Citation Nr: 22013436 Decision Date: 03/09/22 Archive Date: 03/09/22 DOCKET NO. 20-05 304 DATE: March 9, 2022 REMANDED Entitlement to service connection for esophageal cancer, to include as due to exposure to contaminated water at Camp Lejeune (CWCL), is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from December 1956 to December 1959. This matter is before the Board on appeal from a July 2014 Department of Veterans Affairs (VA) rating decision. In March 2021, the Board denied the claim for service connection. Pursuant to a Joint Motion for Remand, the Court of Appeals for Veterans Claims (CAVC) issued a November 2021 Order, vacating the Board's decision and remanding the matter for action consistent with the terms of the Joint Motion. Entitlement to service connection for esophageal cancer, to include as due to exposure to CWCL, is remanded. The Veteran's representative contends that the medical opinion evidence in the record is inadequate regarding whether the Veteran's esophageal cancer was caused by exposure to CWCL. The representative cited the March 2018 VA examination, when the examiner noted that The Assessment of Evidence for the Drinking Water Contamination at Camp Lejeune and Specific Causes and Other Diseases (ATSDR January 13, 2017) does not list esophagus cancer as a condition having a suspected association to potential exposure to the Camp Lejeune contaminated water substances. The examiner further noted that the Veteran's hiatal hernia and gastroesophageal reflux disease caused and/or contributed to the development of Barrett's esophagus, which is a precursor condition that is known to advance and develop into adenocarcinoma of the esophagus; cited other risk factors including his age, gender, and past history of smoking cigarettes, and concluded that the Veteran's esophageal cancer is not caused by or a result of exposure to CWCL. The Veteran's representative contends that the examiner did not explain why the esophageal cancer could not be related to CWCL or address relevant medical literature that suggests a nexus between the two, before concluding that there is no nexus without further explanation of rationale. The representative cited VA treatment records in which two of the Veteran's primary care treatment providers suggest (without adequate explanation of rationale) that his esophageal cancer is due to his exposure to CWCL (see February 2016, May 2016, October 2017, April 2019 VA treatment). The representative also cited a February 2014 research article about a National Institutes of Health study, "Evaluation of mortality among marines and navy personnel exposed to contaminated drinking water at USMC base Camp Lejeune: a retrospective cohort study", which cited elevated mortality hazard ratios for all cancers (including esophageal) among the Camp Lejeune cohort compared to a Camp Pendleton cohort, and concluded that the study found elevated hazard ratios at Camp Lejeune for several causes of death including cancers of the kidney, liver, esophagus, cervix, multiple myeloma, Hodgkin lymphoma, and ALS. The Board agrees that the opinions of record are inadequate for rating purposes. An addendum advisory medical opinion is needed, because a fully informed decision on this issue cannot be made based on the record as it stands. A remand for a fully adequate medical advisory opinion is necessary. 38 C.F.R. § 19.9(a). The matter is REMANDED for the following action: Arrange for the Veteran's record to be forwarded to a subject matter expert for review and an advisory medical opinion addressing whether his esophageal cancer is at least as likely as not (a 50% or better probability) related to his acknowledged exposure to contaminated water at Camp Lejeune during service. The consulting clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and medical principles as deemed appropriate. The consulting clinician must specifically acknowledge the opinions by the Veteran's treatment providers suggesting a nexus between his esophageal cancer and exposure to CWCL, as well as the 2014 NIH study regarding CWCL, cited above. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechner, 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.