Citation Nr: 21032071 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-44 858 DATE: May 25, 2021 ORDER Entitlement to service connection for Barrett's esophagus, to include as due to Camp Lejeune contaminated water (CLCW) exposure, is denied. FINDING OF FACT The evidence of record indicates that the Veteran's Barrett's esophagus is not etiologically related to his period of service, to include as due to CLCW exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for Barrett's esophagus, to include as due to CLCW exposure, 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 in the United States Marine Corps on active duty from June 1972 to June 1975. The issue comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2019. A transcript of the hearing has been included with the record. In November 2019, the Board remanded to provide the Veteran a VA examination. There has been substantial compliance with the remand directives, and the appeal is again before the Board. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Service records confirm that the Veteran served at Camp Lejeune in October 1972 such that the Veteran's exposure to contaminated water has been established. Service Connection Service connection may be granted for a disability from an injury or disease that was incurred in or aggravated during active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection is also available for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The general requirements for service connection are (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the disability and service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA regulations have established a presumption of service connection for diseases associated with exposure to CLCW. If a veteran was exposed to CLCW during military service and the exposure meets the requirements of § 3.307(a)(7), then the following diseases shall be service-connected even though there is no record of such disease during service: kidney cancer; liver cancer; non-Hodgkin's lymphoma; adult leukemia; multiple myeloma; Parkinson's disease; aplastic anemia and other myelodysplastic syndromes; bladder cancer. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). Entitlement to service connection for Barrett's esophagus, to include as due to CLCW exposure The Veteran contends that his current diagnosis of Barrett's esophagus is related to his period of service, including drinking contaminated water while stationed at Camp Lejeune. The Veteran's service treatment records are absent of any treatment, complaints, or symptoms of an esophageal condition. The Veteran's June 1975 separation physical showed the Veteran to be in good health. The Veteran testified before the Board that he started experiencing symptoms of indigestion, upset stomach and gastroesophageal reflux disease (GERD) just months after discharge from service. The Veteran noted his esophageal condition had progressed since. Private treatment records from November 1999 provided a diagnosis of Barrett's esophagus. Medical and lay evidence of record show the Veteran has a history of treatment for GERD as well as Barrett's esophagus. The Veteran underwent esophageal surgery in January 2002. Pursuant to the Board's remand, the RO provided the Veteran with a VA examination in March 2020. Following the review of the Veteran's claims file and a review of medical literature regarding Barrett's esophagus and exposure to chlorinated solvents in the water at Camp Lejeune, the VA examiner provided the medical opinion that the Veteran's diagnosis of Barrett's esophagus was less likely than not incurred in or caused by the Veteran's period of service at Camp Lejeune, to include exposure to contaminated drinking water. The VA examination established that the Veteran was exposed to contaminated water during his time stationed at Camp Lejeune. However, the VA examination found that current medical literature does not support the Veteran's contention that Barrett's esophagus was caused by toxic exposure to CLCW. Specifically, the examination cited the Agency for Toxic Substances and Disease Registry's (ATSDR) April 2018 report on the morbidity and mortality in service members exposed to CLCW. The VA examiner noted the study did not find any evidence of an increased risk of developing Barrett's esophagus. The examiner further rationalized that the Veteran's six-month exposure was not to the level to increase the Veteran's risk of developing any health effects associated with CLCW. The VA examination noted the known risk factors associated with Barrett's esophagus. The VA examiner rationalized that the Veteran's personal risk factors, namely the Veteran's diagnosis of chronic GERD, smoking, drinking alcohol, obesity, age, and gender, markedly increased the Veteran's risk of developing Barrett's esophagus. The examination assigned higher weight to the Veteran's risk factors than to the potential health effects associated with exposure to Benzene, Vinyl chloride, TCE and PCE. In a May 2020 letter, the Veteran objected to the VA examiner's opinion and rationale. In response to the Veteran's contentions, the RO provided an addendum opinion in June 2020. The VA opinion addressed the concerns raised by the Veteran regarding his age, weight, regularity of drinking alcohol, and the Veteran's history as a non-smoker. The addendum opinion cited additional medical records to show that although the Veteran was not obese, records show that he was overweight at the time he was diagnosed with Barrett's esophagus. Additionally, the VA examination stated that the Veteran was not a smoker but was exposed to second-hand smoke from his brother. The VA examination amended inconsistencies in the March 2020 VA opinion and again provided the rationale that the combination of the Veteran's risk factors significantly increased the Veteran's risk of developing Barrett's esophagus. The opinion listed chronic GERD, moderate drinking, excess body fat around the abdomen, ethnicity, and gender as the Veteran's personal risk factors. The VA examiner cited to the ATSDR April 2018 report, concluding that the Veteran's personal risk factors for Barrett's esophagus significantly outweighed the environmental exposure risk from CLCW. The Board finds that the evidence of record does not establish that the Veteran's esophagus condition is due to his period of service, to include as due to exposure to CLCW. The Board notes that the Veteran's diagnosis of Barrett's esophagus is not included in the list of presumptive diseases regarding CLCW, and there has been no showing that the Veteran's disorder was related to the presumptive diseases found in 38 C.F.R. § 3.309(f). Thus, presumptive service connection is not warranted. Notwithstanding the presumptions, service connection for a disability claimed as due to CLCW may still be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. Combee v. Brown, 34 F. 3d 1039, 1044 (Fed. Cir. 1994). Here, the evidence of record does not support such a finding. The March 2020 VA examination concluded there was no nexus between the Veteran's exposure to CLCW and his later diagnosis of Barrett's esophagus. The Board acknowledges that the VA examiner did not opine as to whether the Veteran's disability was otherwise related to service. However, upon review of the Veteran's medical history, the VA examiner noted the Veteran's diagnosis of Barrett's esophagus did not incur at Camp Lejeune. Moreover, the Board reiterates that besides the presumed exposure to CLCW in service, there is no medical or lay evidence of any other in-service event, injury, or complaints during service pertaining to the Veteran's Barrett's esophagus. The service treatment records are negative for any treatment, complaints, or symptoms of a gastrointestinal disability. The Board acknowledges the Veteran's objections to the VA examiner's medical opinions. The Board recognizes the Veteran's contention that he was exposed to chemicals while at Camp Lejeune for a period of time far exceeding the VA requirement for presumed toxic exposure to CLCW. The evidence of record establishes toxic exposure to chemicals associated with CLCW. The issue turns on whether toxic exposure is directly related to the Veteran's Barrett's esophagus. The Board finds the June 2020 addendum opinion and the March 2020 VA examination to be the most probative evidence of record, showing no direct causal relationship between the Veteran's disability and active service. The June 2020 addendum opinion and the March 2020 nexus opinion were based on a thorough review of the Veteran's medical records and the lay evidence presented and were supported by a fully articulated rationale with citations to medical literature. Prejean v. West, 13 Vet. App. 444 (2000); Guerrieri v. Brown, 4 Vet. App. 467 (1993). The Board acknowledges the Veteran's objections to the VA examiner's assessments of the Veteran's personal risk factors. However, the opinions expressed in the VA evaluations are consistent with the medical evidence of record. The Board recognizes the Veteran's lay assertions that his Barrett's esophagus was caused by exposure to CLCW. Lay persons are competent to provide opinions on certain subjective medical issues and of observable symptomatology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, as diagnoses on the level of Barrett's esophagus are complex medical matters, the Veteran as a layperson without the appropriate medical training and expertise is not competent to provide a probative opinion regarding the etiology of esophageal condition. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, the Board finds the preponderance of the evidence weighs against the Veteran's claim. Accordingly, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, Associate 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.