Citation Nr: 21026766 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-35 583 DATE: May 3, 2021 REMANDED Entitlement to service connection for body pain, to due to exposure to contaminated water at Camp Lejeune and as secondary to prostate cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1979 to July 1981. This matter is on appeal from an August 2013 rating decision. In June 2017, the Veteran testified before the undersigned Veterans Law Judge at a Video Conference hearing. A transcript of the hearing is of record. In April 2018, this matter and claims of entitlement to service connection for PTSD and prostate cancer were remanded by the Board for further development. The claims for service connection for prostate cancer and PTSD cancer were granted in July 2020 and October 2020 rating decisions, respectively. The Veteran did not disagree with the disability evaluations or the effective dates assigned. Therefore, these matters are no longer considered to be in appellate status. In the April 2018 remand, the Board requested an etiological opinion as to whether the Veteran's complaints of body pain had their onset in or were etiologically related to his active duty service, including exposure to contaminated water at Camp Lejeune. Pursuant to the Board's remand, in June 2020 a VA examiner opined that the Veteran's current complaints of body pain and a knee disability did not appear to be related to service. The Veteran stated that he was unaware of a diagnosis of fibromyalgia, but complained of knee pain and arthritis which he said was unrelated to prostate cancer. In a March 2021 statement, the Veteran's representative contended that he had chronic body pain secondary to his service-connected prostate cancer. Alternatively, she contends that the Veteran's chronic body pain is comorbid with his service-connected PTSD. The representative also contended that the Veteran may have contracted renal toxicity caused by exposure to water at Camp Lejeune which may have caused swelling and could be the cause of chronic body pain in his knees and throughout his body. As it remains unclear whether the Veteran has a chronic pain disability related to his service or service-connected disabilities, on remand an additional VA examination and medical opinion should be obtained. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following actions: Schedule the Veteran for VA examinations by an examiner, regarding the nature and etiology of the Veteran's chronic body pain. The claims file must be made available to the examiner for review who should indicate that the claims file was reviewed. The examiner should provide the following opinion(s): a) The examiner should state whether the Veteran has a diagnosis of renal toxicity or other kidney disability. b) If a kidney disability is diagnosed, to specifically include renal toxicity, the examiner should opine as to whether it is at least as likely as not (50 percent or more probability) that the kidney disability had its onset in or is etiologically-related to the Veteran's active duty service, to include exposure to contaminated water at Camp Lejeune? If so, is it at least as likely as not (50 percent or more probability) that the Veteran's complaints of chronic pain, including pain in the Veteran's knees, and swelling are related to his kidney disability? c) If the Veteran does not have a diagnosed kidney disability, does the Veteran have a disability, that is manifested by chronic pain? d) If there is no diagnosed disability manifested by chronic pain, is it at least as likely as not (a 50 percent probability or more) that any complaints of pain reach the level of a functional impairment of earning capacity? Described the impairment caused. e) If the Veteran's chronic pain reaches the level of a functional impairment of earning capacity, is it at least as likely as not (50 percent probability or more) that the Veteran's chronic pain is (a) proximately due to or the result of the Veteran's service-connected prostate cancer or PTSD, or (b) aggravated (any incremental increase in the disability beyond its normal progression) by his service-connected prostate cancer or PTSD? If it is determined that the disability is related to a service-connected disability, to the extent possible, the examiner should indicate the approximate degree of disability or baseline before the onset of aggravation. The examiner is asked to consider and discuss as necessary the pertinent evidence of record to include the Veteran's lay statements and complaints concerning the onset of his current complaints of chronic pain throughout his body and bilateral knee pain and swelling, including those made to medical providers; March 2021 Brief, including the articles/treatise evidence cited therein which indicate an etiological relationship between chronic pain and PTSD; and VA examinations and opinions. The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file. The report of examination should include the complete rationale for all opinions expressed. The phrase "at least as likely as not" does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Adams, 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.