Citation Nr: 20021341 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 16-50 352 DATE: March 25, 2020 ORDER Entitlement to service connection for liver disease is denied. Entitlement to service connection for rectal carcinoid cancer is denied. FINDINGS OF FACT 1. The evidence of record indicates that there is no nexus between the Veteran’s liver disease and his period of service, to include his exposure to contaminated water at Camp Lejeune or his exposure to herbicide agents. 2. The evidence of record indicates that there is no nexus between the Veteran’s rectal carcinoid cancer and his period of service, to include his exposure to contaminated water at Camp Lejeune or his exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for service connection for liver disease have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for rectal carcinoid cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty in the United States Marine Corps from November 1968 to November 1972. In September 2018, the Veteran testified before the undersigned Veterans Law Judge at a Video Conference hearing. A copy of the transcript has been associated with the claims file. In February 2019, the Board remanded the appeal for further development. Service Connection 1. Service connection for a liver disability, to include as due to exposure to contaminated water at Camp Lejeune or exposure to herbicides The Veteran contends that his liver disability is due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune or exposure to herbicides. The question 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, event, or disease. The Board concludes that, while the Veteran has a current liver disability, and evidence shows that in-service exposure to contaminated water at Camp Lejeune and herbicide agents is assumed, the preponderance of the evidence weighs against finding that the Veteran’s current liver disability began during service or is otherwise related to an in-service injury, event, or disease. In a September 2013 private medical opinion, the examiner stated that it is at least as likely as not that the Veteran’s hepatic steatosis is due to his period of service. The examiner stated that the Veteran was stationed at Camp Lejeune from 1968 to 1972, where he apparently bathed in and ingested tap water that was contaminated with harmful chemicals. The examiner noted that an undetermined number of former base residents later developed cancer or other ailments, which many blamed on the contaminated drinking water. The examiner then stated that the Veteran did not have any obvious reason why he presented his condition. Therefore, the examiner concluded that the Veteran’s hepatic steatosis was related to his period of service. In an October 2014 VA examination, the examiner stated that it was less likely than not that the Veteran’s hepatic steatosis of the liver is due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune. The examiner reported that the Veteran was found to have hepatic steatosis on an ultrasound in May 2013. The examiner noted that the Veteran had a long history of hyperlipidemia. The examiner explained that hyperlipidemia is a known risk factor for the development of hepatic steatosis. The examiner stated that the known risk factor outweighs the limited/suggestive evidence of association with exposure to contaminated water at Camp Lejeune. Therefore, the examiner concluded that the Veteran’s liver disability was less likely than not due to his exposure to contaminated water at Camp Lejeune. In an October 2019 VA examination, the examiner stated that it was less likely than not that the Veteran’s hepatic steatosis was due to his period of service, to include exposure to herbicide agents. The examiner noted that liver disease is not a presumptive diagnosis for exposure to Agent Orange. The examiner further reported that steatosis has risk factors such as alcohol use, obesity, hypertension and dyslipidemia. Therefore, the examiner concluded that the Veteran’s liver disease was less likely related to exposure to herbicide agents. After review of the record, the Board finds that the evidence does not establish that the Veteran’s liver disease is due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune or exposure to herbicide agents. The October 2014 VA examination indicates that there is no nexus between the Veteran’s exposure to contaminated water at Camp Lejeune and his current liver disease. Moreover, contrary to the September 2013 private opinion, which speculated on the etiology of the Veteran’s hepatic steatosis based on other veterans’ developments of various types of ailments, the October 2014 VA opinion noted that while exposure to contaminated water at Camp Lejeune had no known relationship to the development of hepatic steatosis, the Veteran did have a known risk factor for the liver disease. Moreover, the October 2019 VA opinion similarly indicated that the there is no nexus between the Veteran’s hepatic steatosis and his exposure to herbicide agents. The Board finds that the October 2014 and October 2019 VA opinions are highly probative, as the examiners considered the evidence of record and provided rationale for their findings. The October 2014 examiner also reconciled the medical opinion with the findings of the September 2013 private opinion. The Board places less probative weight on the September 2013 private opinion, as the physician did not consider the Veteran’s other potential risk factors for liver disease. For these reasons, the Board finds that service connection for liver disease is not warranted. While the Veteran believes his liver disability is due to his period of service, he is not competent to provide an etiology in this case. The issue is medically complex. 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. 2. Service connection for rectal carcinoid cancer, to include as due to exposure to contaminated water at Camp Lejeune or exposure to herbicides The Veteran contends that his rectal carcinoid cancer is due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune or exposure to herbicides. The question 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, event, or disease. The Board concludes that, while the Veteran has a current rectal carcinoid cancer, and evidence shows that an in-service exposure to contaminated water at Camp Lejeune and herbicide agents is assumed, the preponderance of the evidence weighs against finding that the Veteran’s rectal carcinoid cancer began during service or is otherwise related to an in-service injury, event, or disease. In a September 2013 private medical opinion, the examiner stated that it is at least as likely as not that the Veteran’s colon cancer is due to his period of service. The examiner stated that the Veteran was stationed at Camp Lejeune from 1968 to 1972, where he apparently bathed in and ingested tap water that was contaminated with harmful chemicals. The examiner noted that an undetermined number of former base residents later developed cancer or other ailments, which many blamed on the contaminated drinking water. The examiner then stated that the Veteran did not have any obvious reason why he presented his condition, noting that the Veteran does not have a family history of cancer. Therefore, the examiner concluded that the Veteran’s cancer was related to his period of service. In an October 2014 VA examination, the examiner stated that it was less likely than not that the Veteran’s rectal carcinoid cancer was due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune. The examiner explained that rectal carcinoid tumor is a neuroendocrine tumor of unknown etiology. The examiner further reported that review of the medical literature does not show an association between exposure to contaminated water at Camp Lejeune and the development of neuroendocrine tumor. Therefore, the examiner concluded that the Veteran’s rectal carcinoid cancer was less likely than not due to his exposure to contaminated water at Camp Lejeune. In an October 2019 VA examination, the examiner stated that it was less likely than not that the Veteran’s rectal carcinoid cancer was due to his period of service, to include exposure to herbicide agents. The examiner explained that carcinoid is a neuroendocrine tumor that has no known etiology. The examiner reported that medical literature does not support any colorectal cancer from Agent Orange exposure. Therefore, the examiner concluded that the Veteran’s rectal carcinoid cancer was less likely related to exposure to herbicide agents. After review of the record, the Board finds that the evidence does not establish that the Veteran’s rectal carcinoid cancer is due to his period of service. The October 2014 VA examination indicates that there is no nexus between the Veteran’s exposure to contaminated water at Camp Lejeune and his current rectal carcinoid cancer. Moreover, contrary to the September 2013 private opinion, which speculated on the etiology of the Veteran’s cancer based on cases of other types of cancer, the October 2014 VA opinion noted that the Veteran’s specific rectal carcinoid cancer had no known etiology. Therefore, the Board finds the September 2013 private opinion to be less probative for the purpose of adjudicating the claim. Moreover, the October 2019 VA opinion indicates that there is no nexus between the Veteran’s rectal carcinoid tumor and his exposure to herbicide agents. For these reasons, the Board finds that service connection for rectal carcinoid cancer is not warranted. While the Veteran believes his rectal carcinoid cancer is due to his period of service, he is not competent to provide an etiology in this case. The issue is medically complex. 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. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ford 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.