Citation Nr: 21012773 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 18-23 780 DATE: March 5, 2021 REMANDED Service connection for a disability of the right hand is remanded. Service connection for a disability of the left hand is remanded. Service connection for a right knee disability is remanded. Service connection for a left knee disability is remanded. Service connection for a right ankle disability is remanded. Service connection for a left ankle disability is remanded. Service connection for a cardiac condition is remanded. Service connection for a bladder mass is remanded. Service connection for benign prostatic hypertrophy is remanded. Service connection for a kidney condition is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Marine Corps from October 1979 to April 1980. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter is being adjudicated under the legacy appellate framework. In the April 2016 substantive appeal perfecting these matters to the Board, the Veteran indicated that he did not desire a personal hearing before the Board. The Veteran did testify at a personal hearing before the Board in decision review officer (DRO) in December 2017, and a transcript of the hearing is of record. The Board notes that in addition to the matters on appeal, the following issues were also certified to the Board: service connection for hypertension; hearing loss; and an anxiety disorder. In the November 2013 notice of disagreement (NOD) commencing this appeal, the Veteran did not identify claims for service connection for hypertension; hearing loss; and an anxiety disorder as being on appeal. Moreover, the record is otherwise silent for a NOD challenging the denial of these claims. Therefore, the Board does not have jurisdiction to consider these issues, and the Board shall not address these matters any further. The Board also notes that, in the November 2013 NOD commencing this appeal, the Veteran attempted to appeal the denial of service connection for a neck disability, a back disability, and a bilateral elbow disability. Nevertheless, the record is silent for a rating decision denying service connection for these disabilities. Therefore, the Board does not have jurisdiction to consider these issues, and the Board shall not address these matters any further. The Board notes that, in the December 2017 hearing, the DRO indicated that service connection for tinnitus was on appeal. Nevertheless, the record is silent for a NOD challenging the denial of service connection for tinnitus. Therefore, the Board shall not address this issue any further. In May 2020, VA attempted to send correspondence to the Veteran’s representative of record, and, in June 2020, the correspondence was returned to VA. An investigation revealed that the correspondence was sent to the wrong address. VA reached out to the Veteran’s representative of record, and, in December 2020, the Veteran’s representative indicated that they desired to submit additional evidence; but the Veteran’s representative failed to elaborate what that evidence might be. Over 60 days has elapsed since that communication, and the Veteran’s representative not submitted additional evidence, requested additional time, or otherwise alleged that they had not been properly notified of the status of the proceedings before the Board. Therefore, the Board finds that further delay is not required. 1. Service connection for a disability of the right hand is remanded. 2. Service connection for a disability of the left hand is remanded. 3. Service connection for a right knee disability is remanded. 4. Service connection for a left knee disability is remanded. 5. Service connection for a right ankle disability is remanded. 6. Service connection for a right ankle disability is remanded. 7. CAD is remanded. At issue is whether the Veteran is entitled to service connection for bilateral hand, knee, and ankle disabilities. In a December 2017 hearing before a DRO, the Veteran alleged that these conditions were due to toxic exposure to contaminated water while serving at Camp Lejeune. See Transcript. The Veteran’s treatment records indicate that the Veteran sought treatment for these disabilities during the pendency of the appeal. Additionally, VA has conceded that the Veteran sustained toxic exposure to contaminated water while serving at Camp Lejeune. The Veteran’s disabilities however are not among those presumed to be linked to toxic exposure at Camp Lejeune. 38 C.F.R. § 3.309. Nevertheless, joint pain and inflammation has been linked to exposure to contaminated water. Water-Related Diseases, World Health Organization, https://www.who.int/water_sanitation_health /diseases-risks/diseases/campylobacteriosis/en/ (last visited February 16, 2021). Cardiac problems have been associated with exposure to contaminated water as well. Arsenic in Drinking Water May Change Heart Structure, Columbia University Mailman School of Public Health, https://www.publichealth.columbia. edu/public-health-now/news/arsenic-drinking-water-may-change-heart-structure (last visited February 16, 2021). This is sufficient to trigger VA’s duty to assist, and this matter must be remanded to provide the Veteran with a VA examination. