Citation Nr: 23008166 Decision Date: 02/08/23 Archive Date: 02/08/23 DOCKET NO. 18-40 967 DATE: February 8, 2023 ORDER Entitlement to service connection for prostate cancer is granted. Entitlement to service connection for erectile dysfunction as secondary to claimed for prostate cancer is granted. Entitlement to service connection for urinary incontinence as secondary to claimed for prostate cancer is granted. FINDINGS OF FACT 1. The Veteran was stationed at Camp Lejeune from May 1, 1985, to July 22, 1985, and is presumed to have been exposed to contaminated water during that time. 2. The evidence is in relative equipoise as to whether the Veteran's prostate cancer condition is at least as likely as not due to exposure of contaminated water at Camp Lejeune. 3. The Veteran's claimed for erectile dysfunction and urinary continence conditions are proximately due to his now service-connected prostate cancer disability. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for erectile dysfunction as secondary to service-connected prostate cancer are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for urinary incontinence as secondary to service-connected prostate cancer are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active-duty service from July 5, 1977 to May 5, 1990 and from January 7, 1991 to March 11, 1991. This matter comes before the Board of Veterans' Appeals (Board) from September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Service Connection 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). Effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 to provide a presumption of service connection for certain diseases based on exposure to contaminants present in the water supply at Camp Lejeune. The amendment defines "contaminants in the water supply" as the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. In order to qualify for presumptive service connection under these provisions, there must be evidence of: (1) a diagnosis of one of the enumerated diseases under the new provision 38 C.F.R. § 3.309(f), if manifest to a degree of 10 percent or more at any time after service; and (2) service of at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987. The enumerated diseases are: kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. Although the Veteran's claimed for conditions do not fall into the category of enumerated diseases under 38 C.F.R. § 3.309(f), when presumption service connection is not warranted, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact incurred during service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 1. Entitlement to service connection for prostate cancer The Veteran claims his currently diagnosed prostate cancer condition is directly related to his service at Camp Lejeune, specifically as due to exposure to the contaminated water supply. See October 2014 Statement in Support of Claim. As to the first element of Shedden, for service connection the Veteran must show a current disability. Per September 2014 VA examination report, the Veteran has a diagnosis of prostate cancer. As such, the Board finds that the first Shedden element to service connection has been met. As to the second element of Shedden, for service connection the Veteran must show an in-service incurrence or aggravation of a disease or injury. Per the Veteran's military personnel file, he had service at Camp Lejeune at from May 15, 1980 thru July 31, 1980. As said active-duty service equates to at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, the Board finds that exposure to contaminated water is to be presumed, and therefore his claim meets the second Shedden element to service connection. As to the last element of Shedden, for service connection the Veteran must show a causal relationship between the current disability and the in-service disease or injury. Of record are medical opinions weighing in favor of, as well as against, the Veteran's claim. The August 2015 VA examiner opined that given the length of duration (36 days), his age upon being diagnosed, as well as the limited scientific documentation linking prostate cancer to exposure to TCE and PERC, it is less likely as not that his claimed for condition was caused by or is a result of the Veteran's exposure the Camp Lejeune's water supply. In support of the Veteran's claim, private medical opinions by urological oncologists were submitted. Dr. W.J.A. opined that as the Veteran does not have a family history of prostate cancer, given his exposure, as well as the medical literature on the subject, it is more likely than not that his prostate cancer is related to service. See August 2015 private medical opinion by Dr. W.J.A. Also submitted in support is a private medical opinion rendered by Dr. J.H. stating that as the Veteran suffers from a more aggressive form of prostate cancer, given that he has no family history of the condition, and in light of his exposure to toxic chemicals at Camp Lejeune, it is more likely than not that his prostate cancer is related to service. See September 2014 private medical opinion by Dr. J.H. The Veteran argues that as both opinions were rendered by Board Certified urological oncologists, the Board should find in his favor on the issue of nexus here. Upon weighing the aforesaid evidence, the Board finds it so evenly balanced to allow for the application of the benefit-of- the-doubt rule. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The VA opinion draws a specific conclusion based on a review of the pertinent records, and provides the underlying reasons for the conclusion. Likewise, the private medical opinions of record are sound and thorough with sufficiently clear and well-reasoned rationales; notably, their rationales align and are not otherwise contradictory in terms of associating the Veteran's claimed for condition with service. See Bloom v. West, 12 Vet. App. 185, 187 (1999). Accordingly, as the evidence of record is found to be at least in equipoise as to whether the Veteran's claimed prostate condition relates to his exposure to the contaminated water supply at Camp Lejeune, the Board finds the Veteran entitled to service connection and the claim is granted. Secondary Service Connection 2. Entitlement to service connection for erectile dysfunction as secondary to claimed for prostate cancer 3. Entitlement to service connection for urinary incontinence as secondary to claimed for prostate cancer The September 2014 VA examiner found that the Veteran has residuals from his August 2014 radical prostatectomy, namely erectile dysfunction and urinary incontinence. Disability which is proximately due to or the result of a service-connected disease or injury shall be service-connected. 38 C.F.R. § 3.310. The record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Given that the Veteran's diagnosed erectile dysfunction and urinary incontinence conditions have been medically related to his now service-connected prostate cancer disability, service connection for these secondary conditions is warranted and the claims are granted. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.