Citation Nr: 21073253 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-06 239 DATE: December 8, 2021 ORDER Entitlement to service connection for stomach disorders, characterized as gastroesophageal reflux disease (GERD) and diverticulosis, to include as due to environmental hazard at Camp Lejeune, is denied. FINDING OF FACT The Veteran's stomach disorders, characterized as GERD and diverticulosis, were not incurred in service or within one year of service and are not otherwise etiologically related to active service, to include as due to exposure to toxic contaminants in the drinking water at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for stomach disorders, characterized as GERD and diverticulosis, to include as due to environmental hazard at Camp Lejeune, 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 in the United States Marine Corps from June 1981 to November 1981. The Veteran also served from December 1985 to October 1986, but a December 2015 VA Administrate Decision determined that this period of service, for which the Veteran was discharged for other than honorable conditions, was dishonorable for VA purposes, and as such, is a bar to payment of VA benefits. See 38 C.F.R. § 3.12. Therefore, the Board may only consider the Veteran's claims based on his period of military service from June 1981 to November 1981. The Board of Veterans' Appeals (Board) remanded this matter in July 2021 to obtain an addendum medical opinion. The requested development has been completed as the Regional Office (RO) obtained a VA medical opinion with thorough supporting rationale sufficient to make a decision on this matter. The appeal has returned to the Board for further appellate consideration. The Board is now satisfied there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). In addition to the regulations cited above, if a veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of 38 C.F.R. § 3.307 (a)(7), the following diseases will be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of § 3.307(d): (1) kidney cancer; (2) liver cancer; (3) Non-Hodgkin's lymphoma; (4) adult leukemia; (5) multiple myeloma; (6) Parkinson's disease; (7) aplastic anemia and other myelodysplastic syndromes; and (8) bladder cancer. 38 C.F.R. § 3.309(f). The rule applies to all claims pending before the finalization of the rule on March 14, 2017, as in this case. Entitlement to service connection for a stomach disorder, characterized as gastroesophageal reflux disease (GERD) and diverticulosis, to include as due to environmental hazard at Camp Lejeune The Veteran contends that his GERD and diverticulosis are related to active duty service. Specifically, he contends that he has experienced abdominal pain and similar symptoms for more than two decades and it is related to his consumption of contaminated water while stationed at Camp Lejeune. After reviewing all the evidence of record, the Board concludes that while the Veteran has current diagnoses of GERD with irritable bowel syndrome and diverticulosis, the preponderance of the evidence weighs against finding that these disorders began during service or within one year of service, or are otherwise etiologically related to an in-service injury, event, or disease, to include as due to environmental hazard at Camp Lejeune. As an initial matter, the Board notes that the Veteran's personnel records show that he served at Camp Lejeune between June and November 1981 for at least 30 days. Accordingly, his exposure to contaminated drinking water therein is conceded. However, the Veteran has not been diagnosed with one of the diseases for which presumptive service connection is granted based on such exposure. 38 C.F.R. §§ 3.307(d), 3.309(f). Next, although the Veteran is not entitled to presumptive service connection for stomach disorders of GERD or diverticulosis due to exposure to toxic contaminants at Camp Lejeune per 38 C.F.R. §§ 3.307 and 3.309, he is not precluded from demonstrating that his stomach disorders are proximately due to, the result of, or aggravated by drinking contaminated water at Camp Lejeune. See Combee v. Brown, 43 F3.d 1039, 1041-42 (Fed. Cir. 1994). However, the competent evidence fails to establish a relationship between active duty and the Veteran's current stomach disorders. First, the Veteran's service treatment records do not contain evidence of any complaints of, treatment for, or clinical observations of abdominal pain or other gastrointestinal symptoms. Indeed, the records do not indicate diagnoses or treatment for abdominal conditions until March 2016. In July 2016, the Veteran underwent a colonoscopy and was diagnosed with diverticulosis. These first complaints of abdominal pain occurred 35 years after separating from service. Therefore, continuity of symptoms since service is not shown. The Board has considered the Veteran's statements that his stomach symptoms have been continuous since service. However, the Board is unable to grant service connection purely on his statements alone. As an initial matter, there is no treatment for such symptoms during or within one year of service, and he did not seek treatment for abdominal symptoms until 35 years after separation from service. Additionally, the Board notes that the Veteran submitted service connection claims for hearing loss, tinnitus, and acquired psychiatric disorders in March 2015 but did not file a claim for stomach disorders until 2 years later. Thus, the Board can infer the Veteran had knowledge of the VA benefits