Citation Nr: 21001330 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 16-46 451 DATE: January 7, 2021 ORDER Service connection for rashes shown as psoriasiform dermatitis and eczematous rash of the palms, as due to exposure to Camp Lejeune contaminated water, is granted. Service connection for myoclonic tremor, as due to exposure to Camp Lejeune contaminated water, is granted. REMAND Service connection for headaches, to include as due to exposure to Camp Lejeune contaminated water, is remanded. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, the evidence is in equipoise as to whether the Veteran’s rashes and myoclonic tremor are related to his exposure to Camp Lejeune contaminated water. CONCLUSION OF LAW The criteria for service connection for rashes and myoclonic tremor have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1970 to February 1972. In November 2020, the Veteran testified before the undersigned Veterans’ Law Judge. A copy of the transcript is associated with the record. Service Connection Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). Effective March 14, 2017, VA amended 38 C.F.R. §§ 3.307 and 3.309 providing a presumption of service connection for certain diseases based on exposure to contaminants present in the water supply at Camp Lejeune. The amendment defines “contaminants in the water supply” as the volatile organic compound trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953 and ending on December 31, 1987. In order to qualify for presumptive service connection under these provisions, there must be evidence of: (1) a diagnosis of one of the enumerated diseases under the new provision 38 C.F.R. § 3.309(f), (i.e., adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin’s lymphoma, and Parkinson’s disease), if manifest to a degree of 10 percent or more at any time after service; and (2) service of at least 30 days (consecutive or nonconsecutive) at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987. The rulemaking applies to claims received by or pending before VA on or after March 14, 2017. See 82 Fed. Reg. 9, 4173-4185 (January 13, 2017). In deciding the Veteran’s claim, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In the current mater, though the Veteran was stationed at Camp Lejeune during the applicable period, none of his claimed conditions are on the list of presumptive service connection conditions. Notwithstanding the presumption, however, service connection for a disability claimed as due to contaminated water at Camp Lejeune may be established by showing that a disorder resulting in disability was in fact causally linked to such exposure. Combee v. Brown, 34 F. 3d 1039, 1044 (Fed. Cir. 1994). Rashes Myoclonic Tremor The evidence of record confirms that the Veteran has been diagnosed with chronic hand dermatitis and myoclonic tremor. See November 2013 private medical opinion. Thus, the only issue before the Board is if there is a link between the Veteran’s diagnosed disorders and his service, including his time at Camp Lejeune and his exposure to contaminated water while there. Resolving any reasonable doubt in favor of the Veteran, the Board finds that the evidence as to the link between his claimed disorders and his service is in equipoise. As such, service connection for hand rashes and myoclonic tremor is warranted. The Veteran submitted letters from his treating providers and an expert which stated that his claimed disorders were plausibly caused by his exposure to contaminated water while at Camp Lejeune, that his skin condition was at least as likely as not from his military service, and that his skin condition could at least as likely as not be linked to his exposure to organic chemicals in the water at Camp Lejeune. See November 2013, June 2014, and August 2014 medical opinion letters. There is also a VA medical opinion which stated that the Veteran’s claimed conditions were not linked to his service, including his exposure to the contaminated water at Camp Lejeune. As such, the Board finds that the evidence as to the etiology of the Veteran’s claimed conditions is in equipoise. There is an approximate balance of positive and negative evidence regarding the etiology of the Veteran’s skin condition, tremor, and headaches, the benefit of the doubt is afforded the Veteran. As such, reasonable doubt is resolved in favor of the Veteran and service connection for skin rash and myoclonic tremor is granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Service connection for headaches The Board regrets additional delay; however, the Veteran has reported that he has a headache condition which is related to his exposure to contaminated water at Camp Lejeune and that he takes medication for the condition. See November 2020 statement. VA records show that the Veteran reported a past medical history which was positive for a headache condition and that he took medication for that condition. However, the record does not contain the private medical records which support that diagnosis. As such, remand is necessary to obtain medical records regarding the Veteran’s headache disorder. The matter is REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify by name, address, and dates of treatment or examination any relevant private medical treatment records for his headaches, including Dr. D.H. Attempt to secure any identified records. 2. Thereafter, obtain a VA medical opinion from an appropriate clinician to determine the nature and etiology of any diagnosed headache disorder. The claims file should be made available to the examiner for review. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder was incurred in, or due to, the Veteran’s service, including the Veteran’s conceded exposure to contaminated water at Camp Lejeune, North Carolina. The Veteran’s lay statements regarding onset and continuity of symptomology should be recorded and considered. The Veteran’s service treatment records, which indicated treatment for headaches should be noted. A rationale for all opinions must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Parrish, 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.