. 38 U.S.C. §§ 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a). Medical records, including the report of an April 2015 VA examination, show the Veteran has a current diagnosis of chronic prostatitis. He contends that this disability is related to his exposure to contaminated water at Camp Lejeune in service. As applicable to this case, a veteran who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987 shall be presumed to have been exposed during such service to water contaminated with volatile organic compounds (VOCs) during such service, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. 38 C.F.R. § 3.307 (a)(7). In this case, the Veteran’s service treatment and personnel records reflect that he was stationed at Camp Lejeune for at least 30 days during service. Hence, he is presumed to have been exposed to water contaminated with VOCs during service. Moreover, the Veteran’s service treatment records reflect that he was treated for some genitourinary problems in service. For instance, he was treated for testicular pain in January and February 1976 and was diagnosed as having epididymitis. Also, he was treated for urethral discharge and pain on urination in March 1976 and was diagnosed as having gonorrhea. As for the prostate specifically, he has reported that he began to experience and receive treatment for prostate symptoms (e.g., prostate pain/burning) in 1980 and that he has continued to experience persistent prostate symptoms in the years since that time. The physician from whom he received treatment in 1980 is now deceased. The Veteran is competent to report continuous prostate problems since approximately 1980. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). There is nothing to explicitly contradict his reports and they are consistent with the evidence of record. Thus, the Board finds that the reports of continuous prostate symptoms in the years since approximately 1980 are credible. There are conflicting medical opinions with respect to whether the Veteran’s chronic prostatitis is related to service. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The Board may favor one medical opinion over another, provided an adequate statement of reasons or bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In a September 2014 letter, a VA physician opined that it was likely (“at least as likely”) that the Veteran’s chronic prostatitis was related to his exposure to chemicals at Camp Lejeune. There was no further explanation or rationale provided for this opinion. In January 2015, a VA psychiatrist reported that he was treating the Veteran and that the Veteran had “chronic [p]rostatitis related to drinking water at Camp Lejeune.” There was no further explanation or rationale provided for this opinion. A March 2015 VA primary care note completed by the VA physician who provided the September 2014 opinion includes an opinion that the Veteran’s recurrent prostatitis was likely (“at least as likely”) related to Camp Lejeune water exposure. There was no further explanation or rationale provided for this opinion. The examiner who conducted the April 2015 VA examination opined that the Veteran’s prostate disability was not likely (“less likely than not”/“less than 50 percent probability”) incurred in or caused by service. She reasoned that the Veteran did have an episode of gonorrhea and possible epididymitis in service and that these “can cause prostatitis.” However, this occurred in the 1970s and there was no medical evidence of any treatment for prostatitis until 2009. Men age 50 and older who have an enlarged prostate (benign prostatic hyperplasia (BPH)) have a higher risk for prostatitis. The prostate gland may become blocked and this makes it easier for bacteria to grow. Symptoms of chronic prostatitis can be similar to symptoms of an enlarged prostate gland. A review of the Veteran’s “urology note” revealed that there was no mention as to the etiology of his chronic prostatitis, although there was some evidence of obstruction (as seen on cystoscopy) and he was being treated with a medication that treats BPH. Thus, there was not enough evidence to tie the Veteran’s condition in service to his current chronic prostatitis. Hence, the prostatitis was not likely (“less likely than not”) caused by a continuation or progression of his symptoms in service. The April 2015 examiner also noted that the Veteran served at Camp Lejeune and was possibly exposed to toxins. Regardless, she explained that there are 15 diseases and conditions for which health benefits will be considered based on such possible exposure, but that chronic prostatitis is not one of those diseases or conditions. In a June 2015 statement, the VA physician who provided the September 2014 and March 2015 opinions explained that she had treated the Veteran for many years and that the Veteran had to stop working as a postman due to symptoms of chronic prostatitis which impaired his ability to ride in his postal truck without frequent breaks. He had noticed his symptoms since he was in service. As for the cause of his prostatitis, the VA physician explained that the Veteran was most certainly stationed at Camp Lejeune for an extended period and was, therefore, exposed to the contaminated water at that location. She opined it was likely (“at least 50 percent or more”) that the Veteran’s symptomatology was related to service and that it was “likely 100% related to the unusual circumstances of being exposed to chemicals in the water at Camp Lejeune.” There was no further explanation or rationale provided for this opinion. In January 2016, a VA physician reviewed the Veteran’s claims file and medical literature. He noted the causes and risk factors for prostatitis from various medical websites (i.e., the Mayo Clinic, the Cleveland Clinic, and Johns Hopkins Medical Center) and other medical literature and explained that the Veteran’s risk factors for chronic prostatitis were his post-service exposure to microorganisms/infectious agents and BPH. These factors were unrelated to chemicals in the water at Camp Lejeune. The water at Camp Lejeune was reported to contain the chemical contaminants perchloroethylene (PCE), trichloroethylene (TCE), benzene, and vinyl chloride. These chemicals are not infectious agents or microorganisms and chronic prostatitis is not listed as a scientifically reported health problem in people of all ages from drinking water contaminated with TCE/PCE or working with TCE/PCE, benzene, or vinyl chloride. Overall, there was no medical or scientific evidence that exposure to the chemical contaminants in the water at Camp Lejeune causes prostatitis. Chronic prostatitis has been related to infection with bacteria and other microorganisms. The Veteran has been treated with antibiotics for his prostatitis and this was indicative of an infectious process acquired in the years after service. Chronic prostatitis has also been related to irritation and inflammation from reflux of urine that occurs in the setting of age-related prostatic enlargement. The Veteran’s treatment records reflect that he has age-related BPH. In sum, the physician concluded that the Veteran’s prostatitis was not caused by or related to his exposure to the contaminated water at Camp Lejeune. In a January 2017 letter, the VA psychiatrist who provided the January 2015 opinion again opined that the Veteran’s chronic prostatitis was related to drinking water at Camp Lejeune. He explained that the prostatitis started shortly after service, but no further explanation or rationale was provided. The April 2015 opinion is of little, if any, probative value because it is partially based on a lack of contemporaneous medical evidence of treatment for prostate problems for many years following service. The opinion does not reflect consideration of the Veteran’s competent and credible reports of continuous prostate symptoms beginning in approximately 1980 (i.e., within years of his separation from service). In this regard, a medical opinion is inadequate if it is based solely on the absence of documentation in the record and does not take into account the Veteran’s reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). The Board also points out that the April 2015 examiner acknowledged that gonorrhea and epididymitis (both of which the Veteran experienced in service) “can cause prostatitis.” Although the January 2016 opinion is accompanied by a detailed rationale that is based on a review of the Veteran’s medical records and various sources of medical literature, it is also of somewhat limited probative value because the physician did not acknowledge or discuss the potential significance of the Veteran’s genitourinary problems in service and his competent and credible reports of continuous prostate symptoms since at least approximately 1980. See Id. Lastly, although the medical professionals who provided the September 2014, January 2015, March 2015, June 2015, and January 2017 opinions did not provide any detailed rationales for these opinions, they nonetheless concluded based upon treatment of the Veteran and consideration of his reported history that his current prostatitis was related to service. These opinions are therefore entitled to some probative weight. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner “did not explicitly lay out the examiner’s journey from the facts to a conclusion,” did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In light of the medical opinions of record, the Board finds that at the very least, the evidence is approximately evenly balanced on the question of whether the Veteran’s current prostatitis is related to service. The reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran. Hence, service connection for chronic prostatitis is granted. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Elwood, Counsel