Citation Nr: 21015880 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 20-05 304 DATE: March 18, 2021 ORDER Entitlement to service connection for esophageal cancer is denied. FINDING OF FACT The Veteran’s esophageal cancer did not have its onset in service, and is not etiologically related to any aspect of service, including exposure to contaminated water while stationed at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for esophageal cancer have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1956 to December 1959. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The claimant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Entitlement to service connection for esophageal cancer Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran 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 (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system (which includes sensorineural hearing loss and tinnitus), are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The record shows that the Veteran served for a period of approximately four months at Camp Lejeune. Certain diseases are presumptively associated with exposure to contaminants present in the water supply at Camp Lejeune. 38 C.F.R. §§ 3.307, 3.309. In order to establish presumptive service connection for a disease associated with exposure to contaminated water at Camp Lejeune, a claimant must show the following: (1) that the veteran served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987; (2) that the veteran suffered from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309 (f); and (3) that the disease process manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307 (a)(7), 3.309(f). Based on the duration of the Veteran’s service at Camp Lejeune, exposure to contaminated drinking water is conceded. Initially, the Board observes that esophageal cancer, with which the Veteran has been diagnosed, is not among those diseases considered to be presumptively associated with such exposure. However, the Veteran has averred that he believes his cancer to be in fact associated with exposure to contaminated water. To explore the Veteran’s theory of entitlement, a VA examination was conducted in March 2018, pursuant to which the examiner indicated that based on the history and progression of the Veteran’s esophageal condition, it was less likely than not that his current cancer bears any etiological relationship to service, to include as a consequence of exposure to contaminated drinking water. Specifically, the examiner noted that the Veteran was diagnosed with a hiatal hernia many years after separation, and subsequently developed gastroesophageal reflux disease, which caused or contributed to the development of Barrett’s esophagus. Barrett’s esophagus is a known precursor to adenocarcinoma of the esophagus. The examiner added that the Veteran’s risk factors included advanced age at the time his cancer was diagnosed, (the Veteran was 73 years old), male gender, and a history of cigarette smoking. The examiner noted there was no objective evidence in the record suggesting any link between the Veteran’s cancer and any aspect of service, including exposure to contaminated drinking water. The Board observes that the examiner’s assessments are in accord with the evidence of record, which does not reflect in-service esophageal symptomatology, nor any complaints associated with the esophagus, or digestive distress or associated symptomatology, until several decades after separation. Further, no treating or examining provider has ever suggested any link between the Veteran’s esophageal cancer or any contributory condition, including Barrett’s esophagus, and any aspect of service, including exposure to contaminated drinking water. While the Board has considered with sympathy the Veteran’s lay statements, it cannot afford probative weight to his assertions with respect to the etiology of his cancer in this case. While he is competent to report his experiences and symptoms since service, the Veteran is not competent to provide a nexus opinion regarding the nature and etiology of his condition. Jandreau v. Nicholson, 492 F. 3d 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran’s reports of his symptoms are relevant, competent, and credible; however, the question of the etiology of esophageal cancer is limited to the purview of someone with medical knowledge and training, such as the VA medical examiner in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran’s diagnosed esophageal cancer is related to active service, to include as a consequence of conceded in-service exposure to contaminated drinking water at Camp Lejeune. The probative value of the Veteran’s assertions is outweighed by the probative value of the thorough and reasoned opinion of the VA medical expert. As the preponderance of the evidence is against the claim, service connection for esophageal cancer must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.