Citation Nr: 21063705 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-39 852A DATE: October 15, 2021 ORDER Entitlement to service connection for benign prostate hyperplasia (BPH) to include as due to exposure to Camp Lejeune Water Contamination (CLWC) is denied. FINDING OF FACT The Veteran's BPH did not have its onset during service, and is not otherwise related to service, to include as due to exposure to CLWC. CONCLUSION OF LAW The criteria for entitlement to service connection for BPH have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1978 to October 2002. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia, denied service connection for a prostate condition. The Veteran filed his notice of disagreement in May 2017, and in August 2017 was issued a statement of the case and perfected his appeal to the Board. In November 2020, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A copy of the transcript is of record. In a March 2021 decision, the Board, among other things, remanded the Veteran's claim for service connection for BPH for a new VA examination to determine its etiology. In August 2021, the RO denied the Veteran's claim for service connection for BPH, notifying the Veteran in a supplemental statement of the case. For the reasons indicated in the discussion below, the opinion that the Board instructed the agency of original jurisdiction (AOJ) to obtain was in fact obtained and is adequate to decide the claim on appeal. Thus, the AOJ complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). SERVICE CONNECTION Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (b). Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to contaminants (defined as the volatile organic compounds trichloroethylene, perchloroethylene, benzene, and vinyl chloride) in the on-base water supply located at Camp Lejeune, even though there is no record of such disease during service, if they manifest to a compensable degree at any time after service, in a veteran, former reservist, or a member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at the United States Marine Corps Base Camp Lejeune and/or Marine Corps Air Station New River in North Carolina, during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307 (a)(7). This presumption may be rebutted by affirmative evidence to the contrary. The eight specified diseases are: kidney cancer; liver cancer; Non-Hodgkin's lymphoma; adult leukemia; multiple myeloma; Parkinson's disease; aplastic anemia and other myelodysplastic syndromes; and bladder cancer. See 38 C.F.R. §§ 3.307 (a)(7), 3.309(f). BPH The Veteran testified that he first started taking medication for his benign prostate hyperplasia a few years after service. The Veteran's service treatment records do not reflect treatment for, or complaints of BPH, or BPH symptomatology. November 2016 VA treatment records reflect treatment for benign prostate hyperplasia. In December 2020, the Veteran submitted treatise material regarding the occurrence of prostate swelling and BPH in men under the age of 45 which indicated that environmental factors may affect the age of BPH symptom onset. March 2021 VA treatment records reflect that the Veteran treats BPH with oral medication. In an April 2021 disability benefits questionnaire (DBQ) the physician opined that the Veteran's BPH was less likely than not (less than a 50 percent probability) incurred in, or caused by an in-service injury, event, or illness, noting that the Veteran was stationed in Camp Lejeune from December 1980 to April 1982, and diagnosed with BPH at the age of 58 in 2016, 36 years after his last exposure to CLCW. He also noted that BPH is a benign enlargement of the prostate gland due to stromal and epithelial cell hyperplasia. He explained the multiple risk factors, and stated that the medical literature does not support an association between BPH and exposure to CLCW. The physician noted that the expected clinical time-line following exposure to toxins in the workplace or general environment to the development of disease is usually measured in days to weeks following such exposure, and not 36 years later for BPH. In a May 2021 DBQ, the physician opined that the Veteran's BPH was less likely than not (less than a 50 percent probability) incurred in or caused by service, stating that there is no evidence of BPH in service, and that BPH is a disorder of aging which was diagnosed around 2012, and that the Veteran was age appropriate at the time of the diagnosis. The physician also reported that there was no evidence of urinary symptoms to suggest any genitourinary condition at separation from service, thus it is less likely than not that the Veteran's BPH had its nexus in service, or is due to events in service. In a July 2021 DBQ, the physician opined that the Veteran's BPH is less likely than not (less than a 50 percent probability) due to, or the result of service, or caused or otherwise related to his hypertension. The physician stated that there is no causative relationship between hypertension and BPH, and that any claim for causation of BPH or aggravation of BPH by hypertension represents a misunderstanding of the current literature and the relationship of the 2 conditions. He reported that while both conditions can be aggravated by the same factors of alpha stimulation by the adrenergic nervous system, neither condition causes the other or aggravates the other. The evidence of record reflects that the Veteran has a diagnosis of BPH, and the Veteran has established service in Camp Lejeune, thus the first 2 elements to establish service connection have been satisfied and the dispositive issue is whether there is a nexus between the two. For the following reasons, service connection for BPH is not warranted. The previously discussed DBQs indicate that the Veteran's BPH is less likely than not (less than a 50 percent probability) related to service, with the physicians providing thorough rationales to support their opinions, noting medical literature, the other factors which contribute to the development of BPH, and the amount of time elapsed from the Veteran's exposure to when he developed BPH. As the physicians provided their opinions with rationales based on an accurate characterization of the evidence of record, their opinions are afforded significant probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). There is no contrary opinion in the evidence of record. Moreover, the Veteran has not indicated that he has experienced continuous symptoms in and since service. Therefore, neither the lay nor medical evidence suggests that the Veteran has BPH that manifested in service and has continued since service, or is otherwise related to service. Additionally, while the July 2021 physician discussed a lack of a relationship between the Veteran's BPH and his service connected hypertension, the issue of entitlement to service connection for BPH as caused or aggravated by a service connected disability has not been raised by the Veteran or reasonably raised by the evidence of record, and the Board therefore need not address this theory of entitlement. Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) ("Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory"). The Board acknowledges the Veteran's contention that his BPH is due to service. While the Veteran is competent to provide testimony or statements relating to symptoms or facts of events that he has observed and are within the realm of his personal knowledge, he is not competent to testify as to complex medical questions such as the nature and etiology of BPH. Jandreau v. Nicholson, 492 F.3d 1372, 1376, n. 4 (Fed. Cir. 2007) ("sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"). The Veteran's statements in this regard are therefore not competent. For the foregoing reasons, entitlement to service connection for BPH is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Maddox, 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.