Citation Nr: 21026071 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 18-42 308 DATE: April 29, 2021 REMANDED Service connection for prostate cancer due to exposure to contaminants in the water supply at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1978 to March 1982, including service at Camp Lejeune. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2021 the Veteran and his wife testified at a Board hearing before the undersigned Veterans Law Judge. Service connection for prostate cancer due to exposure to contaminants in the water supply at Camp Lejeune is remanded. The Board notes that the Veteran has not been provided a VA examination with regard to the claim for service connection for prostate cancer. VA’s duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). In a claim for service connection, evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits still triggers the duty to assist if it indicates that the Veteran’s condition may be associated with service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran asserts that his prostate cancer is etiologically related to exposure to contaminated waters at Camp Lejeune. The Veteran was diagnosed with prostate cancer in May 2017. In a private Disability Benefits Questionnaire, the Veteran reported he was exposed to toxic chemicals while serving at Camp Lejeune and that may have caused his prostate cancer. See April 2018 DBQ. A private doctor submitted a nexus opinion regarding Veteran’s prostate cancer in May 2018, stating the Veteran reported exposure to toxic products and chemicals including benzene, dichloroethylene, tetrafluoroethylene PCE and trichloroethylene TCE were likely or could be the cause of his prostate cancer. The doctor concluded that he did not have a background that allowed him to make a statement about whether these chemicals/toxins were or were not causative agents. See May 2018 Medical Treatment Record. In light of the examiner’s opinion, which is too speculative to support a grant of service connection, see McLendon v. Nicholson, 20 Vet. App. at 85, and the examiner’s report that he was not qualified to offer an opinion as to the etiology of the disability, further development is necessary. See Wise v. Shinseki, 26 Vet. App. 517, 524 (2014). At his April 2021 Board Hearing, the Veteran testified that he was not exposed to toxic chemicals before his military service or after his discharge from service. He stated he developed pain in his prostate area after service and sought treatment at a VAMC. Testing revealed that he had prostate cancer; his cancer is currently in remission, but he reported he experiences numerous residuals due to the condition. The Veteran has never been provided a VA examination specific to the claimed disability. Therefore, as exposure to contaminated waters is conceded by the VA, and there is evidence of symptoms and diagnoses of prostate cancer, the Board agrees with the Veteran’s attorney and finds that evidence overcomes the low threshold necessary to trigger VA’s duty to provide an examination. McLendon, 20 Vet. App. 79. This matter is thereby remanded to afford the Veteran a VA examination and to provide an etiological medical opinion regarding whether the Veteran’s prostate cancer is related to his military service, to include exposure to contaminated water at Camp Lejeune. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records for the Veteran. 2. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) with an examiner competent to determine the etiology of the Veteran’s prostate cancer, including as due to exposure to contaminated water at Camp Lejeune. All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail. The examiner should be notified that the water supply at Camp Lejeune was contaminated between 1957 and 1987 with a number of chemical compounds that have been associated by scientific organizations with the potential for developing certain diseases. These chemical compounds include trichloroethylene (TCE), perchloroethylene (PCE), benzene, and vinyl chloride. The Veteran has verified service at Camp Lejeune during the relevant period. After the record review and a thorough examination and interview of the Veteran, the VA examiner should offer his/her opinion with supporting rationale as to whether it is at least as likely as not that the Veteran’s prostate cancer was incurred in, caused by, or etiologically related to his service, including as due to exposure to contaminated water at Camp Lejeune. In so opining, the examiner is advised that the Board is cognizant that the NAS National Research Council has not included prostate cancer as one of the diseases potentially associated with exposure to TCE and PCE; however, this list is not exclusive. All opinions provided must be thoroughly explained, and an adequate rationale for any conclusions reached must be provided. If the examiner believes that an opinion cannot be provided without resorting to speculation, then he/she must provide a detailed medical explanation as to why this is so. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, 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.