Citation Nr: 21006272 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 17-36 099 DATE: February 3, 2021 REMANDED Entitlement to service connection for multiple sclerosis (MS) to include as due to water contamination at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1979 to October 1983. Entitlement to service connection for MS to include as due to water contamination at Camp Lejeune is remanded. The Veteran contends that his current MS was caused by exposure to chemicals and solvents from contaminated water supplies while stationed at Camp Lejeune during active service. The claim must be remanded again because the June 2020 VA opinion obtained after the most recent remand is inadequate. Stegall v. West, 11 Vet. App. 268 (1998). In the June 2020 VA medical opinion, the examiner states that the “Veteran has risk factors including age, Caucasian race, smoking, and living in a country with temperate climate that likely contributed to the development of multiple sclerosis (MS).” However, the question the examiner needs to answer is whether it is more likely than not that the contaminants in the Camp Lejeune water supply caused or aggravated the Veteran’s MS. Additionally, the above listed demographics provided by the examiner is an extremely large population and does not assist in narrowing down whether this Veteran’s MS condition was caused or aggravated by exposure to contaminated water at Camp Lejeune. Furthermore, the examiner stated that “[b]ased on review of available medical records, [V]eteran has negative family history or occupational history pertinent to MS” and then the examiner provides a negative nexus statement that “[t]hus, it is less likely than not that multiple sclerosis is caused by or a result of CLCW exposure.” The rationale is confusing in that one could conclude that having a negative family history or occupational history supports the Veteran’s contention that his MS is due to factors other than family and occupational factors, such as, exposure to contaminant. Thus, the examiner’s negative nexus opinion is internally inconsistent. On remand, a new medical opinion should be obtained that uses and supports the correct standard in answering the question of whether it is more likely than not that the Veteran’s MS condition was caused or related to exposure to contaminated water at Camp Lejeune. The matters are REMANDED for the following action: Forward the claims file and copies of all pertinent records to the June 2020 examiner (or an appropriate VA examiner if the June 2020 examiner is unavailable) to obtain an addendum medical opinion for the Veteran’s service connection claim for MS secondary to exposure to Camp Lejeune contaminated water (CLCW). If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. After reviewing the claims file, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that the Veteran’s MS was incurred in or is otherwise related to service, to include presumptive exposure to chemicals and solvents from contaminated water supplies at Camp Lejeune? (b) If the answer to (a) is no, is it at least as likely as not (50 percent probability) that the Veteran’s MS was aggravated by his service, to include presumptive exposure to chemicals and solvents from contaminated water supplies at Camp Lejeune? A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.