Citation Nr: 18150018 Decision Date: 11/15/18 Archive Date: 11/14/18 DOCKET NO. 14-11 845 DATE: November 15, 2018 REMANDED 1. Entitlement to service connection for a brain tumor, to include as due to exposure to contaminated water supply at Camp Lejeune, is remanded. 2. Entitlement to service connection for a disability manifested by seizures, to include as secondary to a brain tumor, is remanded. 3. Entitlement to right ear hearing loss, to include as secondary to a brain tumor, is remanded. REFERRED In September 2015, the Board referred to the agency of original jurisdiction (AOJ) a claim of service connection for an acquired psychiatric disability (raised in a June 2015 statement). A review of the claims file found no action taken on the referral. Accordingly, the matter is again referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1976 to February 1987. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision. In September 2015, the case was remanded for additional development. An interim (March 2017) rating decision granted service connection for left ear hearing loss, and that matter is no longer before the Board. 1. Service connection for a brain tumor, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. The record still does not include an adequate medical opinion regarding the likely etiology of the Veteran’s brain tumor (variously characterized as a right-sided schwannoma, right acoustic neuroma, and a cerebellopontine angle tumor). In September 2015, the Board remanded the matter, in part, for a neurological examination to determine the nature and likely etiology of the Veteran’s brain tumor(s) and seizures. A January 2017 VA examination report is of record. On examination of the Veteran and review of the record, the examiner opined that the Veteran’s brain tumor is less likely than not related to service. His rationale simply noted that brain tumors and schwannomas are not listed by VA as presumptive diseases associated with exposure to contaminated water at Camp Lejeune, NC. While the case was on remand, an undated private medical statement from the Veteran’s primary care physician was associated to the record. [Although it contains a July 2015 Regional Office ‘Triage’ date stamp, it apparently was not received by the VA Claims Intake Center until November 2015.] The physician reports that the Veteran has a seizure disorder, chronic headaches, and depression that are secondary to his brain tumor. The physician opined that it is at least as likely as not that “the original Acoustic Neuroma and Depression that the veteran suffers was caused from the contaminated drinking water at Camp Lejeune, NC.” As rationale for the opinion, she wrote, “According to the research, the contaminated water at Camp Lejeune can cause neurobehavior changes such as depression. There is remote possibility that the exposure to water contaminated has contributed to [the Veteran’s] depression.” The Board finds that both opinions are inadequate for rating purposes as they are conclusory and lack adequate rationale. The VA examiner’s opinion is based merely on the absence of brain tumors from VA’s list of presumptive diseases associated with exposure to contaminated water at Camp Lejeune, and the private opinion is apparently based on unidentified research that contaminated water at Camp Lejeune can cause neurobehavior changes and that there is a remote possibility that the Veteran’s disabilities are related to such exposure. Accordingly, a remand to obtain an adequate medical opinion regarding the etiology of the Veteran’s brain tumor(s) is necessary. 2., 3. Service connection for a disability manifested by seizures and for right ear hearing loss, is remanded. The matters of service connection for a disability manifested by seizures and for right ear hearing loss are inextricably intertwined with the claim seeking service connection for a brain tumor. Therefore, appellate consideration of those matters must be deferred pending resolution of the other remanded claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following: 1. Secure for the record all updated records of VA evaluations and treatment the Veteran has received for his claimed disabilities. Ask the Veteran to provide identifying information regarding all private evaluations or treatment he has received for his claimed disabilities (records of which have not already been submitted), and to submit authorizations for VA to secure for the record complete outstanding clinical records from all providers identified. Obtain those records. 2. Thereafter, arrange for a neurological examination of the Veteran (by an examiner other than the January 2017 examiner) to determine the nature and likely etiology of his brain tumor(s) and seizures. The entire record (including this remand) must be reviewed by the examiner in conjunction with this examination. Based on a review of the record and examination of the Veteran, the examiner should provide opinions that respond to the following: (a) Identify the nature and likely etiology of the Veteran’s brain tumor, indicating whether he has one or multiple (and various) brain tumors (as the record shows diagnoses of a right sided schwannoma, a right acoustic neuroma, and a cerebellopontine angle tumor). (b) Identify the likely etiology of each brain tumor diagnosed, indicating specifically whether it at least as likely as not (a 50 percent or better probability) related to the Veteran’s service, and his exposure to contaminants in water at Camp Lejeune including trichloroethylene (TCE), perchloroethylene (PCE), benzene, or vinyl chloride (VC). The examiner is advised that the sole basis for a negative opinion cannot be the fact that brain tumors/schwannomas are not listed by VA as presumptive diseases associated with exposure to contaminated water at Camp Lejeune, NC. (c) Identify the likely etiology of the Veteran’s seizures. Specifically, is it at least as likely as not (a 50 percent or better probability) that they are related to his exposure to contaminated water at Camp Lejeune, or were caused or aggravated by his brain tumor(s). The examiner must include rationale with all opinions provided, citing to factual data and medical literature as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Dupont, Associate Counsel