Citation Nr: 21016123 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 14-16 113 DATE: March 19, 2021 REMANDED Entitlement to service connection for a disability manifested by stomach/digestive issues is remanded. Entitlement to service connection for adhesions of the bowel, to include bowel blockage, is remanded. Entitlement to service connection for ulcerative colitis is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for eczema is remanded. Entitlement to service connection for ventral hernias is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1971 to November 1975, including service at Camp Lejeune. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In July 2018, the Veteran testified before the undersigned at a hearing. A transcript of his testimony has been associated with the claims file. Previously, the Board remanded these claims in February 2019 to obtain VA examinations and opinions with respect to his claims. In June 2020, the RO issued a supplemental statement of the case. The matters now return to the Board. Asthma, digestive issues, hernias, and eczema As set forth in the Board’s previous decision, the Veteran has asserted that his current disabilities, including asthma, digestive issues, and hernias, are etiologically connected to drinking contaminated drinking water at Camp Lejeune, North Carolina, where he was stationed for several months. The record reflects that the Veteran has submitted multiple private medical opinions from his doctor, Dr. J.R., that indicate that there is a positive nexus between his service and his current disabilities. Generally, Dr. J.R. states that the Veteran was exposed to “TCE, PCEs, benzene, vinyl chloride and other compounds” at Camp Lejeune, and that this exposure could “certainly be responsible for” his current health issues. See August 2016 Opinion. He also has stated that his conditions were “certainly related to toxins” in the water at Camp Lejeune, and that these conditions should be considered in the same category with other illnesses presumptively related to contaminated drinking water at Camp Lejeune. See July 2019 Opinion. However, these opinions are brief and lack citations to supporting evidence in the claims file or relevant medical literature. In October 2019, the Veteran was afforded multiple VA examinations in connection with his claims. The VA examiner, however, opined that it was less likely than not that his digestive or stomach issues, asthma, and hernias were related to his service, including drinking contaminated drinking water at Camp Lejeune. In doing so, the VA examiner generally stated that the Veteran’s service treatment records were “inconclusive” for any of these issues, that his service separation examination results were normal, and that medical literature did not support a link between his current disabilities and the contaminated water at Camp Lejeune. Instead, the VA examiner opined, the Veteran’s conditions were more likely than not related to other causes, such as a long history of smoking and alcohol and drug abuse, surgical treatment for a perforated gastric ulcer caused by his alcohol and drug abuse, and, with respect to his claims for some of his digestive issues, helicobacter pylori. However, the VA examiner’s various opinions contain multiple flaws. First, they are conclusory and lack sufficiently detailed rationales. Indeed, the reasoning in the majority of his opinions is nearly verbatim. To that end, he generally did not provide any rationale as to why the Veteran’s smoking or alcohol or drug use were responsible for his health issues. Second, the VA examiner did not directly address or respond to Dr. J.R.’s private medical opinions, including his statements on the impact of exposure to chemicals such as TCEs, PCEs, benzene, vinyl chloride, and other compounds. Third, although the VA examiner stated that no medical literature supported a link between his conditions and the contaminated drinking water at Camp Lejeune, he did not cite to any medical literature or other evidence to support this opinion. Last, although the VA examiner suggested that some of the Veteran’s digestive issues had been caused by a perforated gastric ulcer or helicobacter pylori, he did not adequately explain why these conditions could not have been etiologically linked to his exposure to contaminated water at Camp Lejeune. With respect to the claim for eczema, the VA examiner opined that the Veteran’s skin condition was less likely than not incurred in or caused by service. Instead, he opined that his eczema was more likely than not caused by his severe alcohol and drug abuse. As support for this opinion, the VA examiner cited to general research on the impact of drugs such as cocaine, heroin, methamphetamines, desomorphine, marijuana, and alcohol on the skin. However, the VA examiner failed to consider evidence in the Veteran’s service treatment records reflecting complaints of skin rashes, treatment records from approximately five years after his discharge from service diagnosing tinea versicolor, or treatment records from approximately seven years after discharge diagnosing tinea versicolor and atopic dermatitis. Moreover, the VA examiner failed to opine as to whether his in-service skin conditions were etiologically linked to his current diagnosis of eczema. As such, remand is warranted to obtain new VA medical opinions that contain sufficiently detailed rationales, consider all relevant evidence of record, and address all raised theories of entitlement. Accordingly, the matters are REMANDED for the following action: 1. After obtaining appropriate authorization, obtain and associate with the claims file any outstanding VA treatment records and any outstanding relevant private treatment records. 2. Obtain an addendum VA medical opinion from an appropriate clinician to obtain an opinion addressing the etiology of any current disability of bowel adhesions and/or blockages, stomach holes or perforations, ulcerative colitis, and hernias. The entire claims file, to include a copy of this remand, must be furnished to the examiner. The examiner must review the claims file in its entirety and acknowledge such review in his or her examination report. Based on a review of the record, the examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that each of these claimed conditions arose in or is otherwise etiologically related to service. The examiner should specifically consider the Veteran’s contention that these disabilities are due to his exposure to water contaminants at Camp Lejeune, as well as Dr. J.R.’s private medical opinions that his exposure to water contaminants at Camp Lejeune caused his current disabilities. A complete rationale is required for any opinions rendered by the examiner.  All opinions should be based on examination findings, historical records, and medical principles. If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. 3. Obtain an addendum VA medical opinion from an appropriate clinician to obtain evidence addressing the etiology of any current respiratory disability, including asthma. The entire claims file, to include a copy of this remand, must be furnished to the examiner. The examiner must review the claims file in its entirety and acknowledge such review in his or her examination report. Based on a review of the record, the examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that this condition(s) arose in or is otherwise etiologically related to service. The examiner should specifically consider the Veteran’s contention that his asthma is due to his exposure to water contaminants at Camp Lejeune, as well as Dr. J.R.’s private medical opinions that his exposure to water contaminants at Camp Lejeune caused his current disabilities. A complete rationale is required for any opinions rendered by the examiner.  All opinions should be based on examination findings, historical records, and medical principles. If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. 4. Obtain an addendum VA medical opinion from an appropriate clinician to determine the nature and etiology of any current skin condition, such as eczema. The entire claims file, to include a copy of this remand, must be furnished to the examiner. The examiner must review the claims file in its entirety and acknowledge such review in his or her examination report. Based on a review of the record, the examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that this condition(s) arose in or is otherwise etiologically related to service. The examiner should specifically consider the Veteran’s contention that his eczema is due to his exposure to water contaminants at Camp Lejeune, as well as Dr. J.R.’s private medical opinions that his exposure to water contaminants at Camp Lejeune caused his current disabilities. Additionally, the examiner should consider the Veteran’s service treatment records reflecting treatment for skin conditions, as well as post-service treatment records reflecting treatment for tinea versicolor and atopic dermatitis in 1980 and 1982, and whether these conditions are related to his current skin condition. A complete rationale is required for any opinions rendered by the examiner.  All opinions should be based on examination findings, historical records, and medical principles. (Continued on the next page)   If the requested opinions cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Rademacher, 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.