Citation Nr: 21062455 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 16-42 675 DATE: October 7, 2021 ORDER Entitlement to service connection for prostate cancer due to exposure to contaminated water at Camp Lejeune is granted. FINDING OF FACT 1. The Veteran has been diagnosed with prostate cancer 2. The Veteran had active service at U.S. Marine Corps Base Camp Lejeune, North Carolina, within the period between August 1953 and December 1987. 3. The evidence is at least in equipoise as to whether the Veteran's prostate cancer is the result of his exposure to contaminated water at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for prostate cancer due to exposure to contaminated water at Camp Lejeune have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION Entitlement to service connection for prostate cancer due to exposure to contaminated water at Camp Lejeune is granted. The Veteran had active service in the U.S. Marine Corps from January 1981 to May 1984. This matter originates from an appeal of a June 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that denied a March 2013 claim for service connection for prostate cancer, claimed as due to exposure to Camp Lejeune contaminated water (CLCW). The Veteran timely initiated and perfected an appeal of this issue, and the matter was before the Board of Veterans' Appeals (Board) in July 2019, at which time the Board denied the Veteran's claim. The Veteran appealed further to the Court of Appeals for Veterans Claims (CAVC). In a February 2021 Memorandum Decision CAVC vacated the July 2019 Board decision and remanded the matter back to the Board. At issue is the relative probative value of two medical opinions concerning the etiology of the Veteran's prostate cancer. As discussed further below, in May 2014 a VA examiner opined that the Veteran's prostate cancer was less likely than not a result of his CLCW exposure. In November 2014 the Veteran submitted an opinion from a private treating provider reflecting that provider's opinion that the Veteran's prostate cancer was at least as likely as not a result of his CLCW exposure. In its February 2021 decision, CAVC directed the Board to adjudicate the Veteran's claim de novo, giving sufficient reasons and bases for its decision, to include an explanation of any findings as to the relative probative value and/or adequacy of the May 2014 and November 2014 medical opinions. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (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) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. Entitlement to service connection on a "direct basis" may be shown by proving each of these elements individually. Certain legal presumptions may substitute for individual factual showings of certain elements of a claim for service connection. Veterans who served at U.S. Marine Base Camp Lejeune, North Carolina for no less than 30 days during the period from August 1, 1953 to December 31, 1987, 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. §§, 3.307, 3.309. The Veteran's claimed disability, prostate cancer, is not currently on the presumptive disability list. This does not, however, preclude a claimant from establishing service connection for the claimed disorder on a direct basis, to include as due to CLCW. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). VA medical treatment records reflect that the Veteran underwent a prostatectomy as treatment for prostate cancer in August 2013. 5/25/2016, CAPRI, p. 10. The Veteran's service treatment records (STRs) reflect that the Veteran was stationed at Camp Lejeune during the period between August 1, 1953 and December 21, 1987. 8/23/2006, STR Medical Photocopy, pp., 9, 11, 12, 13, 17, 19, 21, 23. Accordingly, the Board finds that the current disability and in-service occurrence (i.e., exposure to CLCW) elements of the claim are satisfied. The remaining question is whether the Veteran's prostate cancer is the result of his in-service exposure to CLCW. In adjudicating claims for VA benefits, the burden of proof only requires an "approximate balance" of the evidence for and against a claim. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1991). This low standard of proof is "unique" to the VA adjudicatory process, and "the nation, 'in recognition of our debt to our veterans,' has 'taken upon itself the risk of error' in awarding such benefits." Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). In evaluating a claim for disability benefits, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. Applying this standard to the instant case, the question is whether the Veteran's prostate cancer is at least as likely as not the result of his in-service exposure to CLCW. A May 2014 examiner stated as follows: "The veteran was diagnosed with prostate cancer by biopsy . . . 17 days shy of his 51st birthday . . . The CDC shows increasing age to be the leading risk factor for prostate cancer with the 20-year prevalence of prostate cancer in men at age 50 to be 8.1% and at age 60 to be 12.6%. The KNOWN risk factor of age outweighs the limited/suggestive evidence of association with exposure to contaminated water at Camp Lejeune." It is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes probative value to a medical opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion. Stefl v. Nicholson, 21 Vet. App. 120, 125 (U.S. 2007). The probative weight of a medical opinion may be reduced if the examiner fails to explain the basis for an opinion. See Sklar v. Brown, 5 Vet. App. 140 (1993). The Board finds the probative value of the May 2014 VA examiner's opinion to be reduced in light of the examiner's failure to address why, in the specific case of this Veteran, age was found to be the more likely operative risk factor than exposure to CLCW. In particular, the examiner does not explain whether the CDC's analysis of age as the leading risk factor was based on a study population of male prostate cancer patients in the general population, or whether it was specific to male prostate cancer patients with a history of exposure to possible carcinogenic factors such as CLCW. In November 2014, the Veteran submitted an opinion from a private treating provider who stated, in pertinent part, that there "is a strong possibility to a reasonable degree of medical certainty that the chemical exposure could be a causative agent of the prostate cancer." 11/7/2014, Medical Treatment Record Non-Government Facility, p.1. The provider noted that there "is also a link between morbid obesity and . . . prostate cancer . . . it is equally likely that his prostate cancer is related to his [CLCW] exposure." Id. In their analysis of the Veteran's specific cancer risk, the provider also discussed evidence suggesting a bladder cancer diagnosis, noting that bladder cancer is also associated with exposure to CLCW. The Board finds the probative value of this opinion to be enhanced by the provider's consideration of both general medical principles and the specific details of the Veteran's presentation and medical history. In light of the foregoing, the Board finds that the evidence is at least in equipoise as to whether the Veteran's prostate cancer is the result of exposure to CLCW. Accordingly, the criteria for entitlement to service connection for prostate cancer due to exposure to Camp Lejeune contaminated water are met, and the same is hereby granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sametshaw, Eric C. 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.