Citation Nr: 21005102 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 20-24 935 DATE: January 29, 2021 ORDER Service connection for Hodgkin's lymphoma as due to contaminated water at Camp Lejeune is granted. Service connection for atrial fibrillation as due to Hodgkin’s lymphoma is granted. Service connection for congestive heart failure (CHF) as due to Hodgkin’s lymphoma is granted. Service connection for emphysema as due to Hodgkin’s lymphoma is granted. Service connection for chronic obstructive pulmonary disease (COPD) as due to Hodgkin’s lymphoma is granted. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran’s Hodgkin's lymphoma was due to his active duty service, to include his exposure to contaminated water at Camp Lejeune, North Carolina. 2. The Veteran’s atrial fibrillation, CHF, emphysema, and COPD are at least as likely as not due to or aggravated by his Hodgkin’s lymphoma. CONCLUSIONS OF LAW 1. The criteria for service connection for Hodgkin's lymphoma as due to contaminated water at Camp Lejeune have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.3.09. 2. The criteria for atrial fibrillation, CHF, emphysema, and COPD as due to Hodgkin’s lymphoma have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.3.09, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1951 to July 1956. The Veteran and his wife testified at a hearing before the undersigned Veteran’s Law Judge in September 2020. A copy of the transcript is associated with the record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires: (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (i.e., a nexus) between the claimed in-service disease or injury and the current disability. In deciding the Veteran’s claim, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. VA has acknowledged that persons residing or working at the U.S. Marine Corps Base Camp Lejeune between August 1953 and December 1987 were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). The contaminants included trichloroethylene (TCE) (a metal degreaser), perchloroethylene (PCE) (a dry-cleaning agent), benzene, vinyl chloride, and other VOCs. The National Academy of Sciences’ National Research Council (NRC) published its report, “Contaminated Water Supplies at Camp Lejeune, Assessing Potential Health Effects,” in 2009. This report included a review of studies addressing exposure to TCE and PCE, as well as a mixture of the two, and a discussion of disease manifestations potentially associated with such exposure. Effective March 14, 2017, VA amended its adjudication regulations regarding presumptive service connection, adding certain diseases associated with contaminants present in the base water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina from August 1, 1953, to December 31, 1987. The final rule establishes that Veterans who served at Camp Lejeune for no less than 30 days during this period, and who have been diagnosed with any of eight associated diseases (adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, liver cancer, multiple myeloma, Non-Hodgkin’s lymphoma, and Parkinson’s disease) are presumed to have incurred or aggravated the disease in service for purposes of entitlement to VA benefits. See 38 C.F.R. § 3.309(f). The Veteran’s claimed disabilities are not currently on the presumptive disability list. However, the U.S. Court of Appeals for the Federal Circuit has held that when a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact “incurred” during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Hodgkin's Lymphoma The Veteran’s military personnel record confirms that he was stationed at Camp Lejeune, North Carolina for over 30 days beginning in September 1953. As such, the Veteran is presumed to have been exposed to contaminated water while stationed at Camp Lejeune. He has also been diagnosed with and treated for Hodgkins’ lymphoma. However, this condition is not on the presumptive list of diseases associated with contaminated water exposure. In February 2018 and November 2020, the Veteran submitted letters from his treating oncologist stating that it was more likely than not that the Veteran’s Hodgkin’s lymphoma was related to his exposure to contaminated water at Camp Lejeune. In the November 2020 submission, the oncologist provided a detailed summary of the relationship between the chemicals contained in the contaminated water at Camp Lejeune and the Veteran’s lymphoma. Based on these reports, the Board finds that service connection for Hodgkin’s lymphoma is warranted. The record also contains a March 2020 VA examination which did not find that the Veteran’s Hodgkin’s lymphoma was related to his exposure to contaminated water at Camp Lejeune. This examination, however, was not conducted by an oncologist and appears to rely on the absence of a presumption of service connection for its rationale. The Board affords more probative weight to the reports of the Veteran’s treating oncologist. Furthermore, even considering the March 2020 VA opinion, the evidence is in equipoise as to whether the Veteran’s Hodgkin’s lymphoma was related to his exposure to contaminated water while at Camp Lejeune. Accordingly, resolving reasonable doubt in the Veteran’s favor, the Board finds that service connection for Hodgkin’s lymphoma is warranted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Atrial Fibrillation CHF Emphysema COPD The Veteran also has diagnoses of atrial fibrillation, CHF, emphysema, and COPD. See January 2018 medical record. The Veteran’s treating oncologist stated that these conditions were secondary to his Hodgkin’s lymphoma. Additionally, the Veteran’s primary care physician stated that the treatment for his lymphoma could have adversely affected (aggravated) his COPD. See January 2018 medical report. Based on these reports, the Board finds that secondary service connection for the Veteran’s atrial fibrillation, CHF, emphysema, and COPD is warranted. The Veteran has diagnosis of these conditions and his treating providers have provided opinions that the conditions were related to or aggravated by his now service connected Hodgkin’s lymphoma. Although a remand for further medical opinion could be accomplished, the Board will not remand for negative evidence, noting that seeking to obtain negative evidence against the Veteran is prohibited by VA law. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003). (Continued on the next page)   Accordingly, resolving all reasonable doubt in favor of the Veteran, the Board finds that a grant of service connection for atrial fibrillation, CHF, emphysema, and COPD, is warranted. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Parrish, 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.