Citation Nr: 20022558 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 16-05 894 DATE: April 1, 2020 REMANDED Entitlement to service connection for right thumb condition (also claimed as rash to the right hand) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for diabetes, to include diabetes mellitus type II and diabetes insipidus (diabetes condition), as secondary to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1979 to November 1981. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). A hearing was held in December 2019 before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The December 2010 claim for diabetes indicated that the claimed condition was diabetes insipidus. Subsequently, the Veteran submitted a claim for service connection for diabetes mellitus type II. The Board will address the claims in combination and will take jurisdiction of both claims. In addition, the February 2007 rating decision denied service connection for diabetes mellitus type II on the basis that it was not incurred or caused by service, that it was not manifest to a compensable degree within one year after discharge and the record does not show service in Vietnam or exposure to herbicide agents. The Veteran subsequently has asserted that diabetes is related to exposure to contaminated water at Camp Lejeune. New and material evidence is generally required to reopen a previously denied claim. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). Here, however, there is a liberalizing law creating a new evidentiary standard for which a claim of entitlement to service connection for Veterans, former reservists and former National Guard members who served at Camp Lejeune for no less than 30 days for certain diseases. Thus, new and material evidence is not necessary to reach the merits of the claim. Spencer v. Brown, 4 Vet. App. 283 (1993) REASONS FOR REMAND 1. Entitlement to service connection for right thumb condition (also claimed as rash to the right hand) is remanded. 2. Entitlement to service connection for sleep apnea, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. 3. Entitlement to service connection for diabetes, to include diabetes mellitus type II and diabetes insipidus (diabetes condition), as secondary to contaminated water at Camp Lejeune, is remanded. The Veteran had service at Camp Lejeune between August 1, 1953 and December 21, 1987, and therefore the there is an in-service event, namely exposure to contaminated water. The Board acknowledges that the Veteran has not been afforded a VA examination addressing his claim for service connection for a right thumb condition (claimed as a rash to the right hand). Regulations provide that the VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on the claim. 38 C.F.R. § 3.159 (c)(4). In service-connection claims, such as is the case here, VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Board finds that the evidence of record shows the Veteran has a current diagnosis of a skin rash lateral right side of hand, described as scaly and dry-seen. See October 2011 VA treatment record. Additionally, the Veteran’s STRs reveal that he was treated in service for a right-hand infection. See September 1979 STR. The Veteran also testified that he has been dealing with a skin rash condition ever since service. See December 2019 Board hearing transcript. There is also insufficient medical evidence of record addressing the nature and etiology of his currently diagnosed skin rash condition. Accordingly, as the evidence of record suggests that the Veteran may have a currently diagnosed skin rash condition that had its onset in service, the Board finds that the Veteran’s claim meets the low threshold under McLendon, therefore triggering the VA’s duty to assist by providing him with a VA examination to assess the nature and etiology of his claimed for condition. With regard to the claims for service connection for sleep apnea and a diabetes condition, the Board finds that the Veteran should be afforded examination to address the etiology of those conditions, to include as due to exposure to contaminated water at Camp Lejeune. The matters are REMANDED for the following action: 1. Associate with the Veteran’s claims file any outstanding VA treatment records since September 2018. 2. Schedule the Veteran for a VA examination to assess the nature and etiology of his claimed for right-hand skin rash condition. The VA examiner opine as to the following: Is the Veteran’s currently diagnosed right-hand skin rash condition at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease, to include exposure to contaminated water at Camp Lejeune? The examiner should elicit a complete medical history from the Veteran, the pertinent details of which should be included in the VA examiner’s report. The VA examiner’s attention is drawn to the Veteran’s lay testimony as to having experienced a right-hand skin rash condition since service. See December 2019 Board hearing transcript. 3. Schedule the Veteran for a VA examination to assess the nature and etiology of his claimed for sleep apnea. The VA examiner opine as to the following: Whether it is at least as like as not (50 percent or greater probability) that the Veteran's sleep apnea is related to active service, to include his exposure to contaminated water at Camp Lejeune. (Continued on the next page)   4. Schedule the Veteran for a VA examination to assess the nature and etiology of his claimed diabetes condition. The VA examiner opine as to the following: Determine whether the Veteran has a current diagnosis of a diabetes condition, to include diabetes type II and diabetes insipidus. If so, whether it is at least as like as not (50 percent or greater probability) that any diabetes condition is related to active service, to include his exposure to contaminated water at Camp Lejeune. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.R. Fey, 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.