Citation Nr: 21001883 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-27 913 DATE: January 12, 2021 REMANDED Entitlement to service connection for a lumbar spine disability, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. Entitlement to service connection for a thoracic spine disability, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. Entitlement to service connection for a cervical spine disability, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. Entitlement to service connection for a gastrointestinal disability, to include dysentery, is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a liver disability, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. Entitlement to service connection for a prostate disability, to include prostate cancer, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. Entitlement to service connection for a respiratory disability, claimed as the result of asbestos exposure, is remanded. Entitlement to a compensable rating for malaria is remanded. REASONS FOR REMAND The Veteran had certified active service from September 1980 to September 1984. The Veteran appeared at a July 2019 videoconference hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. 1. Entitlement to service connection for a lumbar spine disability, a thoracic spine disability, and a cervical spine disability, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. The Veteran asserts that service connection for lumbar spine, thoracic spine, and cervical spine disabilities is warranted as the claimed disabilities were either initially manifested during active service or as the result of his exposure to contaminated water at Camp Lejeune, North Carolina. The report of the August 1984 physical examination for service separation states that the Veteran reported having “pulled muscle (4/84) in back and continues to have problems with lower back.” No diagnosis was advanced. The service documentation of record shows that the Veteran served at Camp Lejeune, North Carolina. Department of Veterans Affairs (VA) clinical documentation dated in October 2017 states that the Veteran was diagnosed with lumbar spine degenerative disc disease and stenosis; thoracic spine degenerative disc disease and a T2 hemangioma; and cervical spine degenerative disc disease. The Veteran has not been provided a VA examination which addressed the spine. VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Clinical documentation dated after January 2020 is not of record. VA should obtain all relevant service, VA, and private records which could potentially be helpful in resolving the Veteran’s claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to service connection for a gastrointestinal disability to include dysentery and hypertension is remanded. The Veteran asserts that service connection for both a gastrointestinal disability to include dysentery and hypertension is warranted. At a July 2014 VA audiology examination, the Veteran was noted to have “served in the Marines 4 years active duty” and “in the Army Reserves to 1986 and then from 1993 to 1998.” The Veteran’s periods of active duty, active duty for training, and inactive duty for training with the Army Reserve have not been verified and all service medical documentation associated with that duty has not been requested for association with the record. 3. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran asserts that service connection for bilateral hearing loss is warranted secondary to significant noise exposure in service. At the July 2019 Board of Veterans’ Appeals (Board) hearing, the Veteran testified that “I was constantly subjected to loud noises including anti-tank recoils, tank rounds, Dragon missile rounds, TNT explosives, plastic explosives, Bangalore torpedoes, 40-pound, charges, M-16 rifles, M-60 rifles, grenades, 81-millimeter mortars, helicopters, C-130s, and C 140s.” The service personnel records show that the Veteran served as an assaultman in a Marine Corps weapons company and was awarded the Rifle Expert Badge. Therefore, the Veteran’s in service exposure to weapons fire noise is conceded. At a July 2014 VA audiology examination report states that the Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner concluded that “the Veteran’s hearing loss was not at least as likely as not (50% probability or greater) caused by or a result of an event in military service.” The examiner clarified that “numerous audiograms were reviewed in his service treatment records for which all audiograms verified normal hearing thresholds for each ear while in active military service: September 1980; 08/12/82; 07/26/83; and 04/14/84” and “release from active duty audiogram verified hearing thresholds had been within normal limits for each ear for the evaluated frequency range.” Because the examiner noted that the Veteran had additional periods of service with the Army Reserve for which the service records have not been requested and expressly based her opinion on the absence of evidence of hearing loss disability in the service medical documentation currently of record, the Board finds that the examination report is of limited probative value. When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Because of the cited deficiencies in the July 2014 examination report, the Board finds that further VA audiology evaluation is required. 4. Entitlement to service connection for a liver disability and a prostate disability to include prostate cancer, claimed as the result of Camp Lejeune contaminated water exposure, is remanded. The Veteran asserts that service connection for a liver disability and a prostate disability is warranted as the claimed disabilities manifested as the result of presumed exposure to contaminated water at Camp Lejeune, North Carolina or, in the alternative, the disabilities are secondary to service-connected malaria. Service connection may be established for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be established on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service-connected disability has aggravated a nonservice-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for malaria and tinnitus. The service medical records do not refer to any liver disability or a prostate disability. VA clinical documentation dated in December 2019 states that the Veteran was diagnosed with steatosis of the liver and benign prostatic hypertrophy. At the July 2019 Board hearing, the Veteran testified that he had been diagnosed with “hepatocytosis” which was “directly related to the chemicals at Camp Lejeune.” He stated that he has a cyst on the liver which was related to the service-connected malaria. The Veteran testified further that he has undergone multiple prostate biopsies and has been found to have a critically elevated PSA level by his treating urologist. The Veteran has not been provided VA examinations which address the claimed liver and the prostate disabilities. 