Citation Nr: 20046560 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 18-37 567 DATE: July 13, 2020 REMANDED Entitlement to service connection for tremors, claimed as neurobehavioral effects, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1974 to January 1978, to include service at Camp Lejeune for more than 30 days. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). As a preliminary matter, the Board notes that the Veteran perfected an appealed for only the issue of entitlement to service connection for tremors. Although the Veteran’s January 2018 Notice of Disagreement (NOD) includes the issue of entitlement of service connection for a head injury, he specified in the July 2018 substantive appeal that he was only appealing the tremors issue. Entitlement to service connection for tremors, claimed as neurobehavioral effects, to include as due to exposure to contaminated water at Camp Lejeune. The Veteran seeks service connection for tremors. The Veteran contends that his tremors are due to his exposure to contaminated water at Camp Lejeune. VA treatment records show that the Veteran has been diagnosed with and treated for tremors. The Veteran’s personnel records show he was stationed at Camp Lejeune. VA has acknowledged that persons residing or working at the U.S. Marine Corps Base Camp Lejeune from August 1953 through December 1987 were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). Veterans who served at Camp Lejeune for no less than 30 days during this period, and who have been diagnosed with any of eight associated 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) are presumed to have incurred or aggravated the disease in service for purposes of entitlement to VA benefits. See 38 C.F.R. § 3.309 (f). To date, no VA examination has been performed to determine whether the Veteran’s tremors are related to his Camp Lejeune service. In this regard, his representative requested that the Veteran be afforded a VA neurological examination to determine if his tremors are due to Parkinson’s disease, which is one of the diseases on the list of presumptive disabilities as due to exposure to contaminated water at Camp Lejeune. Accordingly, a remand is necessary to determine the nature and etiology of the Veteran’s claimed tremors. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed tremors. All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail. A complete history of symptoms should be elicited from the Veteran. The VA examiner must review the Veteran’s entire claims file, to include a copy of this REMAND, and that review should be noted in the report. a) The examiner should clarify the Veteran’s diagnosis and determine whether the Veteran’s tremors are: i) a separate diagnosable disorder on its own; or, ii) if they are symptoms of a neurologic disorder, to include, but not limited to, Parkinson’s disease. b) For each diagnosed disorder, the examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that it had its onset during service, within the initial year after service, or, is otherwise related to service, to include conceded exposure to contaminated water at Camp Lejeune. c) The examiner is advised that the Board is cognizant that there is no VA presumption of service connection for tremors and/or a tremor disorder other than Parkinson’s disease as due to exposure to contaminated water at Camp Lejeune. The question here is what is the likelihood that this Veteran’s tremors are related to his exposure to contaminated water exposure at Camp Lejeune given his medical history, family history, other risk factors, etc. d) All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Quinn, 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.