Citation Nr: 1027666 Decision Date: 07/23/10 Archive Date: 08/02/10 DOCKET NO. 09-23 486 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to service connection for a skin disorder. 2. Entitlement to service connection for diabetes mellitus. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD K. R. Fletcher, Counsel INTRODUCTION The appellant is a veteran who served on active duty from February 1974 to March 1978. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2009 rating decision by the North Little Rock, Arkansas Department of Veterans Affairs (VA) Regional Office (RO). In February 2010, a Travel Board hearing was held before the undersigned; a transcript of this hearing is of record. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if any action on his part is required. REMAND The Veteran contends that he has a skin disorder and diabetes mellitus due to exposure to Agent Orange in Okinawa or exposure to contaminated water at Camp Lejeune during his military service. In the alternative, he claims that his diabetes mellitus is due to the medication he took for his skin disorder. VBA Training Letter No. 10-03 (April 26, 2010) notes: From the 1950s through the mid-1980s, persons residing or working at the U.S. Marine Corps Base at Camp Lejeune, North Carolina, were potentially exposed to drinking water contaminated with volatile organic compounds. Two of the eight water treatment facilities supplying water to the base were contaminated with either tricholoroethylene (TCE) or tetrachloroethylene (perchloroethylene, or PCE) from an off-base dry cleaning facility. The Department of Health and Human Services' Agency for Toxic Substances and Disease Registry (ATSDR) estimated that TCE and PCE drinking water levels exceeded current standards from 1957 to 1987 and represented a public health hazard. The heavily contaminated wells were shut down in February 1985, but it is estimated that over one million individuals, including civilians and children, may have been exposed. . . . The National Research Council of the National Academies of Science released a report in June 2009, which found that scientific evidence for any health problems from past water contamination is limited. The evidence for amounts, types, and locations of contamination were not well recorded at the time and cannot now be extrapolated. Therefore, conclusive proof of harmful health effects is unlikely to be resolved with any further studies. In October 2008, the Department of the Navy issued a letter to Veterans who were stationed at Camp Lejeune between 1957 and 1987. The letter explained that the Navy had established a health registry and encouraged participation. . . . Disability claims based on exposure to contaminated water at Camp Lejeune must be handled on a case-by-case basis. Actual service at the installation during the timeframe of water contamination must be established. Initially, the Board notes that the Veteran's complete service treatment records (STRs) are unavailable for review. VA has a heightened duty to assist the Veteran in developing his claim since the STRs in this case are not available. See O'Hare v. Derwinski, 1 Vet. App. 365 (1991). The Veteran's DD Form 214 notes that his last duty assignment was at Camp Lejeune. There are no other service personnel records in the claims file, and it does not appear that a request was ever made to obtain such records. If the records exist, they would likely include pertinent, perhaps critical, evidence in the matters at hand, to include how long the Veteran was stationed at Camp Lejeune. Post-service medical evidence includes both VA and private treatment records which note diagnoses of skin disorders and diabetes mellitus. The Veteran has not yet been scheduled for a VA examination in conjunction with his claims. Remand is indicated for VA to obtain a medical opinion pursuant to 38 U.S.C.A. § 5103A. Accordingly, the case is REMANDED for the following action: 1. The AMC/RO is to undertake development of this claim following the guidelines set forth in VBA Training Letter No. 10-03 (April 26, 2010), to include securing and associating with the record, the Veteran's complete service personnel file. If such records are unavailable because they have been irretrievably lost or destroyed, it should be so certified for the record. 2. After the proper development outlined in the training letter had been completed, the AMC/RO should arrange for the Veteran to be examined by a VA physician with the appropriate expertise to ascertain the likely etiology of any current skin disorder. The Veteran's claims folder (to include this remand) must be reviewed by the physician in conjunction with the examination. The examiner should provide an opinion responding to the following: Is it at least as likely as not (i.e., a 50 percent or better probability) that the Veteran's current skin disorder had its onset in, or is otherwise related to, his military service, to include confirmed time spent at Camp Lejeune where the drinking water was contaminated? The examiner must explain the rationale for the opinion. 3. The AMC/RO should arrange for the Veteran to be examined by a VA physician with the appropriate expertise to ascertain the likely etiology of any current diabetes mellitus. The Veteran's claims folder (to include this remand) must be reviewed by the physician in conjunction with the examination. The examiner should provide an opinion responding to the following: Is it at least as likely as not (i.e., a 50 percent or better probability) that the Veteran's current diabetes mellitus had its onset in, or is otherwise related to, his military service, to include confirmed time spent at Camp Lejeune where the drinking water was contaminated? Is it as least as likely as not (i.e., a 50 percent or better probability) that the Veteran's current diabetes mellitus is related to medication taken for his skin disorder? The examiner must explain the rationale for the opinion. 4. The Veteran must be given adequate notice of the date and place of any requested examination. A copy of all notifications, including the address where the notice was sent must be associated with the claims folder. The Veteran is to be advised that failure to report for a scheduled VA examination without good cause shown may have adverse effects on his claims. 5. The AMC/RO should then re-adjudicate the claims of service connection for a skin disorder and diabetes mellitus. If either remains denied, the RO should issue an appropriate supplemental statement of the case, and afford the Veteran the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The appellant has the right to submit additional evidence and argument on the matters that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ RENÉE M. PELLETIER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).