Citation Nr: 21002352 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 19-26 007 DATE: January 13, 2021 ORDER Entitlement to service connection for esophageal cancer is granted. Entitlement to service connection for the cause of the Veteran’s death is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in his favor, the Veteran’s esophageal cancer is etiologically related to his active service. 2. The immediate cause of the Veteran’s death was respiratory failure. Esophageal cancer was listed as an underlying cause of death. 3. The Veteran’s cause of death was due to his esophageal cancer which has been found to be etiologically related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for esophageal cancer are met. 38 U.S.C. §§ 1110, 1116, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307 (2019). 2. The criteria for service connection for the cause of the Veteran’s death are met. 38 U.S.C. §§ 1310, 5107 (2018); 38 C.F.R. §§ 3.102, 3.312 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1966 to October 1969 in the United States Marine Corps. The Veteran died in March 2016. The appellant is the Veteran’s surviving spouse. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2018 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). Service Connection – Esophageal Cancer Prior to his death, the Veteran submitted a claim for esophageal cancer. Unfortunately, he died during the pendency of the claim. In March 2016, the appellant requested to be substituted as the appellant in the processing of the claim and the RO granted the request. The Veteran maintained that his esophageal cancer was etiologically related to in-service exposure to Agent Orange and contaminated water at Camp Lejeune. His military personnel records indicate that he served in the Republic of Vietnam during the Vietnam era. Therefore, it is presumed that he was exposed to Agent Orange during that time period. 38 C.F.R. § 3.307(a)(6)(iii). In addition, his military personnel records indicate that he served at Camp Lejeune for at least 30 days. Therefore, it is presumed that he was exposed to the contaminants in the water supply during that service. 38 C.F.R. § 3.307(7)(iii). The Veteran’s service treatment records are unremarkable for any complaints, treatment, or diagnoses related to esophageal cancer. At his October 1969 separation examination, clinical evaluation of all body systems was normal. VA outpatient treatment reports indicated that the Veteran was diagnosed with a distal esophageal adenocarcinoma in June 2015. In March 2018, a VA examiner noted that the Veteran was diagnosed with esophageal cancer and it was less likely than not related to exposure to contaminated water at Camp Lejeune. The examiner noted that the Veteran had many other risk factors for the development of his esophageal cancer including smoking, chewing tobacco, gastroesophageal reflux disease (GERD), his age, his gender, his having had a prior cancer (basal cell carcinoma), peptic ulcer disease, and obesity which outweighed his risks from his brief exposure to contaminated water at Camp Lejeune. The examiner did not address the Veteran’s exposure to herbicides during Vietnam. In March 2020, Dr. C.R., noted that the Veteran was exposed to Agent Orange during his service in Vietnam and said exposure led to the development of esophageal cancer which led to the Veteran’s death. Dr. C.R. noted that the Veteran was also exposed to contaminated water while serving at Camp Lejeune. She also indicated that the Veteran’s service-connected PTSD was manifested by symptoms including depression, anxiety, flashbacks, and panic attacks and his overwhelming stress led to his nicotine dependence. She cited to various medical studies which indicated that the exposure to herbicides and exposure to the toxic chemicals at Camp Lejeune (volatile organic compounds (VOCs)) increased the risk of esophageal cancer. Dr. C.R. acknowledged the negative etiology opinion from the VA clinician who cited to a multitude of risk factors but noted that the clinician failed to consider the Veteran’s exposure to dioxins in Agent Orange and the multiple studies which show an increased risk of the development of esophageal cancer. The VA clinician also failed to consider the fact that the Veteran’s service-connected PTSD led to his nicotine dependence. She indicated that it was the Veteran’s exposure to VOCs, dioxins, PTSD, and other risk factors contributed to his death and it would be impossible to determine how much each contributed to the development of esophageal cancer. She concluded that after a review of the Veteran’s claims file, the Veteran’s exposure to Agent Orange, VOCs at Camp Lejeune, and service-connected PTSD which led to nicotine dependence substantially or materially aided in the development of esophageal cancer and respiratory [failure], ultimately resulting in the Veteran’s death, and that his esophageal cancer, more likely than not should be considered service-connected. The Board notes that esophageal cancer is not among the diseases presumed to be associated with exposure to Agent Orange or contaminated water at Camp Lejeune. 38 C.F.R. § 3.309(e), (f). However, given the positive medical opinion from Dr. C.R., the Board finds that the evidence for and against the claim of entitlement to service connection for esophageal cancer is at least in equipoise. Resolving reasonable doubt in the Veteran’s favor, the Board finds that service connection for esophageal cancer is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Cause of Death In this case, the death certificate indicates that the immediate cause of the Veteran’s death was respiratory failure. Esophageal cancer was listed as an underlying cause of death. The appellant contends that the cause of the Veteran’s death was due to service. In light of the grant of service connection for service connection for esophageal cancer herein and because the Veteran’s underlying cause of death was esophageal cancer, the Board finds that service connection for the cause of the Veteran’s death is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Cryan, 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.