Citation Nr: 21014250 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 18-16 197 DATE: March 11, 2021 REMANDED The issue of entitlement to service connection for prostate cancer, to include as due to exposure to contaminated water at Camp Lejeune is remanded. The issue of entitlement to service connection for colon cancer, to include as due to exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1954 to September 1957. The Veteran requested a hearing with the Board in his March 2018 VA Form 9. Subsequently, however, he withdrew his request in writing in October 2020. 1. Service connection for prostate cancer 2. Service connection for colon cancer The Veteran contends that his prostate cancer and colon cancer were caused by exposure to contaminated water at Camp Lejeune. In particular, he maintains that the contaminated water he ingested affected his colon and prostate, like it is known to affect the bladder, and that he has no family history of colon or prostate cancer. See March 2018 VA Form 9. His military service records show that the Veteran served at Camp Lejeune during the period that meets the requirement under 38 C.F.R. § 3.307 (a)(7)(iii). Thus, the Veteran shall be presumed to have been exposed during his service to the contaminants in the water supply. Moreover, the post-service medical evidence of record shows that the Veteran was diagnosed with prostate cancer and colon cancer. However, neither prostate nor colon cancer is listed as disease associated with exposure to contaminants in the water supply at Camp Lejeune for which presumption of service connection applies under 38 C.F.R. § 3.309 (f). Thus, the issue before the Board is whether the Veteran’s cancer is at least as likely as not related to his service, to include the presumed exposure to contaminants in water supply at Camp Lejeune. In support of his claim for prostate cancer, the Veteran submitted a letter from his treating physician, dated October 2020, where the physician opined that After review of the pertinent records it is my professional opinion that it is at least as likely as not that [the Veteran’s] condition is a direct result of his time served at Camp Lejeune as due to his military service. The rationale provided was that he had no other known risk factors for prostate cancer and that it is known in the medical literature that this type of exposure can be carcinogenic. While it is indeed known that exposure to water contaminated with pollutants found at Camp Lejeune is known to cause cancer such as those listed in §3.309, prostate cancer is not a presumptive disease under the regulation and it is also known that risk factors for prostate cancer include age and obesity. Therefore, the Board finds that a medical opinion with adequate rationales must be obtained in order to ascertain whether the Veteran’s prostate cancer is at least as likely as not caused by presumed exposure to contaminants in water supply at Camp Lejeune. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). As for the claim of colon cancer, a July 1993 medical evidence of record indicates that the Veteran was invited to participate in a study in order to understand the characteristics of colorectal tumors and “whether those characteristics might be related to the dietary practices of the people who have had them.” Indeed, as the Veteran points out, it is reasonable to assume that presumed exposure to contaminants in water supply at Camp Lejeune occurred through ingestion of water and food there. Thus, a medical opinion must be obtained in order to ascertain whether the Veteran’s colon cancer is at least as likely as not caused by presumed exposure to contaminants in water supply at Camp Lejeune. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s prostate cancer is at least as likely as not related to his service, to include presumed exposure to contaminants in water supply at Camp Lejeune. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s colon cancer is at least as likely as not related to his service, to include presumed exposure to contaminants in water supply at Camp Lejeune.   3. Compete medical rationales should be provided for all opinions entered. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. Taylor, 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.