Citation Nr: 21000678 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 18-50 532 DATE: January 5, 2021 REMANDED Service connection for Barrett's esophagus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from October 1971 to October 1974, including service in Camp Lejeune. This matter come before the Board of Veterans’ Appeals (Board) from a July 2018 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge during a December 2020 video conference hearing. A transcript of that proceeding is associated with the claims file. Service connection for Barrett's esophagus is remanded. The Veteran asserts that his Barrett’s esophagus condition is directly related to his time serving in Camp Lejeune and being exposed to the contaminated water there. See October 2018 VA Form 9. The condition has been bothering the Veteran for many years. See July 2018 Notice of Disagreement. Governing law provides for presumptive service connection based on exposure to contaminated drinking water at Camp Lejeune in service for certain enumerated diseases for Veteran’s who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307 (a)(7) (2017). As detailed herein, the Veteran is presumed to have been exposed to contaminated water at Camp Lejeune. His military personnel records show he served in Camp Lejeune from January 1973 to May 1973. See Military Personnel Record. However, the Veteran’s diagnosed Barrett’s esophagus is not listed as diseases associated with exposure to contaminated drinking water at Camp Lejeune. As such, presumptive service connection is not warranted. Notwithstanding, service connection can still be granted with proof of actual direct causation. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran was provided a VA examination for esophageal conditions in July 2018, in which he was diagnosed with Barrett’s esophagus with dysplasia. In the medical opinion, the examiner opined for a negative nexus, claiming the condition was less likely than not incurred in or caused by military service. The examiner referenced that the VA regulations to establish presumptive service connection for Veterans exposed to contaminant in the water supply at Camp Lejeune, NC do not include Barrett’s esophagus. See July 2018 C&P Exam. The Veteran, in his December 2020 Board hearing, argues that the VA examination and medical opinion provided were inadequate, that his condition was directly caused by his time in Camp Lejeune, and his claim was only denied because it was not on the presumptive conditions list under the regulations. See December 2020 Board Hearing Transcript. The Board notes that although the July 2018 VA medical opinion states that the Veteran is diagnosed with Barrett’s esophagus, that he was stationed in Camp Lejeune and he did consume the water on base, the entire rationale is fixated on the condition not being a part of the presumptive illnesses list under the VA regulations; there is no rationale as to whether his Barrett’s esophagus was caused by active service including exposure to the contaminated water at Camp Lejeune. As such, the Board finds that the VA medical opinion from July 2018 is inadequate as it does not have a rationale as to why the Barrett’s esophagus is or is not due to the contaminated water exposure. Hence, a remand is warranted to obtain a new VA medical opinion that addresses direct service connection as to the Barrett’s esophagus. On remand, the Agency of Original Jurisdiction (AOJ) should also obtain any outstanding VA medical records, including any nexus opinions related to Camp Lejeune toxins. The matters are REMANDED for the following action: 1. Identify and obtain any outstanding VA and private treatment records, to include treatment records from the VA facilities in Wilkes-Barre and associate them with the claims file. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service gastrointestinal symptoms. The Veteran should also be invited to submit medical evidence addressing whether it is at least as likely as not that the Veteran’s Barrett’s esophagus is related to or had its onset in service, to include as due to the Veteran’s exposure to environmental toxins while stationed at Camp Lejeune. The Veteran should be provided an appropriate amount of time to submit this lay and medical evidence. 3. Send the Veteran’s claims file for to an appropriate examiner to determine the nature and etiology of the Veteran’s Barrett’s esophagus. Schedule an examination only if the examiner deems it necessary. The examiner is asked to offer an opinion on the following: Whether it is at least as likely as not that the Barrett’s esophagus manifested in, was caused by, or is otherwise etiologically related to his period of service, to include presumed exposure to contaminated water at Camp Lejeune. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.