Citation Nr: 21068977 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 16-05 894 DATE: November 17, 2021 REMANDED Entitlement to service connection for a right thumb condition (also claimed as rash to the right hand) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1979 to November 1981. This matter comes before the Board of Veterans' Appeals (Board) from a September 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with a Veterans Law Judge (VLJ) in December 2019. A copy of that hearing is associated with the record. This hearing was before a now-retired judge. In an August 2021 letter, the Board notified the Veteran that the VLJ who held the hearing was no longer employed by the Board and offered the Veteran the opportunity to have an additional hearing; however, the Veteran did not respond to this letter within the allotted 30-day time period, as such, it is assumed that he declined the opportunity for another Board hearing. The Board remanded the Veteran's claims in April 2020 to obtain VA examinations to address the nature and etiologies of the claimed conditions, to include as due to exposure to contaminated water at Camp Lejeune. In December 2020, the Board denied the claim for diabetes mellitus type II and diabetes insipidus, and remanded the claims for a right thumb condition and sleep apnea for medical opinions which addressed direct service connection. The claim returns to the Board for further appellate consideration. Service connection for right thumb condition (also claimed as rash to the right hand) Service connection for sleep apnea, to include as secondary to exposure to contaminated water at Camp Lejeune The Veteran asserts his right thumb condition, also claimed as rash on the right hand, and sleep apnea are related to service, to include as secondary to exposure to contaminated water at Camp Lejeune. Unfortunately, the Board finds a remand is necessary as the VA addendum medical opinions did not comply with the December 2020 Board remand and are otherwise inadequate. A July 2020 VA examiner opined that the Veteran's stay of two years at Camp Lejeune is irrelevant for consideration of sleep apnea or a thumb condition claimed as rash to the right hand being due to contaminated water since neither are considered qualified due to exposures at Camp Lejeune. The case was remanded in December 2020 to obtain an additional addendum medical opinion as the July 2020 examiner applied the wrong legal standard as the Veteran could establish service connection based on a direct theory of entitlement, to include as due to exposures at Camp Lejeune. In accordance with the December 2020 remand, additional VA medical opinions was obtained in May 2021. The examiner noted that the Veteran served in Camp Lejeune during the applicable time period for presumption of service connection but stated the right thumb condition and sleep apnea were not qualifying conditions for health conditions caused by exposure at Camp Lejeune. Thus, the examiner opined that the right thumb condition and sleep apnea were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The Board finds the medical opinions inadequate for several reasons. First, the examiner only addressed whether the claimed conditions were presumptively related to contaminated water exposure at Camp Lejeune; as noted above, the December 2020 Board remand requested the examiner to address whether the conditions were directly related to service, to include as related to exposure to contaminated water at Camp Lejeune. Stegall v. West, 11 Vet. App. 268 (1998). To note, it is not sufficient to state that the condition is not due to contaminated water exposure merely because it is not listed as a presumptive condition. Moreover, the examiner did not address the Veteran's lay statements regarding a rash on his right hand in service. Finally, the examiner provided no supporting rationale outside of stating the conditions were not listed as conditions presumptively related to exposure to contaminated water at Camp Lejeune. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, remand for adequate addendum medical opinions is warranted. The matters are REMANDED for the following actions: 1. Associate with the Veteran's claims file any outstanding VA treatment records. 2. Obtain VA addendum medical opinions for the claimed right thumb and sleep apnea conditions. Upon review of the pertinent evidence of record, to include this remand, opine as to the following: a) It is at least as likely as not (50 percent probability or greater) that the Veteran's claimed right thumb condition is directly related to service, to include as due to exposures while stationed at Camp Lejeune? *In doing so, the examiner should consider (i) the Veteran's in-service complaints regarding his right hand in September and November 1979 and January 1980; and (2) his lay statements that the rash on his right hand began in service and has continued since. See December 2019 Hearing Transcript, pages 2-5. b) It is at least as likely as not (50 percent probability or greater) that the Veteran's claimed sleep apnea condition is directly related to service, to include as due to exposures while stationed at Camp Lejeune? The VA examiner must consider the Veteran's claims to service connection on direct theories of entitlement, namely as due to his service at Camp Lejeune. The examiner should provide a complete explanation for all opinions. If the examiner cannot provide an opinion without resorting to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Thereafter, readjudicate the remanded claims. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moldawer, Associate 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.