Citation Nr: 21032686 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-50 457 DATE: May 27, 2021 ORDER Service connection for prostate cancer is denied. FINDINGS OF FACT 1. The Veteran had active service from March 1962 to November 1963, including service at Camp Lejeune. 2. Prostate cancer was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; prostate cancer is not causally or etiologically related to service, to include as due to contaminated water at Camp Lejeune. CONCLUSION OF LAW Prostate cancer was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a procedural matter, the Board denied the appeal in June 2019. The Veteran appealed to the Veterans Claims Court. In May 2020, the Court Clerk granted a Joint Motion for Remand. In October 2020, the Board remanded the appeal. It is now again before the Board for adjudication. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to contaminated water at Camp Lejeune if a veteran, former reservist, or member of the National Guard shows: (1) that he or she served at Camp Lejeune for no less than 30 consecutive or nonconsecutive days between August 1, 1953 and December 31, 1987; (2) that he or she currently suffers from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309(f); and (3) that the current disease manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). This presumption may also be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309. Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Turning to the medical evidence, relevant VA examinations and clinical treatment records reflect that the Veteran was diagnosed with prostate cancer in 2015. Accordingly, a diagnosis of prostate cancer has been shown and the first element of service connection has been met. As to in-service incurrence, the service treatment records (STRs) do not reflect a diagnosis of prostate cancer during service. The October 1963 separation examination did not show a diagnosis of prostate cancer or any related symptoms. Moreover, the Veteran does not contend that prostate cancer began during service. As such, the evidence does not support direct service connection as no in-service incurrence was shown. Next, the Veteran's main contention is that prostate cancer is due to exposure to contaminated water at Camp Lejeune. A review of the military personnel records reflects that he had service at Camp Lejeune from June 1962 to November 1963. As such, exposure to contaminated water is presumed. However, prostate cancer is not a disease that VA has associated with the contaminated water supply at Camp Lejeune. Accordingly, presumptive service connection for prostate cancer due to exposure to contaminated water is not warranted as a matter of law. Further, the medical evidence does not support service connection for prostate cancer on a direct causation basis. As noted above, the STRs do not show the in-service incurrence of prostate cancer. In addition, no medical examiners of record have opined that prostate cancer was directly related to service, to include as due to exposure to contaminated water. Specifically, a November 2020 VA examiner opined that prostate cancer was less likely than not incurred in or caused by the claimed in-service event. The examiner noted other risk factors for prostate cancer, including age, race/ethnicity, geography, family history, and obesity. While the Veteran has reported no family history of prostate cancer, the examiner noted that the medical records show a family history of other types of cancer, which could have an impact on the development of prostate cancer. Further, the examiner explained that there was insufficient medical evidence, based on medical literature and available studies, to support a causal relationship between exposure to Camp Lejeune contaminated water and prostate cancer. Accordingly, he concluded that prostate cancer was less likely as not caused by or a result of the Veteran's exposure to contaminated water at Camp Lejeune. Similarly, a February 2021 VA examiner concluded that prostate cancer was less likely than not incurred in or caused by service. The examiner stated that he agreed with the November 2020 VA examiner who opined that prostate cancer was less likely than not caused by contaminated water at Camp Lejeune. He indicated that there was no medical evidence to support a relationship between prostate cancer and service. There is no contradictory medical opinion. Accordingly, the medical evidence does not support service connection for prostate cancer as due to exposure to contaminated water at Camp Lejeune. The Board has also considered whether presumptive service connection is warranted for prostate cancer under 38 C.F.R. §§ 3.307, 3.309(a); however, the evidence does not support the claim on this basis. Specifically, no chronic disease or injury related to the prostate was shown in service. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, prostate cancer was not diagnosed until 2015. As he was discharged in 1963 and symptoms were not identified until 2015 at the earliest, the medical evidence does not support service connection on a "continuity of symptomatology" basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1963 but did not note symptoms until 2015 at the earliest, with treatment beginning that same year. This evidence does not support presumptive service connection on a "manifest within one-year from separation" basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. The Board has considered the Veteran's lay statements that his disorder was caused by service, including his statements that no one in his family had been diagnosed with prostate cancer. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.