Citation Nr: 20006885 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 16-29 172 DATE: January 28, 2020 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for multiple sclerosis is remanded. Entitlement to service connection for neuromyelitis optica is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1967 to November 1970. The Veteran testified before the undersigned Veterans Law Judge during an October 2019 hearing. This matter is on appeal from an April 2014 rating decision. Entitlement to service connection for diabetes mellitus, multiple sclerosis, and neuromyelitis optica is remanded. Under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), VA is to afford the Veteran an examination when there is an indication that a current disability or symptoms indicating a current disability may be related to an in-service event, and no examination has yet been conducted. Here, the Veteran contends that his diabetes mellitus, multiple sclerosis, and neuromyelitis optica are related to being exposed to contaminated water while he was stationed at Camp Lejeune. In the April 2014 rating decision, the Agency of Original Jurisdiction conceded that the Veteran was, in fact, exposed to contaminated drinking water at Camp Lejeune. During his hearing, he testified that at one point he did have multiple sclerosis, but has now been diagnosed neuromyelitis optica. He indicated that he is seeking service connection for an autoimmune disorder, however, it is diagnosed. On review of the record, the current nature of the Veteran’s disability(ies) remains unclear. VA treatment records dated in October 2006 indicated that the Veteran had multiple sclerosis and diabetes mellitus. A November 2007 treatment record included a history of diabetes mellitus and noted that neuromyelitis optica has been diagnosed in February 2007, which was originally diagnosed as multiple sclerosis in 2000. However, in a September 2018 treatment record from the Mayo Clinic, Dr. B.W. diagnosed the Veteran with myelopathy, bilateral optic neuropathy, and suspected neuromyelitis optica. During the hearing, the Veteran’s wife stated that Dr. B.W. indicated that the Veteran had an autoimmune disorder caused by the contaminated water at Camp Lejeune. The Board finds such evidence provides an indication of an association with the currently claimed disabilities and his military service. The Veteran has not been provided a VA examination regarding his claim for service connection for diabetes mellitus, multiple sclerosis, and neuromyelitis optica, and the Board finds that meets the low threshold of McLendon and an examination and medical opinion are necessary to adjudicate these issues. Additionally, in March 2008, the Veteran authorized VA to obtain treatment records from Dr. A.G.L. from University of Iowa Hospital and Clinics and Dr. P, who appeared to be associated with VA according to the Veteran’s hearing testimony. The Veteran also indicated during his testimony that he had been seeing a urologist with the University of Minnesota related to his claimed conditions. Additionally, treatment records from Dr. B.W. from the Mayo Clinic appear to be incomplete. It does not appear that proper attempts have been made to obtain these treatment records. On remand, all available relevant private and VA treatment records should be requested and associated with the claims file. The matters are REMANDED for the following action: 1. Send the Veteran a letter requesting that the Veteran submit, or authorize VA to obtain on his behalf, any records of private care for his claimed disabilities, to specifically include from the University of Iowa Hospital and Clinics, Dr. D.W. from the Mayo Clinic, and/or the urologist from the University of Minnesota. All appropriate steps should be taken to obtain identified records. 2. Obtain all VA treatment records that are not currently of record, to include any records from Dr. P., whom the Veteran referenced at his Board hearing. 3. Schedule the Veteran for an examination by an appropriate clinician(s) to determine the nature and etiology of his claimed diabetes mellitus, multiple sclerosis, and neuromyelitis optica. The entire claims file should be sent to and reviewed by the VA examiner. The examiner should take a history from the Veteran as to the progression of his symptoms. After review of the record, interview and examination of the Veteran, the examiner should respond to each of the following: (a) Clarify whether or not the Veteran has any current autoimmune disorder, including multiple sclerosis and neuromyelitis optica. See October 2006 and November 2007 VA treatment records, treatment records from Dr. B.W. from the Mayo Clinic, and any additional relevant treatment records obtained on development. (b) For the Veteran’s diabetes mellitus and each disability identified from (a) above, indicate whether it is at least as likely as not (i.e. a 50 percent probability or greater) incurred in, caused by, or otherwise related to service, to include exposure to contaminated water during the Veteran’s service at Camp Lejeune, North Carolina. The examiner should specifically note that service connection can be established on a direct basis for diseases even if they have not been shown to warrant a regulatory presumption of service connection due to herbicide exposure or exposure to contaminated water at Camp Lejeune. The examiner should consider the Veteran’s contentions that in the early 2000s he exhibited a numb spot in his leg, which was diagnosed and treated as multiple sclerosis based on test results. In 2004, he began to lose vision in his left eye around 2003, which was diagnosed as neuromyelitis based on test results. Additionally, the Veteran’s wife reported that Dr. B.W. indicated that the Veteran had an autoimmune disorder that could have been caused by the water at Camp Lejeune. See Hearing Testimony, pgs. 7-9. If the Veteran’s prior history of lymphoma played a role in the development of autoimmune disease, this should also be made clear. The complete rationale for all opinions should be set forth. A discussion of the facts and the medical principles involved will be of considerable assistance to the Board. If the examiner cannot provide an opinion, the examiner must confirm that all procurable and assembled data and information was fully considered, and provide a detailed explanation for why an opinion cannot be rendered. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, readjudicate the Veteran's claim based on the entirety of the evidence. If the claim remains denied, issue the Veteran and his representative a supplemental statement of the case. Allow an appropriate period of time for response. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Crohe, 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.