Citation Nr: 21021221 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 20-29 898A DATE: April 12, 2021 ORDER Service connection for non-Hodgkin's lymphoma, to include as due to Camp Lejeune Contaminated Water (CLCW) exposure, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, the evidence of record finds that his non-Hodgkin’s lymphoma is related to his active duty. CONCLUSION OF LAW The criteria for service connection for non-Hodgkin's lymphoma, to include as due to CLCW exposure, have been met. §§ 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 September 1954 to September 1957, including service at Camp Lejeune. This matter comes before the Board of Veterans Appeals (Board) on appeal from a January 2018 rating decision. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where a veteran served for 90 days or more of active service, service incurrence shall be presumed for certain chronic diseases, including malignant tumors, if the disease manifested to a compensable degree within one year from the date of separation from active service. While the disease need not be diagnosed within the presumption period, it must be shown by acceptable lay or medical evidence that there were characteristic manifestations of the disease to the required degree during that time. The presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Additionally, a veteran who had no less than 30 days 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 to contaminants in the water supply during that service. 38 U.S.C. § 1116(a); 38 C.F.R. § 3.307(a)(7). Effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 providing a presumption of service connection for certain diseases based on exposure to contaminants present in the water supply at Camp Lejeune. The amendment defines “contaminants in the water supply” as the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. To qualify for presumptive service connection under these provisions, there must be evidence of: (1) a diagnosis of one of the enumerated diseases under the new provision 38 C.F.R. § 3.309(f), (i.e., kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer), if manifest to a degree of 10 percent or more at any time after service; and (2) service of at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987. The presumption is rebuttable by affirmative evidence to the contrary. The expression “affirmative evidence to the contrary” will not be taken to require a conclusive showing, but such showing as would, in sound medical reasoning and in the consideration of all evidence of record, support a conclusion that the disease was not incurred in service. 38 C.F.R. § 3.307(d). The Veteran contends that his non-Hodgkin’s lymphoma is the result of his in service CLCW exposure. As an initial matter, the Board notes that his CLCW exposure has been conceded, as the record indicates that he was stationed at Camp Lejeune from December 1954 to May 1955, for a total of 137 days. Further, he has an undisputed diagnosis of non-Hodgkin’s lymphoma of the rectum, which is entitled to presumptive service connection under 38 C.F.R. § 3.309, unless the presumption is rebutted. At a January 2018 VA examination, the examiner opined that the Veteran’s lymphoma was less likely than not caused by, or due to, his in-service CLCW exposure. Rather, the examiner opined that the Veteran’s lymphoma was a complication of his ulcerative colitis based on his medical history and medical literature supporting the conclusion that ulcerative colitis is a risk factor for rectal lymphoma. The examiner explained that the pathology report from the Veteran’s total proctocolectomy noted that the Veteran had a background of ulcerative colitis in the quiescent phase. Further, the examiner noted that the Veteran’s VA primary care provider reported his condition as “ulcerative colitis complicated by lymphoma of the rectum.” Significantly, the Board notes that, while the pathology report lists the Veteran’s history of ulcerative colitis, nowhere in the report does it suggest that his lymphoma is the result of his ulcerative colitis. Further, the VA physician’s characterization of the Veteran’s ulcerative colitis as “complicated by lymphoma” supports the conclusion that his lymphoma has caused his ulcerative colitis to worsen, not that his lymphoma is a result of his ulcerative colitis. Significantly, in a May 2020 letter, the Veteran’s private gastroenterologist stated that, while there is an increased risk of adenocarcinoma in patients with inflammatory bowel disease, such as ulcerative colitis, that is not the case with lymphoma. The physician opined that the Veteran’s history of lymphoma involving his gastrointestinal tract is likely unrelated to his ulcerative colitis. Given the above, the Board finds that the presumption has not been rebutted. When an approximate balance between positive and negative evidence exists, reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 3.102. In this case, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran’s non-Hodgkin’s lymphoma was incurred in service. Thus, resolving reasonable doubt in the Veteran’s favor, the Board finds that service connection for non-Hodgkin’s lymphoma, to include as due to CLCW exposure, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Benson, 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.