Citation Nr: 20006005 Decision Date: 01/24/20 Archive Date: 01/23/20 DOCKET NO. 16-21 212 DATE: January 24, 2020 ORDER Service connection for schizophrenia, claimed as mental illness, is denied. Service connection for a neurobehavioral disorder is denied. FINDINGS OF FACTS 1. The weight of the evidence is against finding that the Veteran’s current psychiatric disorder, including schizophrenia, is related to his exposure to contaminated water at Camp Lejeune, or that it is related to his military service. 2. The preponderance of the evidence of record is against finding that the Veteran has had neurobehavioral effects, to include as due to exposure to contaminated water at Camp Lejeune and/or exposure to asbestos, at any time during or approximate to the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for service connection for schizophrenia, to include as due to exposure to contaminated water at Camp Lejeune, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for neurobehavioral effects are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1984 to August 1984. He also has other periods of Reserves training. He testified before a Veterans Law Judge at a November 2019 Board hearing. This matter is on appeal from a July 2014 rating decision. The Board notes that at his November 2019 Board hearing, the Veteran had previously filed a motion to hold the record open for thirty days so that he could submit additional service treatment records. However, a subsequent motion was advanced, expressing the Veteran’s desire to waive regional office consideration of the newly uploaded evidence. The Board now has jurisdiction to adjudicate the appeal. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303, 3.304. Service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Walker v. Shinseki, 701 F.3d 1331 (Fed. Cir. 2013). The Veteran is currently seeking service connection for a psychiatric condition, including schizophrenia as a result of his exposure to contaminants while stationed at Camp Lejeune. He asserts that he was stationed at Camp Lejeune for approximately 10 months during the summer of 1986 while under Reserve enlistment. Upon review of his military personnel records, the Veteran had additional periods of service beyond August 1984. He returned for several periods of active duty training between January 1985 and December 1989, with duties in food service and supplies. His service treatment records noted that he was stationed at Camp Johnson in Camp Lejeune between June 1986 and August 1986. As such, he is presumed to have been exposed during that service to contaminants in the Camp Lejeune water supply. Post service, the Veteran was seen for psychiatric problems in January 2000. He was ultimately diagnosed with (paranoid) schizophrenia for which he takes daily medication. He also sees a psychiatrist, who closely monitors his condition, every three months for treatment. VA has acknowledged that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1957 through December 1987 were potentially exposed to drinking contaminated water with volatile organic compounds (VOCs), including trichloroethylene (TCE), perchloroethylene (PCE), benzine, and vinyl chloride. Based on analyses of potential exposures at Camp Lejeune and scientific studies involving these chemicals, the National Academy of Sciences National Research Council (NRC) provided an assessment of the potential association between certain diseases and exposure to the chemical contaminants TCE and PCE. Fourteen diseases were placed into the category of limited/suggestive evidence of an association: esophageal cancer, lung cancer, breast cancer, bladder cancer, kidney cancer, adult leukemia, multiple myeloma, myelodysplastic syndromes, renal toxicity, hepatic steatosis, female infertility, miscarriage with exposure during pregnancy, scleroderma, and neurobehavioral effects. VA has determined that manifestation of any of these diseases in a veteran with verified Camp Lejeune service between 1957 and 1987 is sufficient to request a VA medical examination and an opinion regarding its relationship to Camp Lejeune service. Effective March 14, 2017, VA amended its adjudication regulations relating to presumptive service connection, adding eight diseases associated with contaminants present in the water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina, from August 1, 1953, to December 31, 1987. See 82 Federal Register 4173 (January 13, 2017). This final rule establishes presumptive service connection for Veterans, former reservists, and former National Guard members who served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) during this period, and who have been diagnosed with any of the following eight diseases: adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin’s lymphoma, and Parkinson’s disease. Specifically, the rulemaking amends 38 C.F.R. §§ 3.307 and 3.309. Id. Here, while the Veteran has a clinical diagnosis of a psychiatric condition, specifically, schizophrenia, it is not among the eight listed diseases for presumptive service connection in the new rule. But while a psychiatric disorder such as schizophrenia is not included as a presumptive condition, given that there was suggestive evidence of an association between the consumption of water at Camp Lejeune, the Board obtained a medical opinion from a VA physician on the nexus between his possible exposure and his current psychiatric condition. In a June 2013 VA medical opinion, the VA Senior Medical Advisor found that neuropsychiatric disorders are not related to exposure to Camp Lejeune contaminated water. The advisor explained that common unsubstantiated neuropsychiatric disorders claimed due to contaminated water included PTSD, depression, mood disorders, schizophrenia, anxiety disorders, adjustment disorders, panic