Citation Nr: 21074465 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 19-35 006 DATE: December 15, 2021 REMANDED Entitlement to service connection for prostate cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the small intestine to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the large intestine to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the nose (claimed as cancer of the radical flap) to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for skin cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for stomach cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1956 to April 1958. These matters are on appeal from a May 2018 rating decision. The Board remanded the appeals in August 2020 and April 2021 for additional development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). 1. The Claims on Appeal are Remanded. On remand, multiple VA opinions were obtained on the etiology of the cancers of the prostate, small intestine, large intestine, nose (claimed as cancer of the radical flap), stomach, prostate, and skin. After review of the lay and medical evidence an additional remand is necessary. As noted in the October 2021 submission from the Veteran's representative, the opinions obtained on remand contain factual errors and points requiring clarification. Specifically, the VA physician indicated the Veteran was stationed at Camp Lejeune for 273 days, when service personnel records indicated the Veteran was stationed there longer. While the service personnel records reflect the Veteran was onboard a ship from March 1957 it returned to North Carolina in May 1957. He departed on another ship at the end of August 1957 and returned to North Carolina in November 1957. The examiner listed him as being on board ships from March until November 1957 which appears to be incorrect. Further, the VA physician indicated that the Veteran's exposure was considered not heavy based on the incorrect number of days. As such, a remand is necessary. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the June 2021 VA physician, or, if unavailable, another suitably qualified examiner to determine the nature and etiology of the Veteran's claimed cancer of the small and large intestine; prostate; nose; skin; and stomach. The Veteran's claims file should also be made available to and be reviewed by the reviewing clinician. In completing this examination, the examiner is asked to respond to the following: a.) Is it at least as likely as not (50 percent probability or greater) the Veteran's prostate cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? b.) Is it at least as likely as not (50 percent probability or greater) the Veteran's cancer of the small intestine had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? c.) Is it at least as likely as not (50 percent probability or greater) the Veteran's cancer of the large intestine had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? d.) Is it at least as likely as not (50 percent probability or greater) the Veteran's cancer of the nose (claimed as cancer of the radical flap) had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? e.) Is it at least as likely as not (50 percent probability or greater) the Veteran's skin cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? f.) Is it at least as likely as not (50 percent probability or greater) the Veteran's stomach cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? The Veteran's service personnel record indicate that he was stationed at Camp Lejeune from January 1, 1957 to March 1957; May 1957 until August 1957 and November 1957 until April 11, 1958. For the purposes of this remand, the examiner should presume the Veteran was exposed to contaminated water at Camp Lejeune. The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. The examiner should address the Veteran's statements made in his May 2019 notice of disagreement (NOD). If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. The examiner should provide a complete rationale for any opinion provided, and if the examiner is unable to provide any opinion request, then the examiner should state so and why. The examiner is advised that it is insufficient to conclude that any diagnosed cancers of the small and large intestine; prostate; nose; skin; and stomach are not directly caused by exposure contaminated water at Camp Lejeune solely because it is not on the list of diseases presumptively associated with exposure to contaminated water at Camp Lejeune. If the VA examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. A clearly stated rationale for any opinion offered should be provided. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Teague, 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.