Citation Nr: 21002183 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 14-19 613 DATE: January 13, 2021 REMANDED The claim for service connection for erectile dysfunction (ED) due to exposure to contaminated drinking water at Camp LeJeune (CLCW) is remanded. The claim for service connection for prostate cancer with related residuals (prostate cancer) due to exposure to contaminated drinking water at Camp LeJeune (CLCW) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to September 1979, including service at Camp LeJeune from February 1977 to September 1979. The Veteran withdrew his 2014 request for a Board hearing in July 2019 correspondence. Accordingly, his hearing request is considered withdrawn. 38 C.F.R. § 20.704 (e). The claim was remanded by the Board in November 2019 for additional development. Unfortunately, there has not been substantial compliance with the remand order and the claim must be remanded. 1. Entitlement to service connection for ED due to exposure to CLCW 2. Entitlement to service connection for prostate cancer with related residuals (prostate cancer) due to exposure to CLCW The Veteran contends that he incurred ED and prostate cancer as a result of exposure to contaminated drinking water while stationed at Camp Lejeune (CLCW). His exposure to contaminated water is conceded. The Board notes that the Veteran does not contend, nor does the evidence demonstrate that the Veteran’s ED and/or prostate cancer had onset during or within one year of military service. The question for the Board is, therefore, whether the Veteran has a current disability that began during service or is at least as likely as not related to that conceded exposure. VA and private treatment records show diagnoses of ED and prostate cancer with robotic prostatectomy performed in February 2011. The Veteran submitted a private opinion in April 2011 in which Dr. R.K. stated that the prostate cancer and ED were at least as likely as not related to contaminated drinking water, as that had been demonstrated to be a cause and effect relationship. However, the Board finds that this opinion lacks rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). The Veteran was afforded a VA examination in August 2011, and the examiner submitted an addendum opinion in September 2011. The examiner stated that he did not see any significant basis greater than 50 percent probability in all of his literature search that the contaminated water caused prostate cancer. However, the Board notes that the examiner used an incorrect legal standard as the correct legal standard is “at least as likely as not” (defined as 50 percent or greater probability). The Veteran was afforded a VA examination in November 2013, conducted by a member of the subject matter expert panel for the CLCW Project. The examiner stated that he was forced to opine, with a reasonable degree of medical certainty, that the diagnosis of prostate cancer was less likely than not related to exposure to CLCW. The examiner stated that the Veteran served in Camp Lejeune from July 1, 1977, to September 16, 1979. However, as noted above, the Veteran served in Camp Lejeune from February 4, 1977, to September 10, 1979. As such, this opinion was based in part on the inaccurate factual basis. See Reonal v. Brown, 5 Vet. App.458,461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). The Board acknowledges that the Veteran, through his representative, specifically took issue with the credentials of the 2011 examiner, who was a physician’s assistant, and their ability to provide an accurate opinion. The next VA examiner was a subject matter expert. In response, the Board’s 2019 remand requested that either the 2013 VA examiner or, if unavailable, an appropriate substitute provide an addendum opinion consistent with the remand. The December 2019 VA examination and opinion were provided by a Doctor of Occupational Medicine (a specialty dealing with occupational injuries), without demonstrated expertise in CLCW cases. The Board finds significant that the last VA examiner before remand was a CLCW subject matter expert and the current examiner is a physician without expertise in CLCW diseases. In addition, the 2019 examiner relied on the fact that prostate cancer and ED are not listed as presumptively related to CLCW in VA regulation and on a single study about a link between TCE contaminant and prostate cancer had inconclusive results as the rationale. This also tends to demonstrate that a subject matter expert is needed in this claim. The Board finds that the 2019 examination and opinion are inadequate for the purpose of determining the nature and etiology of prostate cancer and ED in this claim. As such, a remand is warranted in order to obtain those opinions from an examiner who is as equally qualified as the 2013 examiner. The matters are REMANDED for the following action: Provide the claims file to an examiner with CLCW subject matter expertise to opine as to the etiology of the Veteran’s prostate cancer and ED. If an examination is determined to be necessary by the examiner, it must be provided. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any prostate cancer and ED diagnosed during the pendency of this appeal had its onset in service or is otherwise etiologically related to service, to include the conceded exposure to CLCW while in Camp Lejeune from February 4, 1977, to September 10, 1979. A full and complete rationale for all opinions expressed must be provided. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Bordewyk, Alicia R. 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.