Citation Nr: 21073074 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 12-30 224 DATE: December 7, 2021 REMANDED Entitlement to service connection for a bilateral kidney disability, as due to exposure to Camp Lejeune contaminated water and/or due to NSAIDs used to treat pain associated with service-connected conditions is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1976 to April 1980, and from June 1980 to May 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from February 2012 and July 2014 rating decisions by the Department of Veterans Affairs (VA) Regional offices (RO). In May 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims file. In September 2016, the Board remanded the issues on appeal for additional development. In April 2020, the Board remanded the issues on appeal for additional development. The Board finds that the Regional Office (RO) substantially complied with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a bilateral kidney disability, as due to exposure to Camp Lejeune contaminated water and/or due to NSAIDs used to treat pain associated with service-connected conditions is remanded. The Veteran contends that his bilateral kidney disability is due to either his exposure to the Camp Lejeune contaminated water or alternately due to NSAIDs he used to treat pain associated with his service-connected conditions. In August 2020, the Board remanded this matter to obtain a curriculum vitae (CVs), the number of medical opinions provided for the VA, and a list of any research or articles published by the VA examiner that provided the December 29, 2018 medical opinion but was unable to do so because the VA has ceased using that specific contract vendor and no other contract vendor has used that examiner; therefore, there is no way of obtaining the requested information. After further review, the Board finds that the December 2018 VA examination report, while includes extensive medical research, the examiner does not adequately discuss the Veteran's specific medical condition. Instead, the research provided gives a generic response to whether service connection is ever warranted based on causation, specific to contaminated water exposure at Camp Lejeune, but fails to address aggravation. A medical opinion as to secondary service connection is inadequate for the Board's decision as to aggravation if the issue of aggravation is not sufficiently addressed by the examiner. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). An examiner's determination that the disease or injury at issue is not "related to" the service-connected condition is not sufficient to address the aggravation issue. Id. Thus, this medical opinion is inadequate, because it only addresses the causation prong of secondary service connection. In addition, the medical opinion suggested that the Veteran's use of NSAID's was also a risk factor. In June 2020, the VA secured an addendum opinion to address whether NSAID's caused or aggravated the Veteran's bilateral kidney disability. The examiner opined that the Veteran's bilateral kidney disability is caused and aggravated by the Veteran's history of uncontrolled hypertension. The examiner stated that, NSAID's used to treat the Veterans service-connected conditions was less likely than not caused his chronic kidney disease or aggravated his chronic kidney disease beyond natural progression. As to the rationale, the examiner stated that the two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. The examiner also stated that, "Although oral NSAIDs are associated with worsening and aggravation of chronic kidney disease, medical record review did not reveal consistent clinical evidence for aggravation of chronic kidney disease caused by usage of chronic oral NSAIDs." The Board finds that the examiner did not adequately explain why the Veteran's chronic use of NSAID's was not at least partially responsible for bilateral kidney disability. The Board also finds that the examiner did not adequately explain what evidence the examiner relied upon in determining that the Veteran's use of NSAID's did not aggravate his bilateral kidney disability. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician. The clinician must be provided with and review the entire claims file, to include a copy of this remand. Following a review of the evidence of record, to include the Veteran's lay statements, the clinician should opine: (a.) Whether the Veteran's bilateral kidney disability is at least as likely as not (50 percent or greater probability) (1) proximately due to his exposure to contaminated at Camp Lejeune; (2) aggravated beyond its natural progression by his exposure to contaminated at Camp Lejeune. (b.) Whether the Veteran's bilateral kidney disability is at least as likely as not (50 percent or greater probability) (1) proximately due to his chronic use of NSAID's used to treat pain associated with service-connected conditions; (2) aggravated beyond its natural progression by his chronic use of NSAID's used to treat pain associated with service-connected conditions. The examiner must note and address that the December 2018 VA examiner indicated that the Veteran's use of NSAID's was a risk factor. The examiner must provide the underlying reasons for any opinions provided. If the examiner is unable to provide this opinion without resorting to speculation, he or she must indicate why this is so. If aggravation is shown, the examiner should quantify the degree of aggravation, if possible. The question of secondary aggravation must be addressed separately from the question of secondary causation. The examiner must note that an opinion to the effect that one disability is not "caused by," "a result of," or "secondary to" another disability does not answer the question of aggravation and will necessitate a further opinion. 2. Thereafter, readjudicate the claim. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and his representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist 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.