Citation Nr: 20002893 Decision Date: 01/14/20 Archive Date: 01/13/20 DOCKET NO. 18-08 949 DATE: January 14, 2020 ORDER Entitlement to service connection for a sleep disability, to include as due to exposure to contaminated water, is denied. FINDING OF FACT The preponderance of the evidence is against finding that any current sleep disability manifested during service, may be presumed to have resulted from the exposure to contaminated drinking water at Camp Lejeune, or is a result of active service, to include exposure to contaminated water at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for a sleep disability, to include as due to exposure to contaminated water have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.159,, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1965 to September 1969. Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be established for any disease initially diagnosed after service, when the evidence establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The disease entity for which service connection is sought must be chronic rather than acute and transitory in nature. For the showing of chronic disease in service, a combination of manifestations must exist 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. Service incurrence will be presumed for certain chronic diseases if manifest to a compensable degree within the year after active service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309. In certain cases when a Veteran has been exposed to water supply contaminants during service, service connection may be presumed for diseases associated with such exposure. Contaminants include the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, which were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period extending from August 1, 1953, to December 31, 1987. When exposure to the water supply contaminants at Camp Lejeune is established in accordance with the regulation, certain diseases associated with that exposure will be service connected if they manifest to a degree of 10 percent or more at any time after service. Sleep apnea and narcolepsy are not diseases VA has associated with the water supply contaminants at Camp Lejeune. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). Entitlement to service connection for a sleep disability, to include as due to exposure to contaminated water The Veteran contends that a sleep disability is due to exposure to contaminated water while stationed at Camp Lejeune. Kidney, liver, and bladder cancer, and Non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease and aplastic anemia and other myelodysplastic anemias, may be service-connected on a presumptive basis if a Veteran was exposed to contaminants in the water supply at Camp Lejeune during service and the exposure meets the requirements of 38 C.F.R. § 3.307(a)(7), even if there is no record of the disease during service. 38 C.F.R. § 3.309(f). Under 38 C.F.R. § 3.307(a)(7), 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 that service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. The claimed sleep disabilities are also not presumptive disabilities for Veterans exposed to herbicide agents during service. In this case, the Veteran’s service records show that he was stationed at Camp Lejeune from November 4, 1965, to November 24, 1965, for a total of 21 days. Therefore, the thirty-day requirement has not been met, and presumptive service connection under 38 C.F.R. § 3.309(f) is not warranted. The Board acknowledges the Veteran’s February 2018 assertion that “the time of exposure is not a proper variable but rather the amount of contaminate a person is exposed to.” However, a determination as to the etiology of sleep disorders is a complex medical determination which goes beyond lay observation of symptoms. Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training or experience are competent to provide evidence on the issue. Jones v. Brown, 7 Vet. App. 134 (1994). In this regard, the question of causation involves a medical subject concerning an internal process extending beyond an immediately observable cause-and-effect relationship. There is no suggestion that the Veteran has had any medical training. Therefore, the question of etiology in this case may not be competently addressed by lay evidence and the opinions of the Veteran are nonprobative evidence. Accordingly, the Board finds that service connection for a sleep disability on a presumptive basis is not warranted. That finding, however, does not preclude a Veteran from establishing direct service connection. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Therefore, the Board will still consider whether entitlement to service connection can be granted on a direct basis for the diagnosed sleep disorders. The service medical records show no complaints of, treatment for, or any diagnosis related to any sleep disorders, to include sleep apnea, narcolepsy, and cataplexy. There are no post-service treatment records prior to 2015. However, in a December 2016 letter, the Veteran’s private doctor stated that the Veteran was diagnosed with obstructive sleep apnea and narcolepsy in 2000, approximately 35 years after separation from service. The doctor stated that the diagnosed conditions “could have been caused by [the Veteran’s] time spent in the military. [The Veteran] was exposed to both contaminated water and agent orange. This may have caused some neurobehavioral effects.” The doctor did not provide a rationale or supporting data for the conclusion. The Board finds that opinion is speculative, and thus cannot be used to establish service connection. A November 2017 VA examiner opined that it was less likely than not that the claimed sleep disorders were due to Camp Lejeune Contaminated Water (CLCW). The examiner stated that the exact cause of narcolepsy/cataplexy is unknown. However, most people with that sleep disorder have low levels of the hypocretin, which is an important neurochemical that helps regulate wakefulness and REM sleep. In a 2000 research study hypocretin was undetectable in seven out of nine people with narcolepsy, indicating abnormal hypocretin transmission. The cause of loss of hypocretin-producing cells in the brain is not known, although experts suspect it is due to an autoimmune reaction. Narcolepsy with hypocretin deficiency is known to be associated with Human Leukocyte Antigen (HLA) and T-cell receptor (TCR) polymorphisms. The examiner stated that in Camp Lejeune, the Veteran was exposed to water contaminated with trichloroethylene (TCE), vinyl chloride, tetrachloroethylene (PCE), dichloroethylene (DCE) and benzene which are known or human carcinogens. There is clear suggestive evidence of causal relationship between occupational exposure to benzene and acute leukemia, non-Hogkin’s lymphoma and multiple myeloma. Based on human epidemiological data, vinyl chloride is a known human carcinogen (liver cancer) by inhalation route of exposure. The EPA concluded that TCE is carcinogenic to humans by all routes of exposure based on convincing evidence of a causal association between TCE exposure in humans and kidney cancer. Human epidemiological data on cancers in occupational groups exposed to PCE provided suggestive evidence for an association with bladder cancer, non-Hodgkin’s lymphoma, and multiple myeloma. Unlike previous studies that show a causal relationship between exposure to contaminated water in Camp Lejeune and certain cancers, there is no research evidence that suggests Camp Lejeune Contaminated Water can cause narcolepsy/cataplexy or hypocretin deficiency. In addition, the Veteran had a short exposure period of 21 days and long latency period of 42 years before he was diagnosed with narcolepsy/cataplexy. Thus, the examiner opined that it was less likely than not that the claimed condition was due to CLCW exposure. The Board finds the November 2017 VA medical opinion highly probative. The opinion was prepared by a medical examiner with general knowledge, skill, and expertise in sleep disorders and reflect a review of the claims file and the reports cite to specific information in the claims file. Moreover, the examiner’s opinions are probative, because it is based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. 295 (2008). The Board acknowledges that while the Veteran might believe that he has sleep disorders related to active service, to include exposure to contaminated water or herbicide agents. However, as a lay person he is not competent to relate any current diagnosis of sleep disorders to his active service, as that is outside the common knowledge of a lay person and would require medical expertise. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In any event, the Veteran’s opinion is outweighed by the medical opinion of the VA examiner who found that the diagnosed sleep disability was less likely than not related to service. Accordingly, the preponderance of the evidence is against a finding that a sleep disability is related to service and the claim of entitlement to service connection for a sleep disability, to include as due to contaminated water at Camp Lejeune, must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.O., Associate Counsel 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.