Citation Nr: 21026048 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-06 530A DATE: April 29, 2021 ORDER Service connection for a liver disorder claimed as a hemangioma, to include as secondary to contaminated water exposure at Camp Lejeune, is denied. FINDING OF FACT The weight of the evidence does not show that the Veteran’s liver disorder was not incurred in or resulted from service, to include as secondary to contaminated water exposure at Camp Lejeune; or was caused by, aggravated by, or otherwise related to any service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a liver disorder, to include as secondary to contaminated water exposure at Camp Lejeune, have not been met. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1981 to September 1984. This case originally came before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran testified before the undersigned Veterans’ Law Judge during a hearing. A transcript of such hearing is of record. 1. Entitlement to service connection for a liver disorder Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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 between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). VA has acknowledged that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1953 through December 1987 were potentially exposed to drinking contaminated water with volatile organic compounds (VOCs). Analyses performed by the National Academy of Sciences, National Research Council (NRC) and the Agency for Toxic Substances and Disease Registry (ATSDR) has placed fourteen diseases were placed into the category of “limited/suggestive evidence” of an association, to include esophageal cancer, lung cancer, breast cancer, bladder cancer, kidney cancer, adult leukemia, multiple myeloma, myelodysplastic syndromes, renal toxicity, hepatic steatosis, female infertility, miscarriage with exposure during pregnancy, scleroderma, and neurobehavioral effects. Additionally, effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 to allow presumptive service connection for certain enumerated diseases related to exposure to contaminated drinking water at Camp Lejeune. Under the new regulations, a veteran who had no less than 30 days (consecutive or nonconsecutive) 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 C.F.R. § 3.307(a)(7). These enumerated disorders include kidney cancer, liver cancer; Non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. § 3.309(f). In this case, the Veteran’s personnel records show that he served as a medical officer at Camp Lejeune in 1983. However, he has no beet diagnosed with liver cancer, but rather with a hepatic hemangioma which, per the document from the Mayo Clinic submitted by the Veteran in March 2013, is a non-cancerous lesion on the liver. As a result, service connection is not warranted on a presumptive basis. Next, presumptive service connection notwithstanding, the Veteran may still establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). However, service connection is also not warranted on this basis. First, the Veteran’s service treatment records do not reflect complaints of, treatment for or diagnosis of a liver disorder during active service. Additionally, his September 1984 separation examination indicated no signs of a liver disorder or related symptoms. Moreover, the post-service evidence does not reflect symptoms of these disorders until many years after separation. Specifically, the medical evidence reports that the Veteran was not treated for issues with related to his liver disorder until approximately 2001. Indeed, the Veteran has not asserted that his disorder has persisted since service. Despite the lack of continuous symptoms, service connection may also be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the Veteran’s asserted disability to active duty service. In this case the Board finds the February 2021 VA examiner’s opinion highly probative. On that occasion, the examiner opined that the Veteran’s liver disorder was less likely than not related than not related to possible contamination at Camp Lejeune after reviewing all the medical literature the Veteran submitted. In providing this opinion, the examiner reflected that the Veteran’s hepatic hemangiomas more likely than not congenital as it was a common occurrence in people around the Veteran’s age at the time of diagnosis. In support of her opinion, the examiner also discussed a number of studies, some of which were presented by the Veteran regarding the proliferation of blood cells resulting from exposure to chemicals that were found at Camp Lejeune. In reviewing this evidence, the examiner cited additional studies reflecting that hepatic hemangiomas are by no means rare for patients of the Veteran’s age, with as much as 20 percent of the population being affected. While there was one study in 2009 regarding a patient who developed a hepatic hemangioma after 50 years of “heavy exposure” to PVC, “no other studies supported that finding.” At any rate, the Board notes that the Veteran does not appear to have experienced such significant or lengthy exposure. In short, the Board gleans from the VA examiner’s opinion that the etiology of his hepatic hemangioma is unknown and appears to be unknowable. This conclusion is supported by the fact that the VA examiner’s opinion was largely in agreement with prior opinions in January 2020 and August 2013. In making this conclusion, the Board acknowledges the Veteran’s opinion statement, as a medical officer, that his liver disorder was due to the contamination. However, this opinion is not supported by any instructive evidence that makes this opinion any more than speculative, which is insufficient for service connection purposes. Additionally, the Board has independently reviewed the medical articles or treatises, and acknowledges that they can provide important support when combined with an opinion of a medical professional if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. See Mattern v. West, 12 Vet. App. 222 (1999). However, as previously discussed, the submitted articles are general in nature and suggest the possibility of a causal relationship between the claimed condition and service at Camp Lejeune. They are not, however, specific to the Veteran’s circumstances and even when considered in conjunction with the Veteran’s statements, do not serve to establish a medical nexus. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Billinger, Associate Counsel