Citation Nr: 21027979 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 18-29 238 DATE: May 10, 2021 ORDER Entitlement to service connection for a left calf tumor, to include as due to exposure to contaminated water at Camp Lejeune, is denied. FINDING OF FACT The Veteran's left calf tumor is not an enumerated condition for presumptive service connection based on exposure to contaminated water at Camp Lejeune, and the probative evidence of record is insufficient to establish a nexus for service connection for a left tumor calf on a direct basis. CONCLUSION OF LAW The criteria for service connection for a left calf tumor, to include as due to exposure to contaminated water at Camp Lejeune have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Marine Corps from March 1959 to March 1963. In September 2019 and August 2020, the Board remanded the appeal for further development. 1. Service connection for a left calf tumor, to include as due to exposure to contaminated water at Camp Lejeune The Veteran contends that his left calf tumor is due to his period of service, to include as due to exposure to contaminated water at Camp Lejeune. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board finds that the evidence is insufficient to establish service connection for left calf tumor. The Veteran's DD 214 indicates that the Veteran served at Camp Lejeune during his period of service. Therefore, the Veteran served during the enumerated time period such that exposure to contaminated water is presumed. At the outset, the Board notes that presumptive service connection under 38 C.F.R. § 3.309(f) is not warranted, as nodular cyst mass is not an enumerated disability encompassed by the regulation. Having established that the Veteran is ineligible for presumptive service connection under the relevant regulatory provisions, the Board's analysis below will focus on direct service connection eligibility. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran's VA and private medical records indicate current treatment for a left calf tumor. The Veteran's service treatment records are silent on complaint of or treatment for left calf injury or tumor. However, as stated previously, exposure to contaminated water at Camp Lejeune has been established. Therefore, analysis will turn to whether there is a nexus between the Veteran's current diagnosis and his period of service. In a May 2018 lay statement, the Veteran, through his representative, asserted that he has had a posterior calf mass on the left lower extremity which had occurred for on or about forty years duration (since 1962). In a July 2018 VA examination, the examiner opined that it was less likely than not that the Veteran's left calf tumor was due to his period of service. The examiner stated that the Veteran had left calf soft tissue mass/tumor for many years and had surgical resection in 2002 with biopsy reporting eccrine spiradenoma. The examiner also stated that earlier in 2018 in same location at his left calf, a lump was noted, and the Veteran had surgical excision of the lump in June 2018 with biopsy report noting skin adnexal tumor, likely spiradenoma and incomplete resection. The examiner stated that the Veteran's left calf soft tissue tumor (including skin adnexal likely spiradenoma as noted in recent biopsy report) is not a presumptive condition. The Board notes that in a September 2019 Board decision, the Board found the July 2018 VA examination to be inadequate in that it did not address the Veteran's claim on a direct basis. In a December 2019 VA addendum opinion, the examiner opined that it was less likely than not that the Veteran's left calf tumor was due to his period of service. The examiner noted the Veteran's 2002 and June 2018 biopsy reports. The examiner also reported that the Veteran's service treatment records did not note a soft tissue tumor. The examiner further noted that the Veteran's soft tissue tumor of spiradenoma was diagnosed in 2002. The examiner reported that literature review noted no association or causal relationship between soft tissue tumor of eccrine spiradenoma and Camp Lejeune contaminated water exposure. The examiner concluded that it is less likely than not that the Veteran's soft tissue tumor, left leg mass, was caused by, or otherwise related to exposure to contaminated water during his service at Camp Lejeune, or is otherwise related to the Veteran's time in service. In an August 2020 Board decision, the Board noted that the examiner in the December 2019 VA opinion added merely that literature review noted no association or causal relationship between the type of soft tissue tumor the Veteran experienced and Camp Lejeune contaminated water exposure, and that the Veteran's separation examination noted no soft tissue tumor. The examiner made no reference to any of the Veteran's or his representative's statements and did not consider service connection on a direct basis. Therefore, the Board found this opinion inadequate. In a September 2020 VA addendum opinion, the examiner opined that it was less likely than not that the Veteran's left calf tumor was due to his period of service. Citing medical literature, the examiner reported that eccrine spiradenoma may present congenitally or spontaneously as tumor of the sweat glands with unclear etiology. The examiner also stated he that is not able to find any evidence that the "tumor disability began in service." The examiner reported that the Veteran's statement without reasonable supportive evidence is not sufficient to consider in favor of the claim. The examiner reiterated that the etiology for the left calf tumor is unclear or unknown. The examiner also reiterated that the Veteran's left calf tumor is not a presumptive condition of exposure to contaminate water at Camp Lejeune as determined by the experts after comprehensive reviews of scientific evidence. After review of the record, the Board finds that the probative evidence of record is insufficient to establish service connection for a left calf tumor. The September 2020 VA addendum opinion is bolstered by the Veteran's medical history, consideration of the Veteran's statements on onset, and application of the medical literature such that a nexus on a direct basis could not be established. The Board finds the opinion to be both adequate and highly probative for the purpose of adjudicating the claim. Therefore, service connection for a left calf tumor is not warranted. The Board has considered the Veteran's contention that his period of service resulted in his diagnosis of left calf tumor. Although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, determining the etiology of his left calf tumor falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this regard, while the Veteran can competently report his symptoms, any opinion regarding whether the Veteran's left calf tumor is related to his service requires medical expertise that the Veteran has not demonstrated. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007). As such, the Board assigns no probative weight to the Veteran's assertions that his left calf tumor is related to his military service, to include as due to exposure to contaminated water at Camp Lejeune. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ford 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.