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board notes that the Veteran has already been provided a knee examination, but the examination did not discuss the medical significance if any of toxic exposure at Camp Lejeune. Therefore, the Veteran claims for service connection for knee disabilities also have to be remanded to ensure that the evaluation of the Veteran’s claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). 8. Service connection for a bladder mass is remanded. At issue is whether the Veteran is entitled to service connection for a bladder mass. The Veteran’s treatment records indicate that the Veteran has a mass on the bladder. As previously noted, VA has conceded that the Veteran sustained toxic exposure to contaminated water while serving at Camp Lejeune. Bladder cancer is a disease associated with toxic exposure at Camp Lejeune. 38 C.F.R. § 3.309. The evidence of record does not current demonstrate that the Veteran’s bladder mass is bladder cancer, but this is sufficient to trigger VA’s duty to assist; and this matter must be remanded for a VA examination. See McLendon. 9. Service connection for benign prostatic hypertrophy is remanded. 10. Service connection for a kidney condition is remanded. As discussed above, the Veteran’s claim for service connection for a bladder mass is being remanded for a new VA examination. Such an examination is reasonably likely to generate evidence favorable to the Veteran’s claims for service connection for benign prostatic hypertrophy and a kidney condition. Therefore, this matter must be remanded in order to avoid piecemeal appellate litigation. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Arrange to provide the Veteran with a VA examination (or if necessary, a phone interview and a medical opinion based on the evidence of record) in order to address the following: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current disability of the right hand? Why or why not? (b.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current disability of the left hand? Why or why not? (c.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current right knee disability? Why or why not? (d.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current left knee disability? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current right ankle disability? Why or why not? (f.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current left ankle disability? Why or why not? (g.) What is the medical significance, if any, of the fact that VA has conceded that the Veteran sustained toxic exposure while serving at Camp Lejeune to the etiology of the Veteran’s bilateral hand, knee, and ankle disability? Why? (h.) What is the medical significance, if any, of the fact that the Veteran’s treatment records indicated that the Veteran was obese to the etiology of the Veteran’s bilateral hand, knee, and ankle disability? Why? 2. Arrange to provide the Veteran with a VA examination (or if necessary, a phone interview and a medical opinion based on the evidence of record) in order to address the following: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a cardiac disability? Why or why not? (b.) What is the medical significance, if any, of the fact that VA has conceded that the Veteran sustained toxic exposure while serving at Camp Lejeune to the etiology of the Veteran’s cardiac disability? Why? (c.) What is the medical significance, if any, of the fact that the Veteran’s treatment records indicated that the Veteran was obese to the etiology of the Veteran’s cardiac disability? Why? 3. Arrange to provide the Veteran with a VA examination (or if necessary, a phone interview and a medical opinion based on the evidence of record) in order to address the following: (a.) Does the Veteran have bladder cancer? Why or why not? (b.) Describe the symptoms associated with the Veteran’s benign prostate hypertrophy; as well as what if any impact these symptoms have on the Veteran’s ability to work. (c.) Describe the symptoms associated with the Veteran’s kidney condition; as well as what if any impact these symptoms have on the Veteran’s ability to work. (d.) Describe the symptoms associated with the Veteran’s bladder mass; as well as what if any impact these symptoms have on the Veteran’s ability to work. (e.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of benign prostate hypertrophy? Why or why not? (f.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a kidney condition? Why or why not? (g.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between an in-service incurrence and a current diagnosis of a bladder mass? Why or why not? (h.) What is the medical significance, if any, of the fact that VA has conceded that the Veteran sustained toxic exposure while serving at Camp Lejeune to the etiology of the Veteran’s benign prostate hypertrophy, kidney condition, and bladder mass? Why? DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Seaton 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.