Citation Nr: 21022547 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 18-30 254 DATE: April 16, 2021 ORDER Entitlement to service connection for prostate cancer is granted. FINDING OF FACT The Veteran’s exposure to contaminated water during service at Camp Lejeune at least as likely as not caused his prostate cancer. CONCLUSION OF LAW The criteria for service connection for prostate cancer have been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1984 to August 1988 and from March 1989 to February 1999. In August 2016 he submitted a claim for service connection for prostate cancer. In rating decisions in September 2016 and March 2017 a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for prostate cancer. The Veteran appealed that denial to the Board of Veterans’ Appeals (Board). In August 2019 the Board remanded the issue to the RO for additional action. The Veteran waived RO review of additional evidence submitted in January 2021. 1. Service connection for prostate cancer The Veteran contends that his exposure to contaminated water while serving at Camp Lejeune, North Carolina, caused his prostate cancer which was diagnosed years later. He also has suggested that during his service in Panama he may have had exposure to herbicides such as Agent Orange. He contends that his prostate cancer could be attributable to any such exposure. Service connection may be established on a direct basis for a 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. Service connection may also be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has acknowledged that at Camp Lejeune, over a period of years, the solvents perchloroethylene, tetrachloroethylene, and trichloroethylene, from an off-base dry cleaner and leaking underground storage tanks, entered the base water supply. In veterans who had no less than 30 days of service at Camp Lejeune between August 1, 1953, and December 31, 1987, service connection for certain specifically listed diseases may be established based upon a legal presumption, by showing that the disease manifested itself to a degree of 10 percent disabling or more at any time after service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The diseases listed at 38 C.F.R. § 3.309(f) are kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia, other myelodysplastic syndromes, and bladder cancer. A report from the National Academy of Sciences (NAS) included prostate cancer among the conditions for which there is inadequate or insufficient evidence to determine whether an association exists with the substances in Camp Lejeune’s water. Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects, National Academy of Sciences, National Research Council, June 2009, available at http://www.nap.edu. Service connection for certain specifically listed diseases, including prostate cancer, may be presumed if a veteran was exposed during service to any of certain herbicide agents, including Agent Orange, that contains dioxin. 38 U.S.C. § 1116; 38C.F.R. §§ 3.307, 3.309(e). The Court has indicated that the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran’s service records show that he served at Camp Lejeune from November 1984 to January 1985. He served in Panama from January 1985 to March 1987. The Veteran submitted an article published in the journal Environmental Health in 2014. The article evaluated mortality in service members exposed to contaminated drinking water at Camp Lejeune. The authors concluded that those service members had elevated mortality hazard ratios for several causes of death, including several cancers. Prostate cancer was not one of the cancers listed. In treatment of the Veteran from July 2016, VA clinicians found evidence of possible prostate cancer. In October 2016 clinicians diagnosed high-risk prostate adenocarcinoma. In an April 2017 statement, the Veteran wrote that in 2016 the United States Marine Corps informed him that he should be checked for cancer in light of his service at Camp Lejeune. He stated that in 2016 VA clinicians found that he had prostate cancer. He reported that during his 1989 to 1999 Coast Guard service he was stationed in Florida, Massachusetts, and Hawaii. He stated that from 2000 forward he worked in information technology (IT). He a related a history of no more than light use of tobacco and alcohol. He reported that he knew of no history of prostate cancer in his immediate family. He contended that his prostate cancer is attributable to chemical exposure during his service at Camp Lejeune. In April 2017 VA physician N. W., M.D., a radiation oncologist, wrote that the Veteran was diagnosed with prostate cancer and was being treated with hormone therapy and external beam radiation. Dr. N. W. described the Veteran as young. She noted that he had no family history of, or other risk factor for prostate cancer. Dr. N. W. opined that, although VA had not proven a relationship between Camp Lejeune water exposure and prostate cancer, increased risk to the Veteran of prostate cancer from his Camp Lejeune service cannot be excluded. In March 2018 a VA-contracted physician reviewed the Veteran’s claims file. The physician noted that the Veteran did not have family history of, or history of occupational risks for, prostate cancer. The physician expressed the opinion that the Veteran’s prostate cancer was less likely than not caused by his exposure to contaminated water at Camp Lejeune. The physician explained that the Veteran was at Camp Lejeune for a relatively short time and that his prostate cancer had onset long after that service. The examiner opined that the Veteran’s prostate cancer at least as likely as not was related to aging and obesity. In August 2019 the Board noted that physician who provided the March 2018 VA opinion did not comment on the April 2017 opinion, and did not reconcile the Veteran’s lack of family history of or occupational risk for prostate cancer with the opinion against a relationship to exposure at Camp Lejeune. The Board remanded the issue to the RO for additional medical opinion. In May 2020 a VA physician reviewed the file and expressed the opinion that Veteran’s prostate cancer is less likely than not a result of his contaminated water exposure at Camp Lejeune. The physician explained that the Veteran’s time at Camp Lejeune was short. He stated that the Agency for Toxic Substance and Disease Registry (ATSDR) found that there was less than equipoise evidence that the chemicals in Camp Lejeune’s water cause prostate cancer. In January 2021, pharmacologist and toxicologist J. N. D. W., M.S., Ph. D., reviewed the Veteran’s claims file. Dr. J. W. concluded that in service at Camp Lejeune the Veteran was exposed to water that contained contaminants. Dr. J. W. also concluded that in service in Panama the Veteran was exposed to Agent Orange that remained present in the soil after it was used there in the 1960s and 1970s. Dr. J. W. stated that adenocarcinoma of the prostate, which the Veteran has, is a cancer that develops slowly and grows slowly. Dr. J. W. expressed the opinion that it is at least as likely as not that the Veteran’s exposure to the contaminants in Camp Lejeune water caused the development of his prostate cancer. Dr. J. W. also opined that it is at least as likely as not that the Veteran was exposed to the chemicals in Agent Orange while he served in Panama. Dr. J. W. opined that the herbicide component exposure additionally contributed to the development of his prostate cancer. In supporting a possibility that Camp Lejeune water increased the Veteran’s risk for prostate cancer, the VA oncologist Dr. N. W. noted that he was relatively young for onset of prostate cancer. That finding undermines the March 2018 opinion relating the Veteran’s prostate cancer to aging. Dr. J. W. explained that diagnosis of adenocarcinoma can occur long after exposure to toxins, as adenocarcinoma develops slowly. Drs. N. W. and J. W. each found that the lack of history of prostate cancer in the Veteran’s family added to the relative likelihood that the Camp Lejeune water contaminants were a causative factor. None of the assembled opinions contained argument against that analysis. On careful consideration, the evidence supporting a causal relationship between the Veteran’s exposure at Camp Lejeune and his prostate cancer is at least as persuasive as the evidence against such a relationship. Resolving reasonable doubt in the Veteran’s favor, the Board grants service connection for his prostate cancer. TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. J. Kunz, 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.