Citation Nr: 21024237 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 17-40 145 DATE: April 22, 2021 REMANDED Entitlement to service connection for the residuals of left side mastectomy, to include as due to exposure to environmental hazards during service in Vietnam and as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for precancerous polyps (tubular adenomas), to include as due to exposure to environmental hazards during service in Vietnam and as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1965 to August 1968, with active service in Vietnam and at Camp Lejeune. This matter comes to the Board of Veterans’ Appeals (Board) from a July 2014 rating decision which denied service connection for the residuals of left side mastectomy. A June 2015 rating decision denied service connection for the residuals of left side mastectomy and precancerous polyps. In February 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. As a preliminary matter, at the February 2021 hearing, the Veteran’s representative requested the Board to broadly construe and recharacterize the claim of service connection for precancerous polyps (tubular adenomas) as a claim of service connection for skin disorder of the back. At the February 2021 hearing, the Veteran reported polyps or cysts on his back in 1970, 1983, and 2003. In a February 2021 letter, the Veteran’s spouse stated that the Veteran had cysts removed from his back. A claim of service connection for a disability should be construed to reflect the reasonable expectations of a non-expert veteran. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In determining the scope of the Veteran’s claim, the Board should consider the Veteran’s description of the claim, the Veteran’s symptoms, the information submitted by the Veteran in support of the claim, and the information obtained by VA in processing the claim. See id. at 5-6. The Board finds that the relevant considerations weigh against expanding the scope of the Veteran’s claim. Prior to the February 2021 hearing, the Board notes that the Veteran’s written pleadings, to include the January 2015 claim, the July 2015 Notice of Disagreement, and the July 2017 Form 9, all framed the claim as service connection for precancerous polyps (tubular adenomas). While a Veteran’s description of the claim is not dispositive, the Board notes that tubular adenomas are found in the colon. Indeed, at the time of the January 2015 claim, the Veteran submitted a November 2014 colonoscopy report that identified three precancerous tubular adenomas in the colon. The Veteran’s written pleadings and supporting evidence shows that the claim was based on a colon disability. Moreover, the Board notes that the Veteran’s written pleadings never described symptoms of a back disability. While the Veteran is not a medical expert, these disabilities affect two different body systems, and a claim for a colon disability would not reasonably include a back disability. The Board further notes that the competent evidence of record does not suggest a connection between these disabilities. The Veteran is not competent to state that these disabilities are related, and the medical evidence of record does not suggest that these disabilities are related. Accordingly, the Board finds that the Veteran’s claim of service connection for precancerous polyps (tubular adenomas) does not include a back disability. While the relevant considerations weigh against expanding the scope of the Veteran’s claim, the Veteran can file a claim of service connection for a back disability. Residuals of left side mastectomy The Board cannot make a fully-informed decision at this time because the Veteran has not been provided with a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). Here, it is unclear whether the Veteran’s residuals of left side mastectomy may be associated to service, to include as due to exposure to environmental hazards during service in Vietnam and as due to exposure to contaminated water at Camp Lejeune, While the Veteran’s military records show service in Vietnam and, therefore, presume exposure to herbicide agents, see 38 C.F.R. § 3.307(a)(6)(iii), additional development is necessary to clarify the Veteran’s representative’s assertion at the February 2021 hearing that the Veteran was exposed to multiple environmental hazards during service in Vietnam. On remand, the Veteran should identify the details of any exposure to environmental hazards during service in Vietnam besides herbicide agents. Furthermore, while the Veteran’s military records show active service at Camp Lejeune, additional development is necessary to identify the specific dates of active service. Similarly, while the Veteran’s disability is not subject to presumptive service connection as due to exposure to contaminated water at Camp Lejeune, see 38 C.F.R. § 3.309(f), the VA examiner should consider the inclusion of breast cancer in 38 C.F.R. § 17.400, which provides hospital care and medical services to certain Camp Lejeune veterans, in determining whether service connection is warranted. Finally, the Veteran’s VA records should be updated, and the Veteran should be provided with VA Form 21-4142 to identify any private treatment records for this disability, to include from Obleness Memorial Hospital and private primary physician Dr. C. Precancerous polyps The Board cannot make a fully-informed decision at this time because the Veteran has not been provided with a VA examination. See McLendon, 20 Vet. App. at 86. Here, it is unclear whether the Veteran’s precancerous polyps may be associated to service, to include as due to exposure to environmental hazards during service in Vietnam and as due to exposure to contaminated water at Camp Lejeune. As noted in the prior section, additional development is necessary to identify any environmental hazards other than herbicide agents and to identify the specific dates of active service at Camp Lejeune. Finally, the Veteran should be provided with VA Form 21-4142 to identify any private treatment records for this disability, to include from Ohio Gastroenterology Group, and relevant private records scanned into the Veteran’s VA treatment records, to include a May 31, 2016, NonVA Note; August 22, 2016, NonVA Note; August 25, 2016, NonVA Note; April 28, 2017, Administrative Note; October 19, 2020, NonVA Note; and March 15, 2021, NonVA Note, should be associated with the Veteran’s claims file. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from March 2021 to the present. 2. Associate relevant private records scanned into the Veteran’s VA treatment records with the Veteran’s claims file, to include May 31, 2016, NonVA Note; August 22, 2016, NonVA Note; August 25, 2016, NonVA Note; April 28, 2017, Administrative Note; October 19, 2020, NonVA Note; and March 15, 2021, NonVA Note. 3. Verify the Veteran’s dates of active service at Camp Lejeune. 4. Ask the Veteran to complete a VA Form 21-4142 for primary care physician Dr. C., Obleness Memorial Hospital, Ohio Gastroenterology Group, and any other private provider for the residuals of left side mastectomy and precancerous polyps (tubular adenomas). Make two requests for the authorized records from each provider, unless it is clear after the first request that a second request would be futile. 5. Ask the Veteran to complete a VA Form 21-4138 to identify the details of any exposure to environmental hazards during service in Vietnam besides herbicide agents. 6. Following the above development, schedule the Veteran for a VA examination for the residuals of left side mastectomy. The examiner should review the claims file and provide a rationale for all opinions. The examiner should opine whether this disability is at least as likely as not related to service, to include as due to in-service exposure to herbicide agents and as due to contaminants in the water during service at Camp Lejeune? The examiner is advised that a negative opinion cannot be based solely on the fact that this disability is not on the list of diseases that are presumptively associated with exposure to herbicide agents or exposure to contaminants in the water supply at Camp Lejeune. The examiner should consider exposure to other environmental hazards during service in Vietnam if alleged by the Veteran. The examiner also should consider the inclusion of breast cancer in 38 C.F.R. § 17.400, which provides hospital care and medical services to certain Camp Lejeune veterans. 7. Schedule the Veteran for a VA examination for precancerous polyps (tubular adenomas). The examiner should review the claims file and provide a rationale for all opinions. The examiner should opine whether this disability is at least as likely as not related to service, to include as due to in-service exposure to herbicide agents and as due to contaminants in the water during service at Camp Lejeune? The examiner is advised that a negative opinion cannot be based solely on the fact that this disability is not on the list of diseases that are presumptively associated with exposure to herbicide agents or exposure to contaminants in the water supply at Camp Lejeune. The examiner should consider exposure to other environmental hazards during service in Vietnam if alleged by the Veteran. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ormson, 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.