Citation Nr: 21021288 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 15-39 350 DATE: April 12, 2021 ORDER Entitlement to service connection for multiple sclerosis, to include as a result of Camp Lejeune water contamination, is denied. FINDING OF FACT The preponderance of the evidence is against the establishment of a nexus between the Veteran’s multiple sclerosis and his service, to include water contamination while stationed at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for multiple sclerosis, to include as a result of Camp Lejeune water contamination have not been met. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (a), (f) (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from May 1977 to February 1982. This appeal arose from an October 2012 rating decision. The Veteran requested a hearing before the Board. The requested hearing was conducted in March 2019 by a Veterans Law Judge (VLJ). A transcript of the hearing is associated with the file. In August 2019, the Board remanded the claim for further evidentiary development. The VLJ who conducted the hearing has since retired. The law requires that the VLJ who conducts a hearing on an appeal must participate in any decision made on that appeal. See 38 U.S.C. § 7102; 38 C.F.R. § 20.707. In February 2021, the Board sent the Veteran a letter notifying him of the unavailability of the VLJ that presided over the March 2019 hearing. The Veteran was provided the opportunity to decide whether he wanted another hearing before another VLJ. See February 2021 Hearing Related. The Board informed the Veteran that if he did not respond within 30 days from the date of the letter, the Board will assume that he does not want another hearing and proceed accordingly. Id. The Veteran did not respond within the time period. Therefore, the Board will proceed with the adjudication of the appeal. Entitlement to service connection for multiple sclerosis, to include as a result of Camp Lejeune water contamination. The Veteran is seeking entitlement to service connection for multiple sclerosis. The evidence of the record establishes that the Veteran has a current diagnosis of multiple sclerosis. Regarding an in-service injury or event, the available service records show that the Veteran was stationed in Camp Lejeune for a period of time during his active service. It was determined that he was stationed there from approximately September 1977 to December 1977. See July 2015 Request for Physical Examination. With respect to persons who resided or worked at the U.S. Marine Corps Base Camp Lejeune from August 1953 through December 1987, the VA has acknowledged that they were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). See Veterans Benefits Administration (VBA) Fast Letter 11-03 (last updated January 28, 2013). In the early 1980s, it was discovered that two on-base water-supply systems were contaminated with the VOCs trichloroethylene (TCE), a metal degreaser, and perchloroethylene (PCE), a dry-cleaning agent. Benzene, vinyl chloride, and other VOCs were also found to be contaminating the water-supply systems. See VBA Training Letter 11-03 (Revised November 29, 2011). Until scientific evidence shows otherwise, it will be assumed by VA that any Veteran who served at Camp Lejeune was potentially exposed in some manner to the full range of chemicals known to have contaminated the water there between 1957 and 1987. Id. Since the Veteran served in Camp Lejeune during the applicable time period, exposure to contaminated water is established. Additionally, the service treatment records show that the Veteran complained of painful urination in December 1978. Multiple sclerosis is not among one of the enumerated diseases under 38 C.F.R. §3.309 (f), which outlines diseases associated with exposure to water contaminants in Camp Lejeune. However, multiple sclerosis is considered a chronic disease under 38 C.F.R §3.309(a). Service connection can still be warranted under a presumptive basis if the evidence shows that the Veteran’s multiple sclerosis manifested within 7 years of his separation from service. As always, service connection can still be warranted on a direct basis. Regarding whether there is a nexus between the Veteran’s multiple sclerosis and his service, in July 2015, the VA clinician opined that it was less likely than not that the Veteran’s multiple sclerosis was incurred in or was caused by his service. The clinician’s rationale was based on the time span that the Veteran was stationed on Camp Lejeune (September 1977 to December 1977) and his diagnosis of multiple sclerosis in 2001. The rationale was also based on the review of medical literature, that included articles and studies from NIH, ATSDR, Bove et al., and NRC. It was stated that multiple sclerosis is a disease of unknown etiology. The clinician continued that while there is one meta-analysis suggesting evidence of association between multiple sclerosis and exposure to organic solvents, this study did not adjust for the confounder of smoking, a known risk factor. The clinician explained the very largest studies cited in this meta-analysis do not show increased risk with exposure to the organic solvents found in the contaminated water at Camp Lejeune and the development of multiple sclerosis. The clinician did not address the lay assertions or reference the Veteran’s service treatment records. Post-service treatment records noted urinary complaints that was indicated to be possibly associated with the Veteran’s multiple sclerosis. The Veteran also asserted that he started to experience symptoms about two years after separating from active service. See August 2012 Statement in Support of Claim (VA Form 21-4138). He reported being seen for medical issues that could not be explained by the physicians. The Veteran noted that he was told by a chiropractor that he had a sciatic nerve in his lower back. The Veteran contended that those were early symptoms of multiple sclerosis. See March 2019 Hearing Transcript. Additionally, post-service treatment records show that in May 2001, the Veteran complained of low back pain after jumping off a ladder. It was noted that he had multiple back strains in the past but never sought treatment. It was stated that the Veteran saw a chiropractor multiple times since an injury for “snapping”. In that same medical record, it stated that the Veteran first saw a doctor in 1981. It was reported that there was no focal