Citation Nr: 21015339 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-05 808A DATE: March 17, 2021 REMANDED Entitlement to service connection for an esophageal condition is remanded. Entitlement to service connection for a bilateral eye condition is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from April 1984 to March 1988. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2015 and September 2016 rating decisions of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a virtual hearing in October 2020. A transcript of this hearing has been associated with the record. 1. Entitlement to service connection for an esophageal condition is remanded. The Veteran contends that his current esophageal condition is a result of his exposure to contaminated water during service at Camp Lejeune. Specifically, the Veteran asserts that he current suffers from Barrett’s syndrome (also known as Barrett’s esophagus), which is argued to be a pre-cursor or related condition to esophageal cancer (which is a condition for which Veterans who have been exposed to Camp Lejeune contaminated water (CLCW) are presumptively service connected); or in the alternative, that his current esophageal condition began during his service at Camp Lejeune and has persisted since. See e.g., August 2016 VA 21-526EZ; November 2016 notice of disagreement (NOD); October 2020 Board Hearing transcript. The Veteran was afforded a VA examination in September 2016 wherein the VA examiner provided an opinion addressing the etiology of the Veteran’s claimed esophageal disability. The VA examiner opined that the Veteran’s current esophageal conditions were less likely than not incurred in or caused by the claimed in-service injury, illness, or event. The VA examiner’s rationale for this opinion was that “[the Veteran’s] service treatment record indicates one note of gastroenteritis in November 1984. There is no additional documentation regarding gastro issues in the STR. Gastroenteritis is an inflammation of the stomach and intestines, typically as a result of viral infection or bacterial toxins causing vomiting and diarrhea. Reflux esophagitis is an inflammation of the esophagus, a chronic condition, caused by reflux of gastric contents into the esophagus. Symptoms usually include heartburn and regurgitation of stomach acid. There is no evidence that the Veteran was symptomatic for reflux esophagitis during active service. He was diagnosed in 2015, which his emergent food bolus, 28 years after active service. There is no evidence of treatment for this condition until 2015. Given the above information, it is not likely, less than 50/50 probability that the current reflux esophagitis is caused by or secondary to the one sick call for gastroenteritis during military service.” The Board finds the September 2016 VA examiner’s opinion to be inadequate. Firstly, it is not clear that the September 2016 VA examiner fully considered the Veteran's competent lay statements regarding the onset and chronicity of his symptoms. Secondly, the September 2016 VA examiner's opinion relied on the absence of evidence in the Veteran's service treatment records, which is inadequate. Additionally, the September 2016 VA examiner did not address the Veteran’s contentions that his current esophageal conditions are related to his exposure to CLCW during his active duty service. As such, a remand is required to obtain an addendum VA medical opinion. 2. Entitlement to service connection for a bilateral eye condition is remanded. The Veteran contends that his current eye condition is a result of an incident that occurred while he was serving on active duty where he suffered severe burns to both of his eyes and face following an explosion during a routine training. The Veteran asserts that since this accident, he has suffered from sensitivity to light and headaches as a result of his current eye condition. See e.g., December 2015 NOD; October 2020 Board Hearing transcript. The Veteran was afforded a VA examination for his bilateral eye condition in September 2016. The Veteran was diagnosed with photophobia as well as trace nuclear sclerosis during the examination. Regarding the etiology of the Veteran’s eye conditions, the VA examiner opined that the conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned that “[s]ince there are no medical records from the date of occurrence in 1987 until 2015, no direct service connection can be made.” The Board finds the September 2016 VA examiner’s opinion to be inadequate. The VA examiner did not provide adequate rationale to support his conclusion and instead made a conclusory statement regarding the etiology of the Veteran’s current eye conditions. Further, the VA examiner did not adequately address or consider the Veteran's competent lay statements regarding the onset and chronicity of his symptoms. As a result, a new addendum opinion is required and must be obtained upon remand. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a qualified VA medical professional to determine the nature and etiology of any current esophageal disability. The examiner should review the claims folder, and then respond to the following question: Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's claimed esophageal conditions are related to the Veteran's service, to include exposure to contaminants at Camp Lejeune? The examiner should note that the lack of diagnosed esophageal condition in service cannot serve as the sole basis for a negative finding, nor can the fact that it is not presumptively related to Camp Lejeune contaminants. The examiner is asked to address the Veteran’s argument that Barrett’s syndrome may be a pre-cursor or related condition to esophageal cancer, which is a condition for which Veterans who have been exposed to Camp Lejeune contaminated water. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. 2. Obtain an addendum medical opinion from a qualified VA medical professional to determine the nature and etiology of any current bilateral eye disability. Following review of the claims file, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s eye conditions: (a.) had its onset in service; or was manifest within one year of discharge from service; (b.) is otherwise related to service, to include due to the explosion accident described by the Veteran during the October 2020 Board hearing and documented in his STRs. See VBMS, document labeled STR, receipt date 07/29/2015, pages 47-48 of 148; see VBMS, document labeled Hearing Transcript, receipt date 10/19/2020, pages 2-6 of 12. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. M. Lowman, 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.