Citation Nr: 22052003 Decision Date: 09/13/22 Archive Date: 09/13/22 DOCKET NO. 19-14 267 DATE: September 13, 2022 REMANDED Service connection for esophageal cancer, for accrued benefits purposes, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from December 1971 to December 1974 and December 1974 to December 1978. The Appellant is the surviving spouse and was properly substituted in the Veteran's claims. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In May 2020 the Appellant testified at a Board hearing before the undersigned; a transcript of the hearing is associated with the record. As an initial matter, the Board expresses its sincere condolences to the Appellant at the passing of the Veteran, her spouse, in September 2018. 1. Service connection for esophageal cancer, for accrued benefits purposes, is remanded. The record shows that the Veteran was stationed and served at Camp Lejeune Marine Corps base in 1974. (See military personnel records, rec'd October 2016.) VA obtained a January 2017 VA medical opinion, in which the VA examiner confirmed the Veteran's current diagnosis of esophageal cancer. The examiner opined that the Veteran's esophageal cancer was less likely than not caused by or the result of exposure to contaminated water at Camp Lejeune. However, within the reasoning of the examiner's opinion, she stated, "while several studies have suggested that dry cleaning workers exposed to organic solvents such as [perchloroethylene] may have increased risks of esophageal cancer, in these studies, confounding by alcohol and smoking could not be ruled out." The Board finds further explanation is warranted because the examiner's opinion seems to suggest that the Veteran's exposure to contaminated water could be a cause of his esophageal cancer. Further, no opinion on direct service connection was rendered. Finally, the Veteran and Appellant have asserted that alcohol and smoking were heavily used by the Veteran as a form of self-medicating relating to his service-connected PTSD. In other words, the Veteran's esophageal cancer may have been caused or aggravated by the Veteran's service-connected disability due to the substances the Veteran used as self-treatment. Accordingly, a remand is required to obtain an addendum medical opinion addressing this theory of entitlement. The matters are REMANDED for the following action: 1. The AOJ should arrange for a VA medical opinion to determine the nature and likely cause of the Veteran's esophageal cancer disability. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) The Veteran's esophageal cancer diagnosis is established, and the examiner may assume this fact for the purposes of any opinion rendered. (b.) For his esophageal cancer disability, is it nearly equally likely (approximately balanced) that the disability was either (1) caused or (2) aggravated by the Veteran's service-connected PTSD? Please explain why. The opinion must address whether the disability increased in severity beyond its natural progression (i.e., was aggravated). If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. The examiner MUST address whether the self-medication (including alcohol and tobacco smoking) was due to his PTSD and, if so, whether it contributed to his development of esophageal cancer. (c.) For his esophageal cancer disability, is it nearly equally likely (approximately balanced) that the Veteran's esophageal cancer was caused or aggravated by exposure to contaminants in the waters of Camp Lejeune? The examiner MUST address the opinion of the January 2017 which indicated that the contaminated water may have caused the Veteran's cancer but concluded otherwise because of the Veteran's tobacco smoking and alcohol consumption. The examiner may not solely rely on an absence of a VA presumption for a diagnosed disability and must discuss the Veteran's specific background. (d.) For his esophageal cancer disability, is it nearly equally likely (approximately balanced) that the Veteran's esophageal cancer was otherwise directly caused or aggravated by the Veteran's military service? The examiner may not solely rely on an absence of a VA presumption and MUST discuss the Veteran's specific background. The examiner is reminded that the Veteran is competent (qualified) to provide information about observable symptoms and events. The examiner should assume, for the purposes of the opinions, that the Veteran's reports are both accurate and credible. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Williams, 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.