Citation Nr: 18157352
Decision Date: 12/12/18	Archive Date: 12/12/18

DOCKET NO. 16-59 858
DATE:	December 12, 2018
REMANDED
Entitlement to service connection for polycythemia vera, to include as due to exposure to contaminants in the water supply at Camp Lejeune, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1973 to September 1975, including at Camp Lejeune.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) denying the Veteran’s claim for service connection for polycythemia vera (PV) due to exposure to contaminated water at Camp Lejeune.
The Veteran was afforded a VA examination in October 2015 after which the examiner opined that the Veteran’s PV was less likely as not caused by exposure to contaminated water at Camp Lejeune. The examiner’s rationale for his opinion was based in part on “the scant amount of available information in the medical file . . . such as an exact date of diagnosis or any pathology records which limits the ability to provide a second opinion on diagnosis [and] the lack of chart notes or medical provider evaluations which address risk factors for the disease and the consequent limited ability to provide a forensic opinion on causation.” However, in reviewing the record, the examiner recorded a February 2014 document that stated the Veteran was diagnosed with PV in January 2014, while also stating that there were no documents in the Virtual VA electronic claims folder. 
Since the VA examination, the Veteran has submitted treatment and other records relating to the PV. Among these, the Board notes a letter from Dr. S.J., who treats the Veteran’s PV, stating that the Veteran has been diagnosed with PV since 2003. Additionally, the Veteran has submitted articles from the University of Maryland Medical Center, WebMD, and Wikipedia concerning the disease, and the Veteran’s brothers, one of whom is the Veteran’s identical twin, have submitted letters that they served in the military but not in Camp Lejeune and have never had PV.
In light of the new evidence of record, including the medical evidence from before the October 2015 VA examination which may address diagnostic or pathology information that the VA examiner found scarce, the Board will remand for an updated opinion regarding an etiological link between the Veteran’s PV and exposure to contaminated water at Camp Lejeune.
Accordingly, the matter is REMANDED for the following action:
1. Obtain an addendum opinion from the October 2015 examiner, if available, or from an appropriate clinician if the October 2015 examiner is unavailable. The examiner should review the Veteran’s claims file, to include the medical records and internet articles submitted by the Veteran as well as the letters from the Veteran’s identical-twin brother and fraternal brother. 
The examiner must provide an opinion whether the Veteran’s polycythemia vera is at least as likely as not related to service, to include his exposure to contaminants in the water supply at Camp Lejeune. (It is conceded that the Veteran was exposed to such contaminants.) The examiner should discuss the reasons and bases for any opinion rendered.
2. After completing the above and any other development deemed necessary, readjudicate the Veteran’s claim based on the entirety of the evidence. To establish entitlement to service connection, the Veteran’s burden is to prove that there is an approximate balance of positive and negative evidence; he need not prove that an earlier rating decision denying the claim committed clear and unmistakable error, nor must any of his evidence be found new and material.
 
K. PARAKKAL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Davis, Associate Counsel