Citation Nr: 19125478 Decision Date: 04/04/19 Archive Date: 04/04/19 DOCKET NO. 17-36 409 DATE: April 4, 2019 REMANDED The issue of entitlement to service connection for Barrett’s esophagus, to include as secondary to service connected Non-Hodgkin’s Lymphoma (NHL), is remanded. The issue of entitlement to service connection for arteriosclerosis, to include as secondary to service connected NHL, is remanded. The issue of entitlement to service connection for colitis, to include as secondary to service connected NHL, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1975 to June 1977. This matter comes before the Board of Veterans’ Appeals (Board) from a November 2015 rating decision by the Department of Veterans’ Affairs (VA) Regional Office (RO). The November 2015 rating decision denied the Veteran’s claim for Barrett’s esophagus, arteriosclerosis, colitis, and peripheral neuropathy. In October 2016, the Veteran submitted a Notice of Disagreement (NOD) asserting that service connection should have been considered on a secondary basis. In May 2017, the RO issued a Statement of the Case continuing the denial of the claimed conditions, but the RO did not consider service connection on a secondary basis. In June 2017, the Veteran submitted a NOD with the May 2017 Statement of the Case. In October 2018, the Veteran underwent VA examinations to consider whether the conditions could be granted on a secondary basis. In February 2019, the RO issued a rating decision granting service connection for peripheral neuropathy, and issued a Supplemental Statement of the Case continuing the denial of service connection for Barrett’s esophagus, arteriosclerosis, and colitis. 1. Entitlement to service connection for Barrett’s esophagus, to include as secondary to service connected NHL 2. Entitlement to service connection for arteriosclerosis, to include as secondary to service connected NHL 3. Entitlement to service connection for colitis, to include as secondary to service connected NHL A review of the record indicates that the Veteran seeks service connection for his disabilities either as a result of his service, to include exposure to contaminated water at Camp Lejeune, or as secondary to service-connected disability, including the service connected NHL. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in or was aggravated by the line of duty in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection is also warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Id. However, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). In an August 2018 statement, the Veteran’s representative reiterated that the Veteran’s disorders were due to the Veteran’s exposure to contaminated water at Camp Lejeune. The Board also notes that during the pendency of the appeal, service connection for NHL and laryngeal cancer has been established. In October 2018, the Veteran underwent VA examinations to assess whether Barrett’s esophagus, arteriosclerosis, or colitis are secondarily related to his service connected NHL. The examiner confirmed the Veteran’s diagnoses. The examiner reviewed the Veteran’s medical records and discussed the Veteran’s medical history in regard to his Barrett’s esophagus, arteriosclerosis, and colitis. The examiner then opined that the Veteran’s Barrett’s esophagus, arteriosclerosis, and colitis are less likely than not proximately due to or the result of the Veteran’s service connected NHL. Although the VA examiner provided analyses regarding whether the Veteran’s Barrett’s esophagus, arteriosclerosis, or colitis have secondary causal relationships to his service connected NHL, the VA examiner did not address whether the Veteran’s Barrett’s esophagus, arteriosclerosis, or colitis were aggravated by his service connected NHL. A secondary opinion which addresses a causal relationship, but which does not address the question of aggravation, is inadequate. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion is inadequate when it does not consider all raised theories of entitlement. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). As such, an addendum opinion is needed to address whether the Veteran’s Barrett’s esophagus, arteriosclerosis, or colitis were aggravated by his service connected NHL. See El-Amin, 26 Vet. App. 136, 140 (2013). Additionally, to ensure that all of the Veteran’s contentions are addressed, an opinion as to whether the Veteran’s disorders are in any way directly related to service or any event of service, including the Veteran’s exposure to contaminated water at Camp Lejeune, should be provided. Accordingly, the matter is REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of any medical provider, VA or private, who has treated him for his Barrett’s esophagus, arteriosclerosis, or colitis conditions. After securing any necessary releases, the RO should request any relevant records identified that are not duplicates of those already contained in the claims file. Additionally, obtain VA treatment records that have not already been associated with the file. If any requested records are unavailable, the claims file should be annotated as such and the Veteran and his representative notified of such. 2. After associating any additional records with the claims file, obtain an addendum opinion addressing whether the Veteran’s Barrett’s esophagus, arteriosclerosis or colitis are in any way related to service, or were caused by, proximately due to, or aggravated by any service connected disability, including NHL. a) The VA examiner should address whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s Barrett’s esophagus, arteriosclerosis, or colitis are in any way related to service or any event of service, including the Veteran’s exposure to contaminated water at Camp Lejeune. b) The VA examiner should address whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s Barrett’s esophagus, arteriosclerosis or colitis were caused by, proximately due to, or aggravated by any service connected disability, including NHL and laryngeal cancer. The term “aggravation” means a permanent worsening of a disability beyond its natural progression. If aggravation is found, to the extent possible, the examiner should attempt to establish a baseline level of severity for the disability prior to its aggravation by the service-connected disability. A complete rationale must be provided for all opinions expressed. The pertinent evidence of record should be discussed, to include the Veteran’s lay statements A rationale for all opinions expressed should be set forth. If the examiner cannot provide an opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.).  (Continued on the next page)   The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369 (1999). C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Temple, Associate Counsel