Citation Nr: 1045673 Decision Date: 12/06/10 Archive Date: 12/14/10 DOCKET NO. 08-23 182 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to service connection for residuals of renal cancer, to include as secondary to chemical and insecticide exposure. REPRESENTATION Appellant represented by: Missouri Veterans Commission ATTORNEY FOR THE BOARD S.J. Janec, Counsel INTRODUCTION The Veteran had active military service from October 1975 to March 1976, from November 1976 to November 1980, from August 1984 to August 1988, and periods of National Guard service from June 1990 to June 2003. This matter comes before the Board of Veterans' Appeals (Board) from an August 2007 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in St. Louis, Missouri. In May 2010, the Board remanded the case for further evidentiary development. After the claim was readjudicated and a supplemental statement of the case was issued, the Veteran submitted additional evidence with a waiver of RO review in accordance with 38 C.F.R. § 20.1304 (2010). Nevertheless, for the reasons explained below, the Board finds that another remand is necessary. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran was diagnosed with clear cell renal cell carcinoma in 2000. He avers that his renal cell carcinoma was causally related to active service, to include exposure to chemical agents while at Red Stone Arsenal in 1977, exposure to insecticides while in the National Guard in August 1993, and exposure to chemically contaminated drinking water while stationed at Camp Lejeune, North Carolina. With regard to chemically contaminated drinking water, the Veteran's service treatment records and personnel records reflect that he was stationed at Camp Lejeune, North Carolina from December 1984 to August 1988. The Board acknowledges that persons residing or working at the U.S. Marine Corps Base at Camp Lejeune, North Carolina, in the early to mid-1980s were potentially exposed to drinking water contaminated with volatile organic compounds. In June 2009, the National Research Council of the National Academies of Science released a report which found that scientific evidence for any health problems from past water contamination is limited. In June 2010, the Veteran's file was reviewed by a VA physician who opined that it was more likely that the Veteran's personal usage of tobacco was more substantially proximate to the development of renal cell carcinoma than the environmental hazards posed by organophosphates and other toxins. He noted that the levels of the toxins in the water at Camp Lejeune were not available in his review of the claims folder, and he was unable to find any literature supporting a strong causation for chemical exposure and kidney cancer, at least not as strong as cigarette smoking. In this regard, the Board observes that the March 2008 letter from the United States Marine Corps to the Veteran pertaining to his exposure to unregulated chemicals in the drinking water systems at Camp Lejeune noted that additional information pertaining to the health registry, on-going studies, and a history of events was available via their website or by calling a toll-free information line. Additionally, the Veteran submitted an internet article about kidney cancer that included exposure to trichloroethylene as a common risk factor to the development of the disease and a September 2010 written testimony statement from another veteran who was stationed at Camp Lejeune and subsequently developed renal cancer. In light of this information, the Board finds that the June 2010 opinion is of limited probative value. Hence, another opinion must be obtained. Moreover, since it may be possible to ascertain the exposure levels in the Veteran's case, an attempt to secure additional information from the Marine Corps with regard to studies, etc. should be made. Accordingly, the case is REMANDED for the following action: 1. Obtain all available information pertaining to the Marine Corps health registry, on-going studies, and possible dose estimates with regard to the unregulated chemicals in the drinking water systems at Camp Lejeune via the website or by phoning the toll-free number, as noted in the March 2008 letter from the United States Marine Corps to the Veteran pertaining to his exposure to unregulated chemicals in the drinking water systems at Camp Lejeune. All pertinent information, including any estimates regarding dosage, should be associated with the claims file. 2. After the above records have been obtained, provide the claims folder to an appropriate VA clinician of relevant expertise to provide a medical opinion in this case. The clinician should review the claims file, to include this remand, and should note such in the opinion. If the clinician determines that an examination of the Veteran is warranted, schedule the Veteran for such an examination. The clinician should provide an opinion as to whether it is at least as likely as not (whether there is a 50 percent or greater probability) that the Veteran's renal carcinoma was causally related to active service, to include the Veteran's potential exposure to contaminated drinking water while at Camp Lejeune, North Carolina between December 1984 and August 1988. The clinician is requested to provide a complete rationale for his or her opinions, as a matter of medical probability, based on his or her clinical experience, medical expertise, and established medical principles. The clinician is advised that the term "as likely as not" does not mean within the realm of possibility. Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is medically sound to find in favor of causation as to find against causation. If the examiner is unable to render an opinion without resort to speculation, he or she should so state. 3. After undertaking any other necessary development, readjudicate the Veteran's claim for service connection for residuals of renal cancer, to include as secondary to chemical and insecticide exposure in light of all the evidence of record, including the information submitted by the Veteran in October 2010. If the benefit sought on appeal remains denied, the Veteran and his representative must be provided with a Supplemental Statement of the Case, and given an appropriate opportunity to respond. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. 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 of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims 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). _________________________________________________ U. R. POWELL 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) (2010).