Citation Nr: 20005475 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 16-00 271 DATE: January 23, 2020 REMANDED Entitlement to service connection for a neurological disorder (claimed as a neurobehavioral disorder and tremors), to include as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1971 to February 1973 in the United States Marine Corps. The Veteran testified before the undersigned Veterans Law Judge at an October 2019 hearing. A hearing transcript is associated with the record. Entitlement to service connection for a neurological disorder (claimed as a behavioral disability with tremors), to include as due to exposure to contaminated water at Camp Lejeune, is remanded. The Veteran contends that he has a neurological disability caused by his exposure to contaminated water at Camp Lejeune during active service. He testified that he was diagnosed with encephalopathy (brain damage) in 2015 and that he first noticed abnormal neurobehavioral symptoms, which he did not specify, roughly 20 years after service discharge. At his hearing, he noted that internet research supports a link between his problems and the contaminated water at Camp Lejeune. The VLJ held the record open for the submission of a medical nexus opinion. It is noted that exposure to contaminated water at Camp Lejeune has been conceded. Further, the record reflects that the Veteran has been diagnosed with essential tremors. A review of the record reflects that the Veteran has provided conflicting reports on the initial onset of his tremors—in one instance, he reported onset of tremors at age thirteen; whereas, on other occasions, he reported a more recent onset of tremors. VA outpatient treatment notes suggest a family history, but in statements to the VA, the Veteran has adamantly denied this, insisting that only a brother who also served at Camp Lejeune has ever experienced tremors. The record shows that the Veteran also sustained a workplace injury to his neck and left shoulder in 2013 and has reported that his tremors worsened following this injury. The question here is whether the Veteran’s current disability is related to his in-service injury, exposure to contaminated water at Camp Lejeune. However, to ensure that VA has met its duty to assist, the Board finds that remand is necessary for the following reasons. First, the etiology of the Veteran’s tremors is unclear. Second, a medical opinion supported by a complete rationale is not of record. Although tremors (outside of Parkinson’s disease) is not a disease presumptively associated with exposure to contaminated water at Camp Lejeune under 38 C.F.R. § 3.309(f), service connection may be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In November 2019, the Veteran submitted a nexus statement from an unidentified neurologist who opined that the Veteran's essential tremors are most likely caused by or related to contaminated drinking water at Camp Lejeune. A complete rationale for the opinion was not provided. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Given that there is competent evidence of an injury in service and a current disability, but insufficient competent medical evidence on file to make a decision on the claim, remand is required. See McLendon v. Nicholson, 20 Vet. App. 79, 81-85 (2006). Additionally, remand is necessary to obtain outstanding Federal treatment record. It is noted that the record includes VA treatment records dated as early as May 2013, but it shows that that he is followed by neurology clinic and suggest earlier records of VA treatment. Also, the record shows that there are outstanding records associated with the Veteran’s Social Security Administration (SSA) disability claim. Murincsak v. Derwinski, 2 Vet. App. 363 (1992). Accordingly, the matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for his neurological symptoms (neurobehavioral disorder with tremors) since service discharge, to include from the neurologist (if non-VA) who completed his November 2019 “nexus statement.” Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records for the period prior to May 2013 and from October 2017 to the Present. 3. Obtain the records associated with the Veteran’s claim for SSA disability benefits. Document all requests for information as well as all responses in the claims file. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any neurological disorder to include neurobehavioral disability with essential tremors. (a.) To the extent that there is an organic disease of the nervous system, indicate whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. (b.) As the Veteran is presumed to have contaminant exposure from water at Camp Lejeune, without a presumptive disease, indicate whether any neurological disorder shown (to include tremors) is at least as likely as not related to contaminants in the water during service at Camp Lejeune. 5. Ensure that the VA medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. CONTINUED ON NEXT PAGE 6. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.D. Anderson, 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.