Citation Nr: 21026685 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-19 613 DATE: May 3, 2021 REMANDED Entitlement to service connection for prostate cancer with related residuals due to exposure to contaminated drinking water at Camp LeJeune is remanded. Entitlement to service connection for erectile dysfunction due to exposure to contaminated drinking water at Camp LeJeune is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1975 to September 1979, including service at Camp LeJeune from February 1977 to September 1979. These matters come before the Board of Veterans' Appeals (Board) from an October 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded these matters to the RO for further development in November 2019 and January 2021. Entitlement to service connection for prostate cancer with related residuals due to exposure to contaminated drinking water at Camp LeJeune is remanded. Entitlement to service connection for erectile dysfunction due to exposure to contaminated drinking water at Camp LeJeune is remanded. The Veteran contends that he incurred prostate cancer and erectile dysfunction as a result of exposure to contaminated drinking water while stationed at Camp Lejeune. The March 2021 supplemental statement of the case reflected favorable findings that the Veteran had service at Camp LeJeune and that he has current diagnoses of prostate cancer and erectile dysfunction. In January 2021, the Board found that a prior September 2020 VA examination and opinion were provided by a Doctor of Occupational Medicine (a specialty dealing with occupational injuries), without demonstrated expertise in Camp LeJeune contaminated water (CLCW) cases. The Board found it significant that the last VA examiner before the prior remand was a CLCW subject matter expert and the current examiner is a physician without expertise in CLCW diseases. Therefore, the Board found that this opinion was inadequate and found that a remand is warranted in order to obtain those opinions from an examiner who is as equally qualified as the 2013 examiner. A VA etiology opinion was obtained in February 2021. However, this opinion was provided by the same examiner who provided the September 2020 opinion. As such, there has not been substantial compliance with the previous remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). On remand, an addendum opinion should be obtained from an examiner with CLCW subject matter expertise. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, provide the claims file to an examiner with CLCW subject matter expertise to opine as to the etiology of the Veteran's prostate cancer and erectile dysfunction. The examiner should explain why and how he or she has CLCW subject matter expertise. The need for further in-person examination is left to the discretion of the examiner. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that any prostate cancer and ED diagnosed during the pendency of this appeal had its onset in service or is otherwise etiologically related to service, to include the conceded exposure to CLCW while in Camp Lejeune from February 4, 1977, to September 10, 1979. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Adeyemi, 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.