Citation Nr: 21039709 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 17-36 099 DATE: July 1, 2021 ORDER Entitlement to service connection for multiple sclerosis (MS), to include as due to water contamination at Camp Lejeune, is denied. FINDING OF FACT The preponderance of the evidence is against finding that MS began during active service, or is otherwise related to an in-service injury or disease, to include exposure to water contamination at Camp Lejeune and exposure to solvents and chemicals in service. CONCLUSION OF LAW The criteria for service connection for MS are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1979 to October 1983. The Veteran testified at a hearing before the undersigned Veterans Law Judge in October 2019. A transcript of the hearing has been associated with the claims file. The issue was most recently before the Board in February 2021 when it was remanded for additional development. The Board finds there has been substantial compliance with the remand directives for the claim decided herein. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for MS to include as due to water contamination at Camp Lejeune. The Veteran contends that his diagnosed MS is etiologically related to his exposure to contaminated water while stationed at Camp Lejeune and/or exposure to solvents and chemicals in service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). If a Veteran served at Camp Lejeune, during the time frame specified, certain diseases including kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer shall be service-connected even though there is no record of such disease during service. 38 C.F.R. § 3.309 (f). The diseases listed in §3.309(f) shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307 (a)(7)(ii). 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. Personnel records indicate that the Veteran served at Camp Lejeune during the pertinent period and, therefore, exposure to contaminated water was conceded. His primary military specialty was as an auto mechanic. MS is not on the list of diseases presumptively linked, under the law, to such exposure. 38 C.F.R. § 3.309 (f). Therefore, the Veteran may establish entitlement to service connection through evidence showing direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Board's analysis below will involve an examination of the Veteran's claim based on direct causation. The Board concludes that, while the Veteran has a current diagnosis of MS, and evidence shows that he was exposed to contaminants in water at Camp Lejeune, the preponderance of the evidence weighs against finding that the MS disability began during service or is otherwise related to an in-service injury, event, or disease. VA treatment records indicate that the Veteran has been diagnosed with MS. See, e.g., VA Treatment,June 2018. A private provider completed a MS Disability Benefits Questionnaire (DBQ) in July 2015. In an August 2015 letter, the provider reported that the Veteran had a diagnosis of MS, he served at Camp Lejeune, and that the drinking water at Camp Lejeune was contaminated with chemicals. The provider rendered the opinion that it was as likely as not that his chronic MS was caused by his exposure to contaminated drinking water while stationed at Camp Lejeune. The provider offered the same opinion in May 2016. At the hearing before the undersigned the Veteran reported that he was diagnosed with MS about 2014 and that he got out of service in 1983. He stated that he began having symptoms around 2003 or 2004. The Veteran's representative indicated that an article discussing solvents and heavy metals and MS was being submitted. The Veteran noted that he was exposed to the water at Camp Lejeune and that he was exposed to solvents in service in his work on trucks. The Board remanded the claim twice for new medical opinions after determining that September 2016 and June 2020 VA opinions were inadequate. Those opinions are not relied upon in this decision and will be not discussed. In a March 2021 opinion provided in response to the most recent remand, the VA examiner concluded that the Veteran's MS was less likely as not caused by or a result of his exposure to contaminated water at Camp Lejeune. The examiner noted the Veteran served at Camp Lejeune for approximately 7.5 months, and would have potentially been exposed to toxic chemicals known to be in the water at Camp Lejeune, including TCE, PCE, vinyl chloride and benzene and he was diagnosed with MS approximately 33 years after having served at Camp Lejeune. In the rationale for the opinions, the examiner stated that MS remains an autoimmunological disease of unknown cause. The examiner discussed medical literature. Unproven theories of causes of MS were reported to include exposure to the heavy metals - mercury (including mercury amalgam tooth fillings), lead or manganese, and organic (chemical) solvents. The examiner noted that the Veteran had some risk factors for the disease, including age of diagnosis, Caucasian race, living in temperate climate and a smoking history. The examiner found that these are, however, features that many patients of MS possess. It was noted that these are not specific causes of the condition, which itself remains unknown. The examiner noted that no definitive link between exposure to certain chemicals and MS has been established. A study found that MS cases were more likely than controls to report lead and mercury exposure, but the study did not provide evidence for causality between exposure to Camp Lejeune water contaminants and MS. The examiner noted that in an article "Heavy Metals, organic solvents and multiple sclerosis: An exploratory look at gene-environmental interactions," the study looked at the relationship between environmental exposure to lead, mercury and solvents and 58 control subjects. The article stated that MS cases were more likely than controls to report lead and mercury exposure. MS cases were less likely to report organic solvent exposure . . . findings of potential environment interactions and lead, mercury or solvents should be considered cautiously due to limited sample size. Other medical literature was noted to not provide definitive evidence for causality nor answer the question whether an individual has been affected by these exposures at Camp Lejeune, that inadequate/insufficient evidence to determine whether an association exists between exposure to solvents and MS. The examiner identified the positive statement of the Veteran's private provider; however, the examiner noted that opinion did not identify specific medical evidence to support the conclusion reached assertion. That opinion did not take into account the Veteran's duration of exposure, method of exposure, concentration, any prior effects, etc. Literature that the private provider later supplied was also considered but did not show any sort of definitive conclusion to whether or not exposure to these chemicals can be implicated in MS development. Therefore, taking the data into account, and noting risk factors and literature as cited, the examiner concluded that the Veteran's MS is less likely as not caused by or a result of the Veteran's exposure to contaminated water at Camp Lejeune. The Board finds that entitlement to service connection for MS is not warranted. The Board acknowledges that the Veteran has a current diagnosis of MS, that he served at Camp Lejeune, and is presumed to have been exposed to contaminated water and chemicals at Camp Lejeune. MS is not a disorder for which presumptive service connection is warranted based on service at Camp Lejeune. The Board has considered whether the Veteran's MS is related to his presumed exposure to contaminated water at Camp Lejeune based on direct causation and concludes that the preponderance of the evidence is against the claim. The positive opinions of the Veteran's private provider are afforded little probative value because they do not include any discussion of the medical literature the medical record, or rationale for the opinion provided. The March 2021 VA opinion provider thoroughly considered the medical literature, including that submitted by the Veteran and the private provider, and the medical record, and rendered a negative opinion. The Board finds the VA examiner's opinion to be highly probative. In addition, although the Veteran has reported that he was exposed to solvents while in service as a mechanic, the Veteran did not identify the solvents to which he was exposed. The VA examiner noted that medical literature stated that MS cases were less likely to report organic solvent exposure and that findings of potential environment interactions and lead, mercury or solvents should be considered cautiously due to limited sample size. Therefore, as the preponderance of the evidence is against a finding that the Veteran's MS is related to his active service, including exposure to contaminated water at Camp Lejeune and exposure to solvents and chemicals, the claim is denied. M.E. LARKIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert J. Burriesci, 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.