Citation Nr: 21039683 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-58 701 DATE: July 1, 2021 ORDER Service connection for a thyroid disorder is denied. FINDING OF FACT A thyroid disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, to include exposure to contaminated water at Camp Lejeune, North Carolina. CONCLUSION OF LAW The criteria for service connection for a thyroid disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from March 1983 to October 1986. She died in October 2015. The appellant is her widow. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in August 2015 by a Department of Veterans Affairs (VA) Regional Office. It was previously before the Board in December 2018, at which time it was remanded for further development. The Board finds that there has been substantial compliance with its December 2018 instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order); Dyment v. West, 13 Vet. App. 141, 147 (1999) (clarifying that substantial compliance with Board remand is required). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Persons residing or working at Camp LeJeune, North Carolina from August 1, 1953 to December 31, 1987, were potentially exposed to drinking water contaminated with volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene, and vinyl chloride that were in on the on-base water-supply systems. VA has determined that a veteran who served at Camp Lejeune for a period of no less than 30 days between August 1953 and December 1987 is presumed to have been exposed during such service to contaminants in the water supply. 38 C.F.R. §§ 3.307, 3.309. Under 38 C.F.R. § 3.309 (f), if a veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of § 3.307(a)(7), the following diseases shall be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of §3.307(d): (1) Kidney cancer; (2) Liver cancer; (3) Non-Hodgkin's lymphoma; (4) Adult leukemia; (5) Multiple myeloma; (6) Parkinson's disease; (7) Aplastic anemia and other myelodysplastic syndromes; and (8) Bladder cancer. While the Veteran did not have a diagnosis of any of the foregoing diseases acknowledged to be presumptively related to exposure to contaminated water at Camp Lejeune, the appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Veteran's service records show that she was stationed at Camp Lejeune from September 1983 to October 1984. Thus, she is presumed to have been exposed to contaminants in the water supply. However, a thyroid disorder is not a disease subject to presumptive service connection. 38 C.F.R. § 3.309. As such, presumptive service connection based on exposure to contaminants in the water supply is not warranted. Thus, in order to warrant service connection, competent evidence linking the condition to service is necessary. See Combee, supra. The Veteran's service treatment records do not show any complaints, treatment or diagnosis of a thyroid disorder during her active service. Her medical records show that she was first diagnosed with the disorder in 2013, over 25 years following her discharge. As noted supra, the Board remanded this claim in December 2018 to obtain a medical opinion which addressed the link, if any, between the Veteran's service and her subsequent thyroid disorder diagnosis. In an August 2020 opinion, a VA physician determined it was less likely than not that the Veteran's thyroid disorder was related to her military service, to include her exposure to contaminated water at Camp Lejeune. In support of this conclusion, the physician explained that the Veteran was first diagnosed with the disorder in 2013, while she was being treated for breast cancer. The condition was stable and was not treated other than with monitoring. The physician found no evidence in the service treatment records of any sort of thyroid issue while the Veteran was in service. In addition, the Veteran had a significant risk factor for thyroid disease in her female gender. In addition, she had multiple medical problems, to include osteoporosis, colonic polyps, and hyperlipidemia; she was a smoker and had been receiving chemo-radiotherapy for breast cancer, which was first diagnosed in 2006. The physician went on to explain hyperthyroidism is great detail, citing to 40 separate medical studies including those which indicated that the condition occurred between two and ten times more often in women. He explained that there was no study which supported an association between thyroid disease and exposure to contaminated water at Camp Lejeune. Instead, the disorder developed as a result of the Veteran's gender. In February 2021, a separate VA physician was asked to review the Veteran's file and provide an opinion as to a direct link, if any, between the Veteran's thyroid disorder and her military service. That physician concluded that it was less likely than not incurred in or caused by service. In support of this conclusion, she explained that the Veteran was found to have soft tissue swelling in the neck in 2013, which was determined to be benign looking, nonsuspicious small nodules. A 2014 ultrasound confirmed such. By July 2015, the nodules remained stable with no significant changes. Lab work showed normal levels, suggesting a normal thyroid state. Thyroid nodules are very common in the general population and found via ultrasound in anywhere from 20 to 70 percent of adults. They are nearly four times more common in women than in men, and 95 percent are benign. As the Veteran had stable thyroid nodules without abnormal function of thyroid and were benign, her thyroid disorder was most likely caused by being a female. No medical literature supported a conclusion that exposure to chemicals caused benign thyroid nodules. The Board finds the foregoing opinions, which reflect consideration of the entirety of the record, relevant medical literature, and provide a complete rationale supported by the evidence of record, highly probative. Furthermore, the opinions offer clear conclusions with extensive supporting data, as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiners each reviewed the file, noted the Veteran's diagnoses and clinical findings, considered the Veteran's lay statements, reviewed medical literature, and included extensive citations to the studies reviewed and relied upon. Notably, there is no competent medical evidence or opinion of record to the contrary. The Board acknowledges the appellant's sincerely held belief that the Veteran's thyroid disorder was due to exposure to contaminated water at Camp Lejeune; however, the etiology of such a disorder is a complex medical question, requiring specialized experience. As such, the appellant is not competent to provide such an opinion, which falls outside the realm of knowledge of a lay person. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis of a thyroid disorder and the etiology of such require medical testing and expertise to determine. The Board finds the opinions of the August 2020 and February 2021 VA examiners to be significantly more probative than the appellant's lay assertions as to the onset and etiology of the Veteran's thyroid disorder. (Continued on the next page) In sum, the preponderance of the competent and probative evidence indicates that the Veteran did not have a thyroid disorder in service or for many years thereafter, and that her thyroid disorder was not related to her service, to include exposure to contaminated water at Camp Lejeune. The Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert, supra. The claim is denied. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jeremy J. Olsen, 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.