Citation Nr: 20002804 Decision Date: 01/13/20 Archive Date: 01/13/20 DOCKET NO. 18-36 708 DATE: January 13, 2020 ORDER Entitlement to service connection for the cause of the service member’s death is denied. FINDING OF FACT 1. The service member’s death certificate list the immediate cause of death as pancreatic cancer. 2. A service-connected disease or disorder did not cause or materially contribute to the service member’s death. 3. The preponderance of the evidence is against a finding the service member’s pancreatic cancer is due to a disease or injury in service, to include as due to exposure to contaminant in the water at Camp Lejeune. CONCLUSION OF LAW The criteria to establish service connection for the cause of the service member’s death have not been met. 38 U.S.C. §§ 1110, 1310, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The service member served on active duty for training (ACDUTRA) from June 1963 to December 1963. The service member passed away in November 2014, and the Appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As part of the appeal, the Appellant requested a hearing before the Board. The Appellant, through her representative, withdrew her hearing request in an October 2019 statement prior to the date of the hearing. Therefore, the Appellant’s hearing request is deemed withdrawn. See 38 C.F.R. § 20.702. The Appellant contends that the cause of the service member’s death was due to exposure to contaminated drinking water at Camp Lejeune. See February 2018 Notice of Disagreement. Dependency and Indemnity Compensation (DIC) benefits are payable to the surviving spouse of a Veteran if the Veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. To establish service connection for the cause of the Veteran’s death, the evidence must show that a disability incurred in or aggravated by active service either caused or contributed substantially or materially to cause death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. A service-connected disorder is one that was incurred in or aggravated by active service; one for which there exists a rebuttable presumption of service incurrence; or one that is proximately due to or the result of service-connected disability. 38 U.S.C. §§ 1110, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309, 3.310. A service-connected disability will be considered as the principal, or primary, cause of death when such disability, singly or jointly with some other disorder, was the immediate or underlying cause of death or was etiologically related thereto. A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially, that it combined to cause death, or that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312. At the time of the service member’s death, he was not service connected for any disabilities. The service member’s death certificate list the immediate cause of death as pancreatic cancer. There were no other significant conditions listed as contributing to the service member’s death. The service member was not service-connected for pancreatic cancer. As the service member was not service-connected for the condition listed as the cause of death on his death certificate, the Board considers whether the cause of death was otherwise caused by the service member’s active duty service, to include as due to exposure to contaminated drinking water at Camp Lejeune. VA has established certain rules and presumptions for chronic diseases associated with contaminants present in the water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina, from August 1, 1953, to December 31, 1987. The eight specified diseases are: kidney cancer; liver cancer; Non-Hodgkin’s lymphoma; adult leukemia; multiple myeloma; Parkinson’s disease; aplastic anemia and other myelodysplastic syndromes; and, bladder cancer. See 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The service member’s medical and personnel records confirm service at Camp Lejeune, and thus, exposure to contaminated drinking water at Camp Lejeune is conceded. 38 C.F.R. § 3.307. The service member was diagnosed with pancreatic cancer, although the February 2017 VA examiner noted that there was no accompanying confirmatory data of diagnosis. The Board notes that pancreatic cancer is not one of the presumptive diseases associated with exposure to contaminated drinking water at Camp Lejeune. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The RO sought medical opinions regarding the nexus or connection between contaminant exposure and the service member’s pancreatic cancer. In a February 2017 VA medical examination, the examiner opined that service member’s pancreatic cancer was less likely than not a result of service member’s past exposure to contaminated water a Camp Lejeune. The examiner noted that pancreatic cancer is not a recognized presumptive condition. As a rationale for the medical opinion, the VA examiner explained that given the scant medical information in service member’s medical chart, the low duration of exposure to contaminated water at Camp Lejeune compared to studies of Marines and civilians, and the lack of medical literature connecting exposure to contaminated water at Camp Lejeune with the service member’s tumor at the low levels measured there, the service member’s claimed condition is less likely than not related to exposure from contaminated water in Camp Lejeune. Further, the examiner noted that the dearth of medical information regarding risk factors for this disease also renders a forensic exam impossible. Additionally, the examiner elaborated that the service member was exposed to contaminated water at Camp Lejeune for a period of 102 days which is less than the mean duration of exposure of 21.3 months, as noted in the published mortality studies of Camp Lejeune Marines titled ATSDR Camp Lejeune Drinking Water Public Health Assessment (January 20, 2017). The examiner pointed out that service member’s death certificate, which lacked any confirmatory data, indicated that the service member had passed away as a result of pancreatic cancer in 2015 at the age of 69; more than 50 years after service at Camp Lejeune. Further, the examiner reviewed the record and found that there were no primary source treatment records, no oncology records, no pathology reports, no exact dates of cancer diagnosis, and no specific pathologic or tissue diagnosis found in the service member’s records relating to pancreatic cancer. Also, absent from the record are notes which would allow a proper forensic evaluation to include past medical, social, family and occupational histories. Based on the evidence of record, the examiner concluded that service member’s pancreatic cancer was not due to exposure from contaminated drinking water at Camp Lejeune. The Board finds this opinion probative as it was made by a medical professional with consideration of the specific facts in this case, a review of the service member’s record, and in consideration of appropriate studies and articles. Notably, the Appellant has not provided a medical nexus opinion contrary to the opinion of the VA medical examiner. The Board acknowledges evidence submitted by the Appellant in a February 2018 Correspondence noting supportive articles regarding the connection between pancreatic cancer and exposure to environmental contaminants. The Appellant asserted that none of service member’s family members had pancreatic cancer and noted that recent research has provided reason to believe that toxic chemicals can contribute to individuals developing pancreatic cancer. However, while Appellant is competent to note a cancer diagnosis, she is not competent to determine that it was due to exposure to contaminated water at Camp Lejeune. This issue is medically complex, as it requires ability to interpret, evaluate, and synthesize multiple empirical studies of relationships between contaminant exposure and cancer. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). Opinions of that nature require medical expertise and are outside the realm of common knowledge of a layperson. Id. Consequently, the Board gives more probative weight to the VA examiner’s opinion. It is important to note that the Appellant does not claim that the service member had pancreatic cancer during service or within one year thereof. Indeed, a review of the service member’s service treatment records, as well as other evidence of record, reveals no complaints, treatment, or diagnosis of pancreatic cancer until the service member’s death. The Appellant instead simply maintains that the service member’s death may have been caused by exposure to contaminated drinking water at Camp Lejeune. However, as noted above, there is no link between service member’s pancreatic cancer and exposure to contaminated drinking water at Camp Lejeune. For the above reasons, the Board finds that the preponderance of the evidence is against the Appellant’s claim and service connection for the service member’s cause of death is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Appellant’s claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Michael Sanford Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.