attacks and manic-depressive psychosis. However, it was noted that there had been no scientific evidence found to support to support a causal link. The Veteran’s current psychiatric disorder and his military service cannot be presumed under the law, regardless of the Veteran’s exposure to contaminated water during service. As such, the Camp Lejeune contamination presumption is insufficient to fill the nexus gap in the Veteran’s service connection claim. Notwithstanding the foregoing presumption provisions for exposure to contaminated water at Camp Lejeune, the Veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Here, the same evidence is also against supporting a claim for direct service connection. The Board finds that the preponderance of the evidence is against finding that the Veteran’s current psychiatric disorder is causally related to service. The Veteran’s service treatment records are silent for any complaints or diagnosis indicative of a psychiatric condition. The Veteran reported no psychiatric conditions in his June 1988 Report of Medical History. He indicated that he was in good health. There was no indication or documentation of head trauma with residuals. At his Board hearing, the Veteran indicated that he was seen at medical sick bay in 1986 and received a thirty-day supply of medication. However, he could not recall why he was treated or what the medication was for. The Veteran was not diagnosed with a psychiatric condition until several years post service. Besides his own assertions, the Veteran has not provided any objective medical opinion that would offer a link between his condition and his military service. The opinion of causation should be determined by medical personnel with the requisite knowledge and training. The record does not show that the Veteran has such expertise and therefore, is not competent to provide the required nexus. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, service connection for a psychiatric condition is not warranted and the claim is denied. In addition, the Veteran also contends that he suffers from neurobehavior effects that are related to his exposure to contaminated water at Camp Lejeune, as well as possible exposure to asbestos. At his Board hearing, the Veteran indicated that he was exposed to asbestos while stationed at Camp Johnson. He specifically stated that during training, asbestos was being physically moved from some of the dormitory buildings. The Board notes that the Veteran’s separate claim for schizophrenia has now been denied. This claim, therefore is a separate service connection claim unrelated to his psychiatric condition. For purposes of hospital care and medical services for Camp Lejeune veterans, “neurobehavioral effects” is among the covered illnesses or conditions. 38 C.F.R. § 17.400 (b). For a Camp Lejeune veteran, VA will assume that a covered illness or condition is attributable to the veteran’s active duty service at Camp Lejeune unless it is clinically determined, under VA clinical practice guidelines, that such an illness or condition resulted from a cause other than such service. Id. § 17.400(c). Having already established that the Veteran is presumed to have been exposed during his service at Camp Lejeune to contaminants in the water supply, the question for the Board is whether he, in fact, has a disability manifested by neurobehavioral effects that is attributable to such exposure. However, the medical evidence of record fails to establish a diagnosis relating to neurobehavioral effects, other than the psychiatric disorder that was just previously denied. In a June 2013 VA medical opinion, the VA medical advisor indicated that neurobehavior conditions have a “limited and suggestive” link to contaminated water at Camp Lejeune. Neurobehavioral conditions and neuropsychiatric conditions are distinct and separate conditions which are frequently co-mingled in claims based on exposure to contaminated water. Neurobehavioral effects related to the contaminants at Camp Lejeune are due to toxic exposures. Common presenting neurobehavioral symptoms include acute loss of consciousness, reduction in cognitive function (i.e. slow thinking), memory loss, irritability, dizziness, headaches, and loss of fine motor functions. These are considered acute effects and occur at high levels of inhalation exposure. Individuals who display neurobehavioral effects of exposure to solvents do not exhibit chronic effects unless they have had acute effects of exposure. In other words, there are no known delayed onset of neurobehavioral symptoms. Other than his current diagnosis of schizophrenia, the Veteran’s medical treatment records do not indicate cognitive decline indicative of a clinical neurobehavioral condition. For example, his September 2005, March 2013, September 2013, January 2014, and May 2014 private treatment records all indicated that his memory and speech were intact. His behavior, judgment, and psychomotor skills were normal. There was no suggestion of functional impact. While there were consistent reports of impaired attention, his insight and impulse were reported as normal. He exhibited goal directed thought process and cooperative behavior throughout multiple psychiatric evaluations through the years prior to and during the pendency of his appeal. Thus, the Board finds that the evidence does not support a finding that the Veteran has a current diagnosis of a neurobehavior disorder. Without such evidence, service connection for a neurobehavior disorder due to exposure to contaminated water at Camp Lejeune or asbestosis cannot be granted. Accordingly, the claim must be denied. the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107 (b). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Yeh, 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.