Citation Nr: 21014414 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 16-46 777 DATE: March 12, 2021 ORDER Service connection for a disorder manifested by rectal bleeding, to include as due to contaminated water at Camp Lejeune, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s disorder manifested by rectal bleeding is related to service. CONCLUSION OF LAW The criteria for service connection for a disorder manifested by rectal bleeding have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1977 to September 1981. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. Subsequently, the Board remanded the matter for further development in March 2020. Service Connection Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires competent evidence showing: (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, 1167 (Fed. Cir. 2004). The Veteran seeks service connection for a disorder manifested by rectal bleeding, to include as due to exposure to contaminated water at Camp Lejeune. A November 2019 private colonoscopy revealed benign neoplasms at several sections of the colon, hemorrhoids, and hemorrhage of anus and rectum. A veteran who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed during that service. 38 C.F.R. § 3.307(a)(7)(iii). For purposes of this presumption, “contaminants in the water supply” means the volatile organic compounds trichlo roethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride. Under 38 C.F.R. § 3.309(f), the following disabilities are presumed to be service connected for such veterans: kidney cancer, liver cancer, Non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. The record confirms the Veteran’s presence at Camp Lejeune for longer than 30 days, and his exposure has been conceded. As noted above, benign neoplasms, hemorrhoids, nor hemorrhage of anus or rectum are presumed to be associated with exposure to contaminants in the water supply at Camp Lejeune; therefore, service connection cannot be presumed, but a direct relationship may still be established by showing that a disorder is casually linked to exposure to contaminants in the water supply at Camp Lejeune. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran’s service treatment records (STRs) indicate that he reported having abdominal pain for 15 months as well as bloody stools in July 1980. In August 1980 a provisional diagnosis of bleeding peptic ulcer and gastric ulcer was given. In September 1980, the Veteran reported having dark, bloody stools; he was diagnosed with possible gastritis. In May 1981, the Veteran reported having epigastrium distress for three days as well as black stools for several weeks; he was diagnosed with gastritis. No gastrointestinal or anus or rectum abnormalities were noted during the August 1981 separation examination. A July 1985, March 1990, and April 1994 report of medical history denied any gastrointestinal or anus or rectum issues. An August 2020 VA examiner opined that the claimed condition is less likely as not caused by or the result of the Veteran’s exposure to contaminated water at Camp Lejeune. He reasoned that rectal bleeding in and of itself is not a disease process but is a manifestation of some other medical condition. He indicated that the Agency of Toxic Substances and Diseases Registry (ATSDR) does not show an association between contaminated water at Camp Lejeune and rectal bleeding or other gastrointestinal conditions. The examiner noted that the Veteran’s STRs indicate gastrointestinal problems in July and August 1980, with some episodes of bloody stools. In May 1981, the Veteran was seen again for gastrointestinal distress; he was diagnosed with gastritis at the time and a rectal examination was unremarkable. A 1993 varicose vein surgery note indicated that the Veteran denied any rectal bleeding or bloody stools, and his rectal examination was normal, with heme negative testing results, showing no blood. The examiner noted that peptic ulcers, gastritis, and hemorrhoids can lead to gastrointestinal bleeding. The examiner concluded that considering the Veteran’s history of gastrointestinal issues, the claimed condition is less likely than not caused by or the result of the Veteran’s exposure to contaminated water at Camp Lejeune. An October 2020 VA examiner opined that the claimed condition is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. She noted that the Veteran was seen for complaints of gastric distress and bloody stools in July and August 1980 as well as May 1981; he was diagnosed with gastric ulcer, but rule out peptic ulcer, cholecystis, cholelithiasis, alcohol abuse, and gastritis. She further noted that his November 2019 colonoscopy demonstrated multiple benign polyps in the colon, and moderate non-bleeding internal hemorrhoids. She also indicated that a November 2019 EGD demonstrated esophageal and gastric type mucosa, consistent with reflux disease and tubular adenoma. She further indicated that medical literature review indicates that causes of rectal bleeding include as due to hemorrhoids, anal fissures, polyps, proctitis, rectal ulcers, cancer, and diverticulosis. Based on this information, the examiner concluded that the Veteran’s rectal bleeding is due to hemorrhoids and benign colon polyps and not due to a gastric ulcer. After considering all of the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for a disorder manifested by rectal bleeding. The evidence of record indicates that there is no relationship between the Veteran’s condition and the toxic water supply at Camp Lejeune. Specifically, the August 2020 VA examiner opined that the claimed condition is less likely than not caused by or the result of exposure to contaminated water at Camp Lejeune. The Board finds the August 2020 VA medical opinion to be probative because it is based on a review of the record and medical literature as well as provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Additionally, there have been no issues raised against the findings made therein. Moreover, the Board finds that the Veteran’s current condition is not etiologically related to service. The October 2020 VA examiner opined that the Veteran’s current cause of rectal bleeding is due to hemorrhoids and benign colon polyps and not due to a gastric ulcer. The Board finds this opinion to be probative and adequate for adjudication, as it is based on the record and review of medical literature. Id. The Veteran has not asserted a relationship, and the record does not contain competent medical evidence suggesting a relationship, between the Veteran’s service and his hemorrhoids and benign colon polyps. In reaching this decision, the Board has considered the Veteran’s lay contentions that his condition is related to exposure to contaminated water at Camp Lejeune. See September 2019 Board hearing transcript. The Board acknowledges his sincere belief; however, he has not been shown to have the training or expertise to competently attribute his condition to that exposure. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record, the Board ultimately affords the objective medical evidence of record, which investigated that theory and found it less likely, with greater probative weight. Specifically, the Board affords more probative weight to the competent opinions of the August 2020 and October 2020 VA examiners.   Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, 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.