Citation Nr: 21063085 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-52 752 DATE: October 13, 2021 REMANDED Entitlement to service connection for a renal disorder, claimed as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1972 to August 1972 and from September 1972 to October 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. 1. Entitlement to service connection for a renal disorder as due to exposure to contaminated water at Camp Lejeune is remanded. The Veteran contends that his renal disease is due to contaminated water exposure while stationed at Camp Lejeune. See Hearing Transcript (July 2021); Correspondence (September 2016); VA 21-526EZ, Fully Developed claim (April 2015). The evidence of record demonstrates that the Veteran served at Camp Lejeune during the relevant time period. See Military Personnel Record (April 2015); 38 C.F.R. § 3.307(a)(7). The Board finds that remand is required to obtain medical records and for an addendum opinion. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This includes making as many requests as are necessary to obtain relevant records from a Federal department or agency, including, but not limited to, military records, VA medical records, records from facilities with which the VA has contracted, and records from Federal agencies such as the Social Security Administration. 38 C.F.R. § 3.159(c)(2). VA's duty to assist also includes making reasonable efforts to obtain relevant private medical records. 38 C.F.R. § 3.159(c)(1). Records scanned into VistA Imaging are not available to the Board. Such records must be separately obtained and scanned into the claims file. Here, there are medical records that are not associated with the claims file. In a November 2015 VA record, it was noted that the Veteran had a kidney transplant work up at Fairfax Hospital. See CAPRI (October 2016). Additionally, it appears that the Veteran received treatment at Walter Reed Hospital. See Medical Treatment Record (July 2021); Buddy/Lay Statement (July 2021). No records from Fairfax Hospital or Walter Reed Hospital are associated with the claims file. Additionally, VA treatment records contain reference to documents scanned into the VistA Imaging System. A review of those entries indicates that most of them are related to informed consent for unrelated procedures, cardiac reports, and anesthesiology, but at least one, dated in September 2016, noted that the Veteran had been seen at "WR." See CAPRI (October 2016). Attempts must be made to obtain these records. The Board notes that there are two private opinions of record. See Third Party Correspondence (April 2015); Medical treatment Record Non-Government Facility (August 2021). Both opinions are insufficient upon which to grant service connection as they are either speculative or the supporting explanation is less thorough and explanatory than the 2019 VA etiological opinion. See C&P Exam (September 2016). After any such records are associated with the claims file, The AOJ must obtain a VA addendum opinion that considers this additional information. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all outstanding records of treatment that were scanned into VistA Imaging; specifically, a documented dated September 11, 2016. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 2. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for signs, symptoms, or treatment of his claimed renal disorder to include from Walter Reed Hospital and Fairfax Hospital. Make two requests for the authorized records from all identified sources unless it is clear after the first request that a second request would be futile. 3. Obtain an addendum opinion regarding the Veteran's renal disease. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, the clinician should provide an opinion regarding whether any of the additional information changes the previously provided opinions. If there are changes in the prior opinion, the clinician should detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with the diagnosed renal disease. The opinion should, among other things, include a discussion of the Veteran's documented history and assertions. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should provide an opinion, with supporting rationale, as to: Whether the Veteran's chronic kidney disease at least as likely as not (1) had its onset in service, or (2) is otherwise related to an in-service injury, event, or disease, to included conceded exposure to contaminated water at Camp Lejeune. Indicate whether chronic kidney disease is more likely than not due to other causesexplain. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): If any medical history is rejected, a complete explanation is required. 4. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.