Citation Nr: 21068935 Decision Date: 11/16/21 Archive Date: 11/16/21 DOCKET NO. 16-64 004 DATE: November 16, 2021 REMANDED Entitlement to service connection for a neurobehavioral disorder manifested by depression, fatigue, poor concentration, memory loss, and insomnia, to include as due to exposure to contaminated water at Camp Lejeune and/or exposure to environmental hazards coincident with service in Southwest Asia, an undiagnosed illness, or a qualifying chronic disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1980 to December 1980 and from November 1988 to August 1994, to include service at Camp Lejeune in North Carolina from July 16, 1980, to December 12, 1980, and in Southwest Asia from October 5, 1990, to April 18, 1991. While he has an additional period of active duty from August 25, 1994, to April 10, 1998, such has been determined to be dishonorable for Department of Veterans Affairs (VA) purposes and, therefore, a bar to VA benefits. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in August 2015 by a VA Regional Office. In November 2018 and July 2021, the Board remanded the issue on appeal for additional development and the case now returns for further appellate review. The Board notes that additional evidence was associated with the record after the issuance of the May 2020 supplemental statement of the case. However, as the claim is remanded herein, the Agency of Original Jurisdiction will have an opportunity to review the newly received evidence such that no prejudice results to the Veteran in the Board considering such evidence for the limited purpose of issuing a comprehensive and thorough remand. Entitlement to service connection for a neurobehavioral disorder manifested by depression, fatigue, poor concentration, memory loss, and insomnia, to include as due to exposure to contaminated water at Camp Lejeune and/or exposure to environmental hazards coincident with service in Southwest Asia, an undiagnosed illness, or a qualifying chronic disability. The Veteran contends he has a current neurobehavior disorder manifested by depression, fatigue, poor concentration, memory loss, and insomnia related to his exposure to contaminated water while serving at Camp Lejeune in North Carolina, or his exposure to environmental hazards, an undiagnosed illness, or a qualifying chronic disability while serving in the Southwest Asia theatre of operations during the Persian Gulf War era. Following examination of the Veteran and review of the record in January 2016 and January 2018, VA examiners could not identify any undiagnosed illness or medically unexplained chronic multi-system illness attributable to the Veteran's service in Southwest Asia. Specifically, in January 2018, the VA physician opined the Veteran's claimed disability pattern, described as sleep disturbances, fibromyalgia, headaches, chronic pain, and muscle stiffness, included symptoms/conditions that were not part of an undiagnosed illness or a medically unexplained chronic multi-symptom illness of unknown etiology attributable to environmental exposures. Further, the evidence was against the presence of chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders, as the criteria for those diagnoses had not been met. Finally, the VA physician found that the Veteran's non-specific symptoms were common in the general population and were attributable to his multiple, diagnosed conditions of degenerative joint disease, lumbar spine; left knee disability; pes planus; right knee disability; left epicondylitis; diabetes mellitus, type II, with neuropathy lower extremities; bilateral carpal tunnel syndrome; allergic rhinitis; sleep apnea; mental health conditions; and symptomatic headaches that did not meet the criteria for a primary or secondary headache disorder. Specifically, the Veteran described sleep disturbances attributable to his diagnosed sleep apnea and mental health conditions, intermittent headaches, and longstanding complaints of joint and muscle pain/stiffness attributed to his diagnosed structural musculoskeletal conditions. He also reported discomfort related to peripheral neuropathy conditions. In this regard, the VA physician explained that a review of medical literature did not support at least a 50 percent probability that the Veteran's symptoms/conditions were etiologically related to a specific exposure event experienced during service in Southwest Asia. At a May 2019 VA examination, a VA examiner found the Veteran did not have a diagnosis of a central nervous system disorder. Rather, he had symptoms consistent with peripheral neuropathy and, since he was a type II diabetic, the examiner determined the Veteran likely had diabetic neuropathy. In addition, he noted the Veteran's symptoms of memory loss, poor concentration, fatigue, and insomnia were supported by documentation in the record. In an August 2021 addendum opinion, a VA physician determined the Veteran did not have a central nervous system condition connected to a neurobehavioral disorder. According to the physician, it appeared the Veteran's symptoms were due to peripheral neuropathy and a diagnosed depressive disorder. As such, they did not constitute a Gulf War/Southwest Asia condition and were unrelated to exposures therein. In addition, such were known conditions with a partially explained etiology, inasmuch as all depressive disorders are considered related to psychological factors and neurotransmitter metabolism. Therefore, it was less likely than not that the Veteran had a central nervous system-mediated neurobehavioral disorder. In addition, the VA physician found there was no evidence of depression in service or proximate to service and that the Veteran was not diagnosed with a depressive disorder until around 2018. Notably, the record does not contain a competent medical opinion addressing whether the Veteran's claimed symptoms, and the disorders to which such have been attributed, are related to his acknowledged exposure to contaminated water while serving at Camp Lejeune in North Carolina. Consequently, the Board finds a remand is necessary to obtain an addendum opinion addressing such theory of entitlement. The matter is REMANDED for the following action: Forward the record, to include a copy of this Remand, to the VA physician who provided the August 2021 opinion, or an appropriate substitute if unavailable, for an addendum opinion concerning the Veteran's claimed neurobehavioral disorder. The need for additional examination is left to the discretion of the clinician selected to provide the opinion. Following a review of the record, the clinician should provide an opinion as to whether any of the Veteran's reported symptoms, described as depression, fatigue, poor concentration, memory loss, and insomnia, and the disorders to which they have been attributed, are at least as likely as not (i.e., a 50 percent or greater probability) related to his acknowledged in-service exposure to contaminated water at Camp Lejeune. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. M. Celli, 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.