Citation Nr: 18100735
Decision Date: 04/20/18	Archive Date: 04/20/18

DOCKET NO. 14-39 392
DATE:	April 20, 2018
ISSUES DECIDED:	0	ISSUES REMANDED:	2
 
REMANDED ISSUES
The issues of entitlement to service connection for bladder cancer and prostate cancer, based on exposure to contaminants in the water supply at Camp Lejeune are remanded for additional development.
The Veteran served on active duty from May 1969 to May 1972.  During service, the Veteran was stationed at Camp Lejeune, North Carolina on multiple occasions.
The Veteran seeks service connection for bladder cancer and prostate cancer, based on exposure to contaminants in the water supply at Camp Lejeune, North Carolina.
In January 2013, the AOJ obtained a medical opinion on the etiology of the Veteran’s bladder and prostate conditions.  The VA examiner first opined that, while the Veteran had a diagnosis of prostate cancer, he did not have a diagnosis of bladder cancer.  Specifically, the VA examiner opined that the Veteran’s prostate cancer was close to the bladder, but that the Veteran did not have bladder cancer.  Next, based on review of medical literature, the VA physician opined that the Veteran’s prostate cancer was not caused by the Veteran’s exposure to contaminants while stationed at Camp Lejeune.  The rationale provided was that the Veteran’s occupational exposure did not generate a higher-than-two-fold-risk.
In September 2014, the Veteran submitted a treatment note from his private treating physician.  The private physician indicated a concern that the Veteran’s prostate cancer may be related to his exposure to contaminants while stationed at Camp Lejeune.  See Swann v. Brown, 5 Vet. App. 229, 232 (1993) (noting that the weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated).
Given the medical evidence submitted by the Veteran and inadequate rationale provided in the January 2013 VA medical opinion, a new medical opinion is necessary to allow the Board to make a fully informed decision.

 
The matters are REMANDED for the following action:
1.  Contact the Veteran and ask him to provide sufficient information and necessary authorization in order to obtain copies of any outstanding records of treatment by VA or non-VA health care providers for any lumbar or cervical spine treatment.  The letter should invite the Veteran to submit any pertinent medical evidence in support of his claim.
2.  After completion of the development above.  Obtain an addendum medical opinion by an appropriate clinician to determine the nature and etiology of any bladder and prostate disabilities. If the VA examiner determines that an additional examination of the Veteran is necessary to provide reliable opinions as to causation, such examination should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary.  
The examiner is asked to provide the following opinions:
	(a) Does the Veteran have a current diagnosis of 	bladder cancer?
(b) Concerning the current diagnosis of prostate cancer, provide an opinion as to whether it is at least as likely as not that it was incurred during the Veteran's active military service, to include exposure to contaminants in the water supply while stationed at Camp Lejeune?
The VA examiner should discuss the Veteran’s exposure to contaminants in the water supply while stationed at Camp Lejeune.  Further, the examiner must comment on the September 2014 treatment note from the Veteran’s private treating physician.
3.  After completing all indicated development, and any additional development deemed necessary, readjudicate the claims.  If any benefit sought on appeal remains denied, then a fully responsive supplemental statement of the case should be furnished to the Veteran and his representative, and they should be afforded a reasonable opportunity for response.
 
 
H. SEESEL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Teague, Associate Counsel