Citation Nr: 21023027 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 17-36 226A DATE: April 19, 2021 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from February 1961 to June 1964. Sadly, the Veteran died in June 2016; the Appellant is his surviving spouse. The Appellant filed for service connection for the cause of the Veteran’s death in August 2016. The Veteran’s cause of death was listed on his death certificate as a myocardial infarction, with underlying causes of chronic obstructive pulmonary disease (COPD), end stage renal disease, and chronic congestive heart failure. The Appellant contends that the Veteran’s death was due to his active service, including as a result of exposure to contaminated water at Camp Lejeune during his service. Notes in the Veteran’s service treatment records (STRs) show that he received medical treatment while stationed at Camp Lejeune in June 1961, August 1961, December 1961, March 1962, April 1962, May 1962, June 1962, August 1962, and March 1963. While the claims file does not contain a copy of the Veteran’s service personnel records (SPRs), and the exact dates the Veteran served at Camp Lejeune are therefore unclear, the notes in his STRs make it more likely than not that the Veteran spent at least 30 total days serving at Camp Lejeune. The Veteran is therefore presumed to have been exposed to contaminants in the water supply at Camp Lejeune during his active service. 38 CFR § 3.307(a)(7)(iii). None of the conditions listed on the Veteran’s death certificate are on the list of diseases presumptively caused by exposure to contaminants at Camp Lejeune. 38 CFR § 3.309(f). However, entitlement to service connection may still be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). No medical examiner has yet opined on whether exposure to contaminants at Camp Lejeune was a cause of any of the conditions that lead to the Veteran’s death. The Board finds that such a medical opinion is necessary to resolve the claim, and therefore remands. See 38 U.S.C. § 5103A. The matters are REMANDED for the following action: 1. Obtain a copy of the Veteran’s service personnel records (SPRs), as well as any outstanding treatment records, and associate these records with the claims file. 2. Once the above records have been associated with the claims file, obtain a medical opinion from an appropriate clinician regarding the nature and etiology of all conditions that contributed to the Veteran’s death. The entire claims file, including a copy of this remand, should be made available to the examiner for review. Once the examiner certifies that they have reviewed the full claims file, they shall answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s myocardial infarction was principally or contributorily caused by exposure to contaminated water at Camp Lejeune, or by any other incident of service? (b.) Is it at least as likely as not that the Veteran’s renal failure was principally or contributorily caused by exposure to contaminated water at Camp Lejeune, or by any other incident of service? (c.) Is it at least as likely as not that the Veteran’s chronic obstructive pulmonary disease (COPD) was principally or contributorily caused by exposure to contaminated water at Camp Lejeune, or by any other incident of service? (d.) Is it at least as likely as not that the Veteran’s chronic congestive heart failure was principally or contributorily caused by exposure to contaminated water at Camp Lejeune, or by any other incident of service? (e.) Is it at least as likely as not that any of the Veteran’s already service-connected conditions (listed on a July 2017 Rating Decision Codesheet) contributed to the Veteran’s death in any way? (CONTINUED ON THE NEXT PAGE) The examiner must provide a complete rationale for all opinions stated, citing all evidence and medical literature relied upon. If the examiner cannot provide an opinion without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shermila Sundquist 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.