Citation Nr: 21027283 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 16-00 288A DATE: May 5, 2021 REMANDED Entitlement to service connection for vertigo, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), as include as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for a skin disorder other than pseudofolliculitis barbae, claimed as rash or scars, as include as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1977 to November 1989, including verified service at Camp LeJeune. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions dated July 24, 2013 and April 9, 2014each issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. By way of background, the Veteran filed one Notice of Disagreement, see NOD (rec'd July 11, 2014), noting disagreement with denied claims for service connection for COPD, vertigo, pseudofolliculitis barbae, and an additional skin disorder. There is no dispute that this NOD is timely and valid as to all of these issues. During the pendency of this appeal, the Veteran was granted service connection for pseudofolliculitis barbae, and assigned an initial noncompensable rating for it, in a December 21, 2018 rating decision. There is no NOD within a year challenging the propriety of the rating or effective date for pseudofolliculitis barbae. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). The Board also notes that the Veteran initially requested a hearing before a Veterans Law Judge. See VA Form 9 (rec'd Jan. 29, 2019 ), at Question No. 7. The Veteran was informed that his hearing was to be conducted on May 9, 2019. See Correspondence ( Apr. 5, 2019 ). The Veteran did not attend his scheduled hearing, did not request that the hearing be rescheduled and did not communicate good cause as to why his absence should be excused. The Board proceeds accordingly. 1. Entitlement to service connection for vertigo is remanded. A VA examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. The evidence of record confirms that the Veteran has been diagnosed with vertigo since February 23, 2009, as the latest possible date of diagnosis. See VA Medical Records (rec'd July 13, 2020 ). The Board also notes that while in service, the Veteran was diagnosed with labyrinthitis, a condition of the inner ear. See STR ( June 10, 1985 ). See also STR ( April 18, 1983 ) (handwritten notation of "no longer" next to "Dizzy spells"). The Veteran appears to broadly attribute his current disabilities with his service at Camp LeJeune, see generally 38 C.F.R. §§ 3.307(a)(7), 3.309(f). As the Veteran has a current diagnosis and there is a suggestion of a possible in-service event, a VA etiology opinion is required. McLendon v. Nicholson, supra. The Board accordingly remands the claim for appropriate development. 2. Entitlement to service connection for COPD is remanded. The Veteran appears to broadly attribute his current disabilities to his service at Camp LeJeune, see generally 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The Board notes that the Veteran appears to have denied any knowledge of in-service exposure to asbestos, see STR ( July 29, 1986 ). Nonetheless, the Veteran was diagnosed with COPD no later than January 2016. See VA Treatment Record ( Jan. 11, 2016 ). As noted above, entitlement to a VA examination to help substantiate a claim for benefits, see McLendon, supra, is a low threshold. The Board concludes that as the Veteran may have been placed on notice of potential exposure to asbestos, generally contends that his disabilities are attributable to service at Camp LeJeune or otherwise during service, and currently has a diagnosis of COPD, a VA etiology opinion is warranted. The matter is remanded accordingly. 3. Entitlement to service connection for a skin disorder other than pseudofolliculitis barbae, claimed as rash or scars, is remanded. The Board notes that the Veteran's pseudofolliculitis barbae, which has since been granted service connection and is no longer on appeal, appears to have first manifested as a rash on the Veteran's face. See STR ( June 5, 1980 ) (rec'd Feb. 27, 2014). To the extent that there is a separate disorder for a rash that can be diagnosed as separate from pseudofolliculitis barbae, see 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994), the Board determines that a remand is required to appropriately develop the claim. The Veteran's service treatment records indicate, at the very least, some dermatological findings that may be relevant to the claim. See, e.g.: STR (Apr. 18, 1983), at Question No. 39 ( mole on right bicep ). On October 9, 2012, the Veteran filed a claim for service connection for "skin disorder, undiagnosed," that he claims manifested in 1985. See VA Form 21-526 (rec'd Oct. 9, 2012 ), at Part B, Section I. The Veteran then filed a claim for service connection for pseudofolliculitis barbae with scars. See VA Form 21-526b (rec'd Feb. 19, 2014 ). A VA examination determined that the Veteran is diagnosed with pseudofolliculitis barbae and recurrent inclusion cysts; however, the examiner concluded that the cysts were "pathophysiologically and geographically unrelated to his pseudofolliculitis barbae, occurring in different areas and by different means." See VA Exam ( Apr. 24, 2020 ). The Board concludes that this examination does not contain a rationale with sufficient scientific rationale as to why these cysts are not attributable to pseudofolliculitis barbae. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2009); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion...must support its conclusion with an analysis the Board can consider and weight against contrary opinion"). There is also no opinion as to whether these cysts are alternatively attributable to service by reasons other than as secondary to pseudofolliculitis barbae. Finally, there is no discussion as to whether the Veteran has a specific rash or scar disorder, for which the Veteran appears to have initially filed his claim. For these reasons, the Board concludes that a remand is required for addendum opinions. 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 claim 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 their 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, schedule the Veteran for all appropriate VA examinations by an appropriate clinician to assess the nature and etiology of his claimed COPD, vertigo, and skin disorderto specifically include due to service at Camp LeJeune. The claims file, including a copy of this remand, must be made available to and reviewed by the examiner. The examiner should also take a history from the Veteran as to the progression of his disability. The need for further in-person examination is left to the discretion of the examiner. After a review of the record, an examination and interview of the Veteran, the examiner should address each of the following: (A) For the claimed vertigo, is it at least as likely as not (i.e., whether it is 50 percent or more probable) that the disorder was caused by, or is otherwise etiologically related to, the Veteran's active service, including service at Camp LeJeune? The examiner should specifically address the relevance, or lack thereof, of a June 1985 diagnosis of labyrinthitis and an April 1983 notation that he was "no longer" suffering from dizzy spells. (B) For the claimed COPD, is it at least as likely as not (i.e., whether it is 50 percent or more probable) that the disorder was caused by, or is otherwise etiologically related to, the Veteran's active service, including service at Camp LeJeune? (C) For any skin disorder other than pseudofolliculitis barbae, including but not limited to a rash disorder or scar, is it at least as likely as not (i.e., whether it is 50 percent or more probable) that the disorder was caused by, or is otherwise etiologically related to, the Veteran's active service, including service at Camp LeJeune? The examiner should specifically address the relevance, or lack thereof, of the Veteran's contention that the disorder was undiagnosed but manifested as early as 1985. The examiner should also address whether this rash disorder or scar are encompassed under the Veteran's pseudofolliculitis barbae and explain why or why not. 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 for the Board 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 Michael B. Engle, 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.