Citation Nr: 21026280 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 19-27 555 DATE: April 30, 2021 REMANDED Entitlement to service connection for dementia to include as due to water contamination at Camp Lejeune is remanded. Entitlement to service connection for neurobehavioral effects to include as due to water contamination at Camp Lejeune is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1961 to May 1964. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Veteran and his wife testified at a hearing before the undersigned in April 2021. Given the Veteran’s current physical and mental status, his wife gave most of the testimony. A copy of the hearing is associated with the record. Entitlement to service connection for dementia, to include alas due to water contamination at Camp Lejeune. Entitlement to service connection for neurobehavioral effects, to include as due to water contamination at Camp Lejeune. It is contended that claimed disabilities were caused by exposure to chemicals and solvents from contaminated water supplies while stationed at Camp Lejeune during active service. The Veteran’s service at Camp Lejeune has been conceded. See July 2018 rating decision. The Agency of Original Jurisdiction (AOJ) denied service connection because the claimed disabilities are not on the list of diseases that VA has presumed are related to exposure to contaminants in the water supply at Camp Lejeune. However, evidence in support of the claims includes references to studies that suggest a connection between the claimed condition and the Camp Lejeune exposure. Service connection could be established by showing actual causation. Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). The claim must be remanded for a medical opinion. 38 C.F.R. § 3.159 (c)(4). During the hearing, the Veteran’s representative asserted that the claimed conditions may be related to exposure to herbicides. The representative and the Veteran’s wife noted that while the Veteran was stationed in Japan he may have had reason to travel to the Republic of Vietnam. The Veteran separated from service in May 1964. His service personnel records do show that he specifically served in Vietnam and neither the representative nor the Veteran’s spouse was aware of any details related to possible temporary duty that took the Veteran to Vietnam. On remand, the AOJ should review the record and determine whether further development can be undertaken on that. The matters are REMANDED for the following action: 1. Review the record and determine whether any further development needs to be done to confirm possible duty, even temporary, in Vietnam. The Veteran’s service personnel records confirm he was stationed in Japan and was separated from service in May 1964. 2. After completion of the foregoing, obtain a medical opinion from an appropriate clinician, preferably a neurologist, on the current nature and likely etiology of the Veteran's (1) dementia and (2) neurobehaviorial effects. Copies of all pertinent records, including the appellant’s May 2018 submission related to neurological effects related to exposure to TCE and/or PCE, must be made available to the examiner. After reviewing the record, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed dementia and neurobehaviorial effects were incurred in or is otherwise related to service, to include presumptive exposure to chemicals and solvents from contaminated water supplies at Camp Lejeune? (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed dementia and neurobehavior effects has been aggravated by any of the Veteran’s service, to include presumptive exposure to chemicals and solvents from contaminated water supplies at Camp Lejeune? The examiner must review and discuss the studies and literature submitted in May 2018 that suggest a link between demential and neurobehavioral effects and exposure to chemicals and solvents from contaminated water supplies while stationed at Camp Lejeune. If those studies are not available to the examiner, the examiner must contact the AOJ. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner’s own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.