Citation Nr: 21014093 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 17-56 806 DATE: March 11, 2021 REMANDED Entitlement to service connection for low grade adenocarcinoma of the hard palate, to include as due to exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to March 1969 to include time at Camp Lejeune. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision of a Department of Veteran’s Affairs (VA) Regional Office. The Veteran was afforded a hearing before the undersigned Veteran’s Law Judge in November 2020. The hearing transcript has been associated with the file. 1. Entitlement to service connection for low grade adenocarcinoma of the hard palate, to include as due to exposure to contaminated water at Camp Lejeune. The Veteran asserts that his current low-grade adenocarcinoma of the hard palate is related to service which includes exposure to the contaminated waters of Camp Lejeune. He has not been provided a VA examination. VA must provide a medical examination when there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, (3) some indication that the claimed disability may be associated with the established event, injury, or disease, and (4) insufficient competent evidence of record for VA to make a decision. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i). The third prong, which requires evidence that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. The Veteran is presumed to have been exposed to contaminated water at Camp Lejeune because he served there for more than 30 days during the period from August 1, 1953 to December 31, 1987. 38 C.F.R. § 3.307(a)(7). This establishes the in-service injury element of service connection. Eight diseases enumerated in 38 C.F.R. § 3.309(f) are entitled to presumptive service connection due to contaminated water exposure. Adenocarcinoma is not one of the eight diseases subject to presumptive service connection. The Veteran’s private treatment records from July 2016 indicate a diagnosis of “low-grade adenocarcinoma.” In the Veteran’s November 2020 hearing he asserts that while his disability is not one of the presumptive conditions for service connection, his disability is the direct result of exposure to the contaminated water at Camp Lejeune. See 38 C.F.R. § 3.309(f). Furthermore, while the Veteran’s service treatment records are silent as to any treatment or diagnosis of adenocarcinoma, the Veteran did report having a sore throat during service at Camp Lejeune. See STR December 30, 1968 treatment note (received 10/10/2016, pp. 17). The Veteran also submitted an October 2017 private medical opinion that stated the Veteran’s condition is rare. The provider also stated that while they could not provide a definite connection, “it is within the realm of possibility that the exposure to contaminated water contributed to the development of his malignancy.” However, no reasoning or explanation was provided. “Within the realm of possibility” is too speculative to provide the degree of certainty required for medical nexus evidence. See McLendon, 20 Vet. App. at 81; Bloom v. West, 12 Vet. App. 185, 187 (1999). However, it is sufficient to indicate that the current disability may be related to the in-service injury. Based on the foregoing evidence, the low threshold for obtaining a VA examination regarding the Veteran's adenocarcinoma claim has been met in this case and a remand is necessary. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his adenocarcinoma. The examiner must review the entire claims file, including the hearing transcript. The examiner is asked to provide a response to the following: (a.) Is the Veteran’s adenocarcinoma at least as likely as not related to exposure to the contaminated water at Camp Lejeune? The examiner is advised that a negative opinion cannot be based solely on the fact that the Veteran’s adenocarcinoma is not on the list of diseases that are presumptively associated with exposure to contaminants in the water supply at Camp Lejeune. Provide a rationale to support the opinion. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.