numbness or pain, and that that the pain was non-radiating. In a December 2007 VA treatment record, the Veteran was concerned that his back pain was a flare-up of his multiple sclerosis, since he was having back pain at the time of being diagnosed with multiple sclerosis. See October 2012 VA Treatment Records (CAPRI). Based on this evidence, the Board remanded the claim in order to obtain an opinion addressing the Veteran urinary issues and back pain symptoms. In Janaury 2020, the VA clinician opined that the Veteran’s urinary symptoms in-service were not an early manifestation of multiple sclerosis. The clinician explained that in December 1978, the Veteran presented with painful urination and purulent urethral discharge. The Veteran was diagnosed with gonorrhea and he was treated with penicillin. The clinician stated that there was no overlap between the urinary symptoms associated with multiple sclerosis and those associated with gonorrhea. The clinician commented that it could be said “with certainty” that the in-service urinary symptoms were not manifestations of multiple sclerosis. Regarding the recurring back strains, the clinician opined that those were less likely as not early manifestations of multiple sclerosis. The clinician noted that there were no post-service treatment records relevant to that problem. The clinician commented that the service treatment records showed the Veteran experienced back strains and suffered from recurring back pain with no associated neurological symptoms. The clinician explained that pain in multiple sclerosis is typically associated with other neurological findings, such as sensory loss or weakness. There is often evidence of spinal cord involvement. The clinician stated that the Veteran experienced apparent musculoskeletal strains and associated pain. This is a pattern of symptoms much more suggestive of ordinary muscular injury than of multiple sclerosis. The clinician concluded that the probability that it represented multiple sclerosis was well below the standard of “at least as likely as not.” After a thorough consideration of all of the evidence of the record, the Board finds that the preponderance of the evidence is against the establishment of a nexus between the Veteran’s multiple sclerosis and his service, to include exposure to water contamination at Camp Lejeune. The VA examiner in July 2015 noted that the largest studies do not show an increased risk with exposure to organic solvents found in Camp Lejeune’s water and the development of multiple sclerosis. The claims file includes the reference to the NRC report which concluded that there was inadequate and insufficient evidence to determine whether there is an association between exposure to solvents and multiple sclerosis. See March 2019 Correspondence. The VA clinician in Janaury 2020 also explained that the Veteran’s in-service complaints of urinary symptoms were attributed to gonorrhea, which was treated in service. Additionally, the VA clinician thoroughly explained that the Veteran’s back strains were more likely than not musculoskeletal injuries and not symptoms of multiple sclerosis. This is supported by the medical evidence on the record that documents back pain after an injury, such as falling from the ladder, and not having any associated numbness or weakness. A review of the post-service treatment records shows that the earliest date regarding the manifestations of multiple sclerosis was noted in November 1998, when the Veteran sought treatment for blurred vision in the right eye. Also, in July 2001, it was noted that the Veteran experienced intermittent numbness for two weeks. He was formally diagnosed with multiple sclerosis in July 2001. In another record in Janaury 2002, the Veteran reported the onset of back discomfort with associated numbness to have begun in April 2001. See December 2014 Medical Treatment Records – Furnished by SSA. The January 2020 VA clinician explained that symptoms of multiple sclerosis usually have associated neurological manifestations. The Board acknowledges the Veteran’s assertions that his multiple sclerosis is due to his service. Although lay persons are competent to provide opinions on some medical opinions, determining the etiology of multiple sclerosis falls outside the realm of common knowledge of a lay person. The Veteran has not demonstrated the medical expertise required for this matter, specifically the complex nature surrounding the diagnosis of multiple sclerosis. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Furthermore, the VA clinicians have demonstrated that medical expertise and have provide thorough rationales to support their conclusions, which includes applying the medical principles and literature to the relevant facts of the Veteran’s particular case. The Board also acknowledges the Veteran’s assertions regarding the onset of his symptoms and seeking treatment in the 1980’s from doctors who could not explain his symptoms. The Veteran attempted to retrieve those medical treatment records but was informed that they were not available. The Board does not determine that the Veteran’s assertions lack credibility merely because those assertions are unaccompanied by contemporaneous medical evidence. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board finds that those assertions are contradicted by the medical reports of symptoms. As previously noted, the Veteran reported his symptoms attributed to multiple sclerosis to be as early as 1998. When seeking treatment for multiple sclerosis, the Veteran did not report his symptoms to have begun in the 1980s, or that he sought treatment before for his complex symptoms. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (ascribing heightened credibility to statements made to clinicians for the purpose of treatment); Williams v. Gov. of Virgin Islands, 271 F.Supp.2d 696, 702 (V.I.2003) (noting that statements made for the purpose of diagnosis or treatment "are regarded as inherently reliable because of the recognition that one seeking medical treatment is keenly aware of the necessity for being truthful in order to secure proper care"). Although the Board is sympathetic to the Veteran’s claim, the weight of the evidence is against a finding of service connection for multiple sclerosis. The Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, the doctrine is not applicable. John Kitlas Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.