Citation Nr: 21027890 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 20-04 559 DATE: May 7, 2021 REMANDED Entitlement to service connection for neuropathy, left upper extremity, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for neuropathy, right upper extremity, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for neuropathy, left lower extremity, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for neuropathy, right lower extremity, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1954 to July 1957. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in July 2020 for additional development. The matter is now returned to the Board for further appellate review. This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). 1. Entitlement to service connection for neuropathy, left upper extremity, to include as due to exposure to contaminated water at Camp Lejeune is remanded. 2. Entitlement to service connection for neuropathy, right upper extremity, to include as due to exposure to contaminated water at Camp Lejeune is remanded. 3. Entitlement to service connection for neuropathy, left lower extremity, to include as due to exposure to contaminated water at Camp Lejeune is remanded. 4. Entitlement to service connection for neuropathy, right lower extremity, to include as due to exposure to contaminated water at Camp Lejeune is remanded. The Veteran contends his left upper extremity neuropathy, right upper extremity neuropathy, left lower extremity neuropathy, and right lower extremity neuropathy (bilateral upper and lower extremity neuropathies) are due to his conceded exposure to contaminated drinking water at Camp Lejeune (CLCW). VA provided the Veteran an examination in January 2021. VA has a duty to ensure that any medical examination or opinion it provides is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 311; see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). The January 2021 VA opinion is inadequate to adjudicate the Veteran's claims. The examiner opined the Veteran's bilateral upper and lower extremity neuropathies are less likely than not incurred in or caused by his active duty military service. However, the examiner indicated an additional medical opinion addressing any association between his bilateral upper and lower extremity neuropathies and CLCW is warranted and should be completed by a CLCW specialist. The CLCW specialist also provided a negative nexus opinion. The CLCW specialist reasoned, in part, that the Veteran's bilateral upper and lower extremity neuropathies are not conditions listed as having an association with exposure with CLCW; the disease onset was 46 years after his exposure, in 2000; and his exposure was limited to 43 days. Although the Veteran's bilateral upper and lower extremity neuropathies are not conditions presumptively associated with CLCW under 38 C.F.R. § 3.309(f), this is not relevant because a Veteran may still pursue service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Further, the examiner does not explain why the Veteran spending only 43 days at Camp Lejeune would make it unlikely that the Veteran's bilateral upper and lower extremity neuropathies are due to his conceded CLCW exposure. Moreover, the examiner does not explain the significance of the temporal relationship between CLCW exposure and when the Veteran began experiencing symptoms of neuropathy. As noted above, the examiner indicated the onset of the Veteran's neuropathies were in 2000, 46 years after exposure. However, in the January 2021 examination, the examiner reported the Veteran began to experience symptoms in the 1980s. Accordingly, the CLCW examiner based his negative nexus opinion on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (indicating an opinion based on an incorrect factual premise has no probative value). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the July 2020 remand, the Board requested the Agency of Original Jurisdiction (AOJ) make two attempts to obtain any private treatment records identified by the Veteran and if any such records are unavailable, inform the Veteran, and afford him an opportunity to submit copies. The Veteran identified, among others, Dr. S.L.H. as a private treatment provider. In October 2020, VA attempted to obtain the Veteran's medical records from Dr. S.L.H.; however, it was unable to do so because the medical provider required a fee to make copies. There is no indication in the claims file that VA notified the Veteran it was unable to obtain these records on his behalf and afford him an opportunity to obtain them. The matters are REMANDED for the following action: 1. Obtain and associate with the file any outstanding VA treatment records. Moreover, the Veteran should be given an opportunity to identify any private medical records relevant to the appeal. 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 of such attempt and afford him an opportunity to submit copies. 2. Obtain an opinion regarding the etiology of the Veteran's left upper extremity neuropathy, right upper extremity neuropathy, left lower extremity neuropathy, and right lower extremity neuropathy. Schedule the Veteran for an examination only if deemed necessary by the clinician selected to provide the opinion. The examiner must opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's left upper extremity neuropathy, right upper extremity neuropathy, left lower extremity neuropathy, and right lower extremity neuropathy are at least as likely as not related to an in-service injury, event, or disease, to include the Veteran's exposure to contaminated water at Camp LeJeune during service. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. K. Anderson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zachery S.C. Luce, 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.