Citation Nr: 21068734 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 17-29 316 DATE: November 12, 2021 REMANDED Entitlement to service connection for chronic kidney disease is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1973 to July 1975. In May 2021, the Veteran appeared before the undersigned during a virtual Board hearing. A transcript of the hearing is associated with the claims file. Entitlement to service connection for chronic kidney disease is remanded. In May 2016, a VA medical opinion was obtained regarding the etiology of the Veteran's chronic kidney disease. The examiner opined that the Veteran's current chronic kidney disease was less likely than not due to his exposure to contaminated water at Camp Lejeune. The examiner stated that given the multiple-year lag time between exposure to contaminated water at Camp Lejeune and onset of renal disease, the lack of medical literature directly linking low dose exposures such as were measured in CL with renal disease, and given the Veteran's alternate risk factors (diabetes mellitus with diagnosed diabetic nephropathy, hypertension, ex-smoker, hyperlipidemia, elevated BMI, and age) that the Veteran's current chronic kidney disease was less likely than not due to his exposure to contaminated water at Camp Lejeune. In September 2021, the Veteran submitted a private medical opinion completed by M.J.F., M.D. that the Veteran's chronic kidney disease as likely as not began in service with exposure to the contaminated water at Camp Lejeune. The physician noted that the National Academy of Sciences listed 14 conditions associated with exposure to TCE and PCE, which included renal toxicity. Further, the physician noted that some workers in dry cleaning plants exposed to PCE developed CKD progressing to end stage renal disease and that some studies have shown an equipoise and above for the causation of CKD after exposure to TCE and PCE. Unfortunately, the Board finds that both of these opinions are inadequate to resolve the issue on appeal. First, the 2016 VA opinion does not discuss the studies indicating a potential relationship between PCE and TCE and chronic kidney disease discussed in the opinion provided by M.J.F., M.D. However, the opinion provided by M.J.F., M.D. indicates that the Veteran was stationed at Camp Lejeune for "almost three years", while the Veteran's active service was only two years and two months in totality. Further, it opines that the Veteran's chronic kidney disease "began in service," despite the lack of a diagnosis for many years after separation from service and the second negative urine test prior to separation in July 1975. The Board notes that testing upon admission to a hospital related to ketoacidosis in February 1988 did not report a diagnosis of (or history of) chronic kidney disease. Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The Board finds that a new medical opinion regarding the etiology of the Veteran's chronic kidney disease should be obtained. The matters are REMANDED for the following action: 1. Undertake efforts to obtain a VA medical opinion from an appropriate clinician regarding the etiology of the Veteran's chronic kidney disease. An examination of the Veteran is not necessary, unless determined by the examiner. The Veteran's claims file must be made available to and reviewed by the examiner prior to completion of the medical opinion. Review of such should be noted in the examiner's report. The examiner is requested to provide an opinion as to the following: (a). Whether it is at least as likely as not (that is, a probability of at least 50 percent) that the Veteran's chronic kidney disease was caused by an injury, event, or disease incurred during service, including exposure to contaminated water while serving at Camp Lejeune. The examiner is asked to consider and discuss the report provided by M.J.F., M.D in September 2021. A complete rationale should be provided for any opinions rendered. If an opinion cannot be provided without resort to pure speculation, the VA examiner should explain why speculation would be required in this case. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.M. Johnson, 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.