Citation Nr: 21066165 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 16-55 785 DATE: October 28, 2021 REMANDED Entitlement to service connection for Grave's disease, to include as due to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1978 to October 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. The Veteran testified at a hearing conducted by the undersigned Veterans Law Judge in February 2019. The issue was previously before the Board in June 2019 and April 2020 when it was remanded for further development. 1. Entitlement to service connection for Grave's disease, to include as due to contaminated water at Camp Lejeune The Board regrets the delay associated with this remand, especially considering that this matter was the subject of two previous remands. However, another remand is necessary to ensure that the Veteran is afforded full compliance with the statutory duty to assist. In April 2020, the Board remanded the Veteran's claim for additional development. Specifically, the Board requested that the Agency of Original Jurisdiction (AOJ) obtain a complete copy of the January 13, 2017 Agency for Toxic Substances and Disease Registry's report titled: ATSDR Assessment of the Evidence for Drinking Water Contaminants at Camp Lejeune and Specific Cancers and Other Diseases. The Board's April 2020 remand also requested that a clinician provide an opinion as to whether it is at least as likely as not, that the Veteran's Grave's disease was caused by his presumed exposure to contaminants at Camp Lejeune. The clinician was instructed to consider and address a May 2019 statement from Dr. P., as well as the articles submitted in support of his opinion. Following the remand, a May 2020 addendum medical opinion was obtained finding that the Veteran's Grave's disease was not caused by or a result of the Veteran's exposure to contaminated water at Camp Lejeune. The VA examiner noted that after reviewing the ATSDR Assessment of the Evidence for Drinking Water Contaminants at Camp Lejeune and Specific Cancers and Other Diseases, "there are no studies cited that document Grave's disease as a sequelae to exposure to CLCW." The Board notes that the May 2020 medical opinion did not address the May 2019 statement from Dr. P., as or the articles submitted in support of his opinion. Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. The AOJ should arrange for an appropriate health care provider to review the Veteran's claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that Graves' disease is due to an event or incident of the Veteran's period of active service, to include his presumed exposure to contaminated water. In answering the foregoing, the clinician must consider and address the May 2019 statement from Dr. P., as well as the articles submitted in support of his opinion. The report should indicate that such evidence has been considered. In addition, in providing the opinion, the clinician must take into account the Veteran's personal circumstances and how the recognized risk factor(s) apply in his particular case. The physician may not rely solely on the fact that the Veteran's Graves' disease is not on the presumptive list of diseases associated with contaminated water exposure. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Morrad, 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.