Citation Nr: 21065450 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 19-37 068 DATE: October 26, 2021 REMANDED Entitlement to service connection for sinus cancer, including residuals thereof, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from January 1972 to September 1974, including service in Camp Lejeune from May 1972 to September 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for sinus cancer, including residuals thereof, is remanded. The Veteran contends that he developed maxillary sinus squamous cell cancer due to his exposure to contaminated drinking water at Camp Lejeune and due to sinus infections he suffered during active-duty service. The matter last appeared before the Board in May 2021 at which time the Board remanded the issue to afford the Veteran a VA examination. The Board noted that the Veteran was stationed at Camp Lejeune and was presumed to have been exposed to contaminated water while stationed there. The medical evidence shows a diagnosis of maxillary sinus squamous cell cancer in October 2013, with surgical treatment. The Board notes that sinus cancer is not on the list of diseases associated with exposure to contaminants in the water supply at Camp Lejeune for presumptive service connection. 38 C.F.R. § 3.309(f). In the May 2021 Board remand, the Board noted that the Veteran provided a September 2016 Journal of Clinical & Diagnostic Research article titled "Carcinoma of Maxillary Sinus Masquerading as Odontogenic Infection" which indicated that the most common risk factors for maxillary sinus cancer are smoking and a history of chronic sinusitis and that other risk factors include air pollution or occupational exposure to chemical substances, such as formaldehyde, chromium, and nickel. The Veteran underwent a VA examination in June 2021 and was diagnosed with benign or malignant neoplasm of sinus, nose, throat, larynx or pharynx. The examiner opined that the condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner rationalized that the Veteran was seen for symptoms of a sore throat, productive cough, whitish mucous, sinus and nasal congestion during service, and noted February 1972 and April 1973 service treatment records (STRs). The examiner indicated that these records do not show a diagnosis of sinusitis (acute or chronic) having been made in service nor do the STR's support a diagnosis of sinusitis in service. The examiner noted the risk factors for sinus cancer and found that the Veteran's risk factors are his remote history of smoking, history of alcohol use, marijuana use, age, male gender, and post-service workplace exposures as an artist with exposure to granite, marble, and dust through his mask. The examiner further indicated that, currently, medical evidence does not support a causal relationship between exposure to Camp Lejeune water and sinus cancer. Here, in light of 38 C.F.R. § 3.303(d) which provides that service connection may also be granted for any disease diagnosed after discharge, the Board finds that the examiner did not discuss the Veteran's post service history of chronic sinusitis as noted in multiple VA medical treatment records. Instead, the examiner only noted the Veteran's sinus complaints in service without addressing these in service complaints in relation to sinusitis and moreover, the claimed condition of sinus cancer, in the rationale. The Board finds that the opinion is thus inadequate. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). A second opinion provided by a Camp Lejeune contaminated water (CLCW) subject matter expert in June 2021 opined that the condition claimed was less likely than no incurred in or caused by the claimed in-service injury, event, or illness. The examiner rationalized that the Veteran has risk factors, including smoking, post-service workplace exposures (dust, granite, marble), aging, and male gender, which likely contributed to the development of sinus cancer. The examiner found that the weight of medical evidence does not currently support a causal relationship between CLCW exposure and sinus cancer. The examiner noted that, in addition, there is a long latency period between CLCW exposure and onset of sinus cancer. Here, the Board finds that the examiner generally found that the weight of the medical evidence does not support a causal relationship between CLCW exposure and sinus cancer as opposed to making a finding based on the specific facts of the case. Although the examiner noted the Veteran's specific risk factors, there is a lack of discussion of the in-service sinus complaints. As such, the Board finds that the opinion is also inadequate. Nieves-Rodriguez, 22 Vet. App. at 301. Further, the Veteran, through his attorney, argues that while the above examiners indicated that the Veteran has post-military risk factors for sinus cancer, they failed to consider whether the Veteran had the same or similar exposures during the course of his military career as a combat engineer, that the examiners did not address the evidence submitted by the Veteran and failed to adequately explain why the Veteran's 852 days at Camp Lejeune could not have caused or contributed to his sinus cancer. The matter is REMANDED for the following action: Forward the claims file to a physician with appropriate expertise, who has not previously provided an opinion in this matter, to obtain an addendum to determine the nature and etiology of the Veteran's sinus cancer and residuals. The Veteran's claims file, to include a copy of this remand, must be made available to the examiner, who should note said review in the addendum report. The Veteran needed not be reexamined, unless the examiner determines that another examination is needed in order to provide opinions in this matter. The examiner is asked to provide an opinion addressing the following: Is it at least as likely as not (50 percent probability or more) that the Veteran's sinus cancer and residuals are causally or etiologically related to his military service, to include the Veteran's exposure to contaminated drinking water at Camp Lejeune AND his reports of sinus problems during active duty service? The VA examiner should also consider and directly address the Veteran's service in Camp Lejeune (including the duration of his time at that duty station) and his presumed exposure to contaminants in the water supply, his service as a Combat Engineer, reports contained in the service treatment records noting sinus complaints and post service treatment records, including the July 2013, September 2013, November 2013, January 2014, March 2014, and May 2014VA treatment records, and notably the chronic sinusitis as mentioned above. The examiner should consider and directly address the September 2016 Journal of Clinical & Diagnostic Research article titled "Carcinoma of Maxillary Sinus Masquerading as Odontogenic Infection" which indicated that the most common risk factors for maxillary sinus cancer are smoking and a history of chronic sinusitis and that other risk factors include air pollution or occupational exposure to chemical substances, such as formaldehyde, chromium, and nickel, submitted by the Veteran. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, Associate 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.