Citation Nr: 20002091 Decision Date: 01/09/20 Archive Date: 01/09/20 DOCKET NO. 18-33 284 DATE: January 9, 2020 REMANDED Entitlement to service connection for an enlarged prostate is remanded. Entitlement to service connection for fibroadenosis of breasts, claimed as bilateral breast cysts or nodules, is remanded. Entitlement to service connection for kidney cysts is remanded. Entitlement to service connection for heart disease is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marine Corps from June 1970 to September 1971. In the Veteran’s June 2018 substantive appeal, he requested a hearing before the Board. In July 2019, the Veteran withdrew his request for a hearing; consequently, there remain no outstanding hearing requests of record. 38 C.F.R. § 20.704(e). 1. Entitlement to service connection for an enlarged prostate, fibroadenosis, kidney cysts, and heart disease. The Veteran claims entitlement to service connection for an enlarged prostate, fibroadenosis, kidney cysts, and heart disease. The Veteran contends that his exposure to contaminated water at Camp Lejeune is related to his current disabilities. Further, the Veteran contends that his current heart disease was incurred during his period of active service and resulted in his medical discharge form the United States Marine Corps. The Veteran’s VA and private medical treatment records note a current diagnosis for the Veteran’s claimed disabilities. The Veteran’s claimed disabilities are not listed as presumptive disabilities associated with contaminated water. See 38 C.F.R. § 3.309(f). However, service connection for a disability claimed as due to contaminated water at Camp Lejeune, North Carolina, may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. Combee v. Brown, 34 F. 3d 1039, 1044 (Fed. Cir. 1994), citing 38 U.S.C. § 1113(b) and 1116 and 38 C.F.R. § 3.303. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in initial service connection claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is a low one. Id., at 83. At present, the Veteran’s VA treatment and private medical records note a current diagnosis of his claimed disabilities. Further, the Veteran has established exposure to contaminated water at Camp Lejeune. Moreover, the Veteran submitted evidence noting a medical disability that occurred in-service leading to the Veteran’s medical discharge. The Veteran contends that his current disabilities were incurred during or caused his active service. At present, the probative evidence of record does not contain a medical opinion regarding the etiology of the Veteran’s claimed disabilities. The Veteran’s claims for service connection cannot be comprehensively evaluated without a VA opinion regarding etiology. Accordingly, the matters are REMANDED for the following action: 1. Obtain a VA opinion from appropriate examiner(s) for the Veteran’s enlarged prostate disability, fibroadenosis of breasts disability, kidney cysts, and heart disease. The examiner(s) must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s prostate disability, fibroadenosis of breasts disability, kidney cysts, and heart disease began during active service, or is related to an incident of service, including exposure to contaminated water at Camp Lejeune, North Carolina. The examiner(s) must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner(s) must state this and provide a rationale for such conclusion. (Continued on the next page)   2. After all completed development, the AOJ should then readjudicate the claim. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case and afforded the requisite opportunity to respond before the case is returned to the Board. Irvin Cannaday Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Riordan, 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.