Citation Nr: 18148039 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 15-22 935A DATE: November 6, 2018 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. Entitlement to service connection for lung cancer, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. Entitlement to service connection for pulmonary nodule, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. Entitlement to service connection for a gall bladder disability, including as secondary to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. Entitlement to service connection for bone loss of the jaw, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. Entitlement to service connection for a dental disability due to abscess, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. REASONS FOR REMAND The Veteran had active duty military service from April 1978 to November 1981 and from May 1982 to May 1984. These matters come before the Board of Veterans’ Appeals (Board) from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for a dental disability due to abscess, bone loss of jaw, gall bladder disability to include surgical residuals, COPD, lung cancer, and a pulmonary nodule. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in February 2017. A copy of the transcript has been reviewed and associated with the claims file. 1. – 3. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), lung cancer, and/or pulmonary nodule, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. The Veteran asserts that his lung disabilities, including COPD, lung cancer, and pulmonary nodule were incurred in military service, including due to his exposure to contaminated water at Camp Lejeune and Camp Pendleton. The Veteran’s service-treatment records reveal that he was positive for tuberculosis and underwent annual chest x-rays. He was treated for one year with an infection in 1972. The Veteran’s military personnel records confirm that he was stationed at Camp Lejeune and Camp Pendleton during his active duty service. Throughout the rating period on appeal, the Veteran has been assessed with a pulmonary nodule and COPD. His VA treatment records dated in October 2011 indicated that he had a lung nodule, which was possible stage 1 cancer. A VA examination was performed in April 2012, at which time the examiner concluded that his pulmonary nodule and COPD were not related to service. The examiner reasoned that the Veteran did not have a history of COPD or any other obstructive lung disease in the military service and his chronic COPD was not related to his pulmonary nodule. After a review of the evidence, the Board finds that the April 2012 VA examination is insufficient to determine the present claim. In this regard, the examiner failed to acknowledge or discuss the Veteran’s assertions that his lung disabilities were related to his exposure to contaminated water at Camp Lejeune and/or Camp Pendleton. Furthermore, the examiner did not discuss whether the Veteran had a preexisting lung disease, or tuberculosis, that was aggravated by service. Accordingly, the Board finds that a remand is warranted in order for a new VA examination to be performed. 4. Entitlement to service connection for a gall bladder disability, including as secondary to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. The Veteran asserts that his gallbladder disability was incurred in service, including his exposure to contaminated water at Camp Lejeune and/or Camp Pendleton. The Veteran’s service treatment records reveal that he complained of abdominal pain and swelling and was assessed with a ventral hernia in September 1982 and June 1983. In January 2012, a CT scan of the chest revealed sludge within the gallbladder and minimal hiatal hernia. In August 2012 the Veteran was assessed with gallstones and subsequently underwent gallbladder removal in September 2012. The Board notes that the Veteran has not been afforded a VA examination on this issue. Given that he has a present disability that may be related to service, the Board finds that a VA examination is warranted. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). 5. – 6. Entitlement to service connection for bone loss of the jaw and/or dental disability due to abscess, to include as secondary to exposure to contaminated water at Camp Lejeune and/or Camp Pendleton is remanded. The Veteran asserts that he had a loss of his jaw and gums, teeth removed, and abscess of skin due to his military service, including exposure to contaminated water at Camp Lejeune and Camp Pendleton. In September 2011, the Veteran complained of excess tissue distal to tooth number 19. He was assessed with mild recession on buccal and mild buccal furcation involvement. A bone spur was removed from his gums subsequently and he was assessed with a healing extraction socket with small lingual area that needed to epithelialize. The Veteran testified at the hearing in February 2017 and indicated that he had 4 wisdom teeth extracted while he was at Camp Lejeune. After service the abscess and infection led to bone and gum loss. The Board notes that the Veteran has not been afforded a VA examination on this issue. Given that he has a present disability that may be related to service, the Board finds that a VA examination is warranted. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran’s updated VA treatment records from April 2016 to the present. Furthermore, obtain and associate with the claims file all Vista imaging documents from August 2010 to the present. 2. After completing #1, schedule the Veteran for a VA examination to determine the nature and etiology of any jaw or dental disability. The claims file, including this remand, must be reviewed by the examiner and such review should be noted in the examination report. The examiner should identify all dental and jaw disabilities found on examination and identified during the pendency or soon before the filing of this claim in August 2011, and respond to the following: is it at least as likely as not (50 percent probability or more) that the Veteran’s jaw and/or dental disability was incurred in and/or otherwise related to his period of active duty service, including exposure to contaminated water at Camp Lejeune and/or Camp Pendleton? If any bone loss is found, is it at least as likely as not (50 percent probability or more) that this bone loss is due to trauma or osteomyelitis incurred in service? The examiner must provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. 3. After completing #1, schedule the Veteran for a VA examination to determine the nature and etiology of any gallbladder disability. The claims file, including this remand, must be reviewed by the examiner and such review should be noted in the examination report. The examiner should identify all gallbladder disabilities found on examination and identified during the pendency or soon before the filing of this claim in August 2011, and respond to the following: is it at least as likely as not (50 percent probability or more) that the Veteran’s gallbladder disability was incurred in and/or otherwise related to his period of active duty service, including exposure to contaminated water at Camp Lejeune and/or Camp Pendleton? The examiner must provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. 4. After completion of #1, schedule the Veteran for a VA examination to determine the nature and etiology of any lung disability. The claims file, including this remand, must be reviewed by the examiner and such review should be noted in the examination report. The examiner should identify all lung disabilities found on examination and identified during the pendency or soon before the filing of this claim in August 2011, including a pulmonary nodule, COPD, and possible lung cancer. For each diagnosed lung disability, the examiner should respond to the following questions: a. Is there clear and unmistakable (undebatable) evidence that any lung disability pre-existed the Veteran’s entry into active duty military? b. If the answer to (a) is yes, then is there clear and unmistakable (undebatable) evidence that the pre-existing lung disability was NOT aggravated (i.e., permanently worsened) during his period of active service? (Continued on the next page)   c. If the answer to (a) is no, then for each diagnosed lung disability, is it at least as likely as not (a 50 percent probability or more) that it had its onset in and/or is otherwise etiologically related to his period of active service, including his exposure to contaminated water at Camp Lejeune and/or Camp Pendleton? Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Hurley, Associate Counsel