Citation Nr: 19159409 Decision Date: 07/31/19 Archive Date: 07/31/19 DOCKET NO. 16-52 805 DATE: July 31, 2019 REMANDED Entitlement to service connection for coronary artery disease (CAD), to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. Entitlement to service connection for peripheral vascular disease, to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. Entitlement to service connection for diabetes mellitus, type II, with bilateral amputation of the lower legs, to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1972 to December 1975. 1. Entitlement to service connection for coronary artery disease (CAD), to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. 2. Entitlement to service connection for peripheral vascular disease, to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. 3. Entitlement to service connection for diabetes mellitus, type II, with bilateral amputation of the lower legs, to include as due to exposure to herbicides and as due to exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina is remanded. The Veteran has asserted multiple theories of entitlement to service connection for his CAD, peripheral vascular disease and diabetes mellitus, type II. One of the theories of entitlement is that he was exposed to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune, North Carolina. A review of the Veteran’s military personnel files shows that he was stationed at Camp Lejeune for a period of 14 weeks ending in November 1972. The Veteran has not been afforded a VA examination to determine whether any of his claimed conditions are a result of exposure to contaminants present in the water supply at U.S. Marine Corps Base Camp LeJeune. Therefore, the Board finds that medical examinations and opinions are needed with regard to the cause of his CAD, peripheral vascular disease and diabetes mellitus. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his cardiac, hypertension, and diabetes mellitus disorders. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding, relevant VA medical records should also be obtained and associated with the claims file. 2. After the above development has been completed, the AOJ should schedule the Veteran for a VA medical examination to determine the nature and etiology of any diagnosed peripheral vascular disease. The examiner is requested to perform all testing deemed necessary, review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran’s military records confirm that the Veteran was stationed at Camp Lejeune during the relevant time period, and thus, he could have been exposed to contaminated drinking water. The examiner should then render an opinion as to: Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran has peripheral vascular disease that is causally or etiologically related to his military service. In rendering this opinion, the examiner should also specifically address whether the Veteran’s peripheral vascular disease may be due to exposure to toxic chemicals or contaminated drinking water at Camp Lejeune. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After the above development has been completed, the AOJ should schedule the Veteran for a VA medical examination to determine the nature and etiology of any cardiac disorders that may be present, to include coronary artery disease. The examiner is requested to perform all testing deemed necessary, review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran’s military records confirm that the Veteran was stationed at Camp Lejeune during the relevant time period, and thus, he could have been exposed to contaminated drinking water. The examiner should then render an opinion as to: Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran has a cardiac disorder and/or coronary artery disease that is causally or etiologically related to his military service. In rendering this opinion, the examiner should also specifically address whether the Veteran’s cardiac disorder and/or coronary artery disease may be due to exposure to toxic chemicals or contaminated drinking water at Camp Lejeune. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. After the above development has been completed, the AOJ should schedule the Veteran for a VA medical examination to determine the nature and etiology of his currently diagnosed diabetes mellitus, type II. The examiner is requested to perform all testing deemed necessary, review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran’s military records confirm that the Veteran was stationed at Camp Lejeune during the relevant time period, and thus, he could have been exposed to contaminated drinking water. The examiner should then render an opinion as to: Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran has diabetes mellitus, type II, that is causally or etiologically related to his military service. In rendering this opinion, the examiner should also specifically address whether the Veteran’s diabetes mellitus, type II, may be due to exposure to toxic chemicals or contaminated drinking water at Camp Lejeune. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 5. When the development requested has been completed, the case should be reviewed by the AOJ on the basis of the additional evidence. If the benefits sought on appeal are not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case (SSOC) and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.