Citation Nr: 21067778 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 14-20 260A DATE: November 5, 2021 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1977 to March 1980. He died in July 2012 and the appellant is his surviving spouse. The case is on appeal from a February 2014 rating decision. This matter has been before the Board on several prior occasions. In October 2018, the Board remanded for substantial compliance with the Board's previous December 2015 Remand directives, and referenced the February 2018 memorandum decision issued by the United States Court of Appeals for Veterans Claims (Court). Subsequently, in August 2020, the Board issued a decision a denied that service connection for cause of death. The Veteran appealed the August 2020 Board decision to the Court. In a joint motion for remand (JMR), the Court vacated this Board decision, and remanded this matter on appeal back to the Board for action in accordance with the JMR. Entitlement to service connection for cause of death is remanded. The parties to the JMR found that the Board erred in not obtaining an adequate examination. In the June 2020 VA examination report, the examiner addressed whether the Veteran's lung cancer, which caused his death, was due to his exposure. The examiner opined that it was less likely as not (less than 50 percent probability) that the Veteran's squamous cell lung cancer was caused by or result of this Veterans exposure to asbestos (no exposure noted while in service) nor his likely exposure to Camp Lejeune water contamination since current data does not support lung cancer as a presumptive condition. The parties noted that the part of the VA examiner's rationale was based on the fact that lung cancer was not listed as a disease presumptively caused by exposure to contaminated water at Camp Lejeune. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("A medical nexus opinion finding a condition is not related to service because the condition is not entitled to presumptive service connection, without clearly considering direct service connection, is inadequate on its face."). To the extent the examiner provided an opinion as to service connection on a direct basis, the examiner failed to provide a rationale for that opinion. See Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). Therefore, in accordance with the JMR a remand is necessary to obtain an additional addendum opinion must be provided regarding whether the Veteran's lung cancer was as likely as not due to exposure to contaminate water at Camp Lejeune without regard to whether VA recognizes lung cancer as a presumptive condition associated with contaminate water at Camp Lejeune. This matter is REMANDED for the following action: Send the claims file to the VA oncologist that provided the June 2020 addendum opinion. If this clinician is not available, then send the claim file to a similar qualified clinician. After reviewing the record, to include a copy of this Remand, the examiner is offer an opinion to the following: Whether the cause of the Veteran's death was at least as likely as not related to contaminants in the water during service at Camp Lejeune. In answering this question, the examiner is asked to disregard whether the disorder is one for which a "presumption" is established and, instead, to answer whether the medical condition is a result of Camp Lejeune exposures even though it is not on the list of "presumptive" diseases. Stated another way, a rationale that relies on the disability not being a presumptive disability is not an adequate opinion. The examiner is notified that the water supply at Camp Lejeune, North Carolina, where the Veteran was stationed from June 1977 to January 1978 was contaminated, and the Veteran is presumed to have been exposed to chemical compounds, to include trichloroethylene, tetrachloroethylene, also known as perchloroethylene, benzene, and vinyl chloride. (Continued on the next page) A comprehensive medical rationale for all opinions expressed must be provided. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.