5. Entitlement to service connection for a respiratory disability, claimed as the result of asbestos exposure, is remanded. The Veteran asserts that service connection for a respiratory disability is warranted as the claimed disability was incurred secondary to asbestos exposure in service. The service medical records convey that the Veteran complained of chest pain and “coughing up blood.” No respiratory disability was diagnosed. The service documentation includes a document entitled “Asbestos Medical Surveillance Program.” The Board observes that the Veteran’s response to the question concerning his asbestos exposure during service is illegible. The Veteran has not been provided a VA respiratory examination. 6. Entitlement to a compensable rating for malaria is remanded. The Veteran contends that a compensable rating is warranted for service-connected malaria. The report of an October 2013 VA malaria examination states that the Veteran reported that he was experiencing high fevers, dizziness, nausea, weakness, and diarrhea every two to three weeks. The Veteran was diagnosed with inactive malaria. The examiner found that the Veteran exhibited no malarial symptoms and no malarial residuals and that the malaria did “impact his ability to work due to absenteeism due to high fevers, dizziness, nausea, weakness, and diarrhea.” Because of the conflicting findings as to whether the service-connected malaria was symptomatic and the passage of over seven years since the examination, the Board finds that the examination report is of limited probative value and further VA evaluation is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for any spine, gastrointestinal, hypertension, hearing loss, liver, prostate, or respiratory disabilities and service-connected malaria. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Contact the National Personnel Records Center (NPRC) and/or the appropriate service entity and request that the Veteran’s periods of active duty, active duty for training, and inactive duty for training with the Army Reserve be verified and all available service medical records associated with that duty be forwarded for incorporation into the record. 3. Obtain the Veteran’s VA treatment records dated after January 2020. 4. Schedule the Veteran for a VA spine examination conducted by a medical doctor to assist in determining the nature and etiology of any identified lumbar spine, thoracic spine, and cervical spine disabilities and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all spine disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified lumbar, thoracic, and cervical spine disabilities had their onset during active service or are related to any incident of service, including documented lumbar spine complaints in service; documented service at Camp Lejeune, North Carolina; and presumed exposure to contaminated water at that facility. 5. Schedule the Veteran for a VA audiology examination to assist in determining the nature and etiology of any identified hearing loss disabilities and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hearing loss disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hearing loss disability had its onset during active service or is related to any incident of service, including the Veteran’s conceded in service weapons fire noise exposure. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that hearing loss disability was caused by service-connected tinnitus. (d) Opine whether it is at least as likely as not (50 percent probability or greater) that hearing loss disability has been aggravated (increased in severity beyond the natural progress of the disorder) by service-connected tinnitus. 6. Schedule the Veteran for a VA liver examination conducted by a medical doctor to assist in determining the nature and etiology of any identified liver disability and any relationship to active service or a service connected disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all liver disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified liver disability had its onset during active service or is related to any incident of service, including the documented service at Camp Lejeune, North Carolina and presumed exposure to contaminated water at that facility. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified liver disability is due to service-connected malaria. (d) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified liver disability has been aggravated (increased in severity beyond the natural progress of the disorder) by service-connected malaria. 7. Schedule the Veteran for a VA prostate examination conducted by a medical doctor to assist in determining the nature and etiology of any identified prostate disability and any relationship to active service or a service connected disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all prostate disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified prostate disability had its onset during active service or is related to any incident of service, including documented service at Camp Lejeune, North Carolina and presumed exposure to contaminated water at that facility. 8. Schedule the Veteran for a VA respiratory examination conducted by a medical doctor to assist in determining the nature and etiology of any identified respiratory disability and any relationship to active service or a service connected disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all respiratory disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified respiratory disability had its onset during active service or is related to any incident of service, including documented in service respiratory complaints and claimed asbestos exposure. 9. Schedule the Veteran for a VA examination conducted by the appropriate medical doctor to assist in determining the current nature and severity of service-connected malaria. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should expressly state whether the service connected malaria is active. An opinion as to the impact of the malaria upon the Veteran’s vocational pursuits. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Hutcheson, 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.