Citation Nr: 21021503 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 19-35 006 DATE: April 13, 2021 REMANDED Entitlement to service connection for prostate cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the small intestine to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the large intestine to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for cancer of the nose (claimed as cancer of the radical flap) to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for skin cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. Entitlement to service connection for stomach cancer to include as due to exposure to contaminated water at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served in active duty service with the Marine Corps from June 1956 to April 1958. This matter is on appeal from a May 2018 rating decision. The Board remanded this appeal in August 2020 for additional development. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Board finds that remand is warranted for additional development. The Board notes that review of the Veteran’s military personnel record shows the Veteran was stationed at Camp Lejeune from January 1957 to April 1958. The Veteran in his May 2019 notice of disagreement (NOD) stated that he drank and bathed in the water at Camp Lejeune for 2 years and that “all body systems that processed, stored, and extracted the water all have cancer.” VA has acknowledged that persons residing or working at Camp Lejeune from August 1953 through December 1987 were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). Certain diseases including kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer shall be service connected even though there is no record of such disease during service. The Veteran’s claimed cancers involving the small and large intestine; nose; prostate; skin; and stomach are not on the presumptive lists for exposure to herbicides or contaminated water at Camp Lejeune. However, the absence of a disease from the presumptive list does not preclude a Veteran from otherwise proving that his disability resulted from exposure to contaminated water at Camp Lejeune. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Service connection may still be granted on a direct basis. Review of the claims record does not show the Veteran has been afforded an examination on the nature and etiology of the appealed issues in relation to the Veteran’s active duty service to include exposure to contaminated water at Camp Lejeune. As such, the Board finds that remand is warranted to obtain an examination and opinion on the nature and etiology of the Veteran’s claimed issues. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. After any additional records are associated with the claims file, Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed cancer of the small and large intestine; prostate cancer; cancer of the nose; skin cancer; and stomach cancer. The Veteran’s claims file should also be made available to and be reviewed by the reviewing clinician. In completing this examination, the examiner is asked to respond to the following: (a.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s prostate cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? (b.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s cancer of the small intestine had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? (c.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s cancer of the large intestine had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? (d.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s cancer of the nose (claimed as cancer of the radical flap) had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? (e.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s skin cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? (f.) Is it at least as likely as not (50 percent probability or greater) the Veteran’s stomach cancer had its onset during, was caused by, or is otherwise related to active service, to include exposure to contaminated water at Camp Lejeune? For the purposes of this remand, the examiner should presume the Veteran was exposed to contaminated water at Camp Lejeune. 3. The examiner is also advised that the Veteran is competent to report in-service events and treatment, and his symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. The examiner should address the Veteran’s statements made in his May 2019 notice of disagreement (NOD). If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (a.) The examiner should provide a complete rationale for any opinion provided, and if the examiner is unable to provide any opinion request, then the examiner should state so and why. The examiner is advised that it is insufficient to conclude that any diagnosed cancers of the small and large intestine; prostate; nose; skin; and stomach are not directly caused by exposure contaminated water at Camp Lejeune solely because it is not on the list of diseases presumptively associated with exposure to contaminated water at Camp Lejeune. (b.) If the VA examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. A clearly stated rationale for any opinion offered should be provided. 4. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.