system at that time and had the opportunity to file a claim for his stomach disorders. See generally, Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (Lance, J., concurring) (discussing the distinction between cases in which there is a complete absence of any evidence to corroborate or contradict the testimony, and cases in which there is evidence that is relevant either because it speaks directly to the issue or allows the Board as factfinder to draw a reasonable inference). Accordingly, service connection for stomach disorders is not warranted, based on continuity of either the medical evidence or the Veteran's statements. Next, although the evidence does not reflect that the Veteran's symptoms were continuous since service, service connection may nonetheless be established if a relationship is otherwise demonstrated by competent evidence, including medical evidence and opinions. However, the competent evidence fails to establish a nexus between active duty service and the Veteran's current stomach disorders. As discussed, medical treatment records indicate the Veteran was first diagnosed with diverticulosis in July 2016. VA examinations were scheduled to determine whether there is a nexus between the Veteran's current disorders and an event or injury that occurred in service, to include exposure to contaminated water at Camp Lejeune. During a September 2019 VA examination, the examiner opined that it is less likely than not that the Veteran's GERD is due to active military service and his exposure to contaminated water at Camp Lejeune. The examiner explained that GERD is the most common gastrointestinal disorder in the United Stated and there is insufficient evidence to support a causal relationship between GERD and Camp Lejeune water exposure. However, the examiner did not discuss what other factors likely caused the Veteran's GERD, and an addendum opinion was required. As such, the Board finds this opinion lacks probative value. Next, an August 2020 VA examiner opined that the Veteran's GERD is less likely than not related to his exposure to contaminated water at Camp Lejeune because GERD is caused by acid reflux in the lower esophageal tract causing irritation and the typical symptoms of burning pain in the chest that usually occurs after eating and worsens when laying down. The examiner also explained that GERD is often due to anatomic changes associated with the inability of the lower esophageal sphincter to tighten or close properly. As such, the examiner explained, there is no physiologic basis or scientific logic to justify a causal relationship between contaminated water at Camp Lejeune and the development of GERD. Lastly, the examiner explained that GERD is an exceedingly common and highly prevalent condition, and that some risk factors associated with increased likelihood of developing GERD are older age, male sex, family history, and obesity. The examiner stated that it is possible that one or more of these factors played a role in the Veteran's development of GERD. Although the examiner did not address whether the Veteran's diverticulosis is related to active duty service, the opinion, as it pertains to whether the Veteran's GERD is likely related to service, is highly probative because the examiner examined the Veteran, considered his contentions and lay statements, reviewed the evidence of record, and cited medical literature in forming a thoroughly supported opinion that provides sufficient evidence on which to base a decision in this matter. Next, the Veteran underwent a VA examination in October 2021. The examiner acknowledged that the Veteran was diagnosed with diverticulosis in 2016 and noted that diverticulosis is "not a condition that affects the stomach but does affect the colon." The examiner opined that the Veteran's diverticulosis and GERD are less likely than not related to exposure to contaminated water at Camp Lejeune because there are no conclusive studies indicating that such disorders are caused by contaminated Camp Lejeune water exposure. Because the examiner reviewed the evidence of record, considered the Veteran's contentions, cited to medical literature, and provided thorough supporting rationale in forming their opinion, the Board finds the opinion to be highly probative. In addition to reviewing all the evidence of record, the Board has considered the statements made by the Veteran and his wife asserting a causal connection between his stomach disorders and active duty service. Specifically, the Board notes their contentions that his stomach disorders were caused by exposure to contaminated water at Camp Lejeune. While lay statements may be competent on a variety of matters concerning the nature and cause of disability, etiology of dysfunctions and disorders is a medical determination and generally must be established by medical findings and opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In the present case, the Veteran and his wife are lay persons without appropriate medical training and expertise, and thus, are not competent to make an etiological conclusion regarding the cause of his stomach disorders, especially given that the evidence fails to demonstrate symptoms in service, or any other in-service incident, illness, or injury to which such a condition may be presently linked. The Board concludes that the weight of the evidence is against the claims for service connection and there is no other doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Veltri, Associate Counsel