Citation Nr: 21041194 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-59 102 DATE: July 8, 2021 REMANDED Entitlement to service connection for a recurrent disability manifested by "neurobehavioral effects," claimed as the result of exposure to contaminated water at Camp Lejeune, North Carolina, is remanded. REASONS FOR REMAND The Veteran had active service from August 1987 to July 1990. He served in Panama and was awarded the Combat Action Ribbon. Entitlement to service connection for a recurrent disability manifested by "neurobehavioral effects," claimed as the result of exposure to contaminated water at Camp Lejeune, North Carolina, is remanded. Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for posttraumatic stress disorder (PTSD) with major depressive disorder, pain disorder, and alcohol and substance abuse; bilateral hearing loss; and tinnitus. In its July 2020 Remand instructions, the Board of Veterans' Appeals (Board) directed that the Veteran was to be scheduled for a Department of Veterans Affairs (VA) examination "to determine the nature and etiology of any neurobehavioral effects" identified. The examiner was requested to opine "whether the myopathy of the upper and lower extremities diagnosed by the April 2020 VA examination is a neurobehavioral effect." The report of a November 2020 examination conducted for VA states that the Veteran was diagnosed with myopathy of the upper and lower extremities. The examiner commented that "the symptoms of uncontrolled diabetes, PTSD, and neurobehavioral effect intersect, in regard to irritability, slow thinking, and memory loss, and cannot be distinguished without mere speculation." The nurse practitioner did not advance an opinion as to "whether the myopathy of the upper and lower extremities diagnosed by the April 2020 VA examination is a neurobehavioral effect." The Agency of Original Jurisdiction's compliance with the Board's remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, the Board finds that further VA evaluation is necessary. Clinical documentation dated after November 2020 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provide who has treated him for any "neurobehavioral effects" and other claimed recurrent residuals of exposure to Camp Lejeune contaminated water. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA clinical documentation not already of record, including that pertaining to treatment after November 2020. 3. Schedule the Veteran for a VA examination conducted by a medical doctor to assist in determining the nature and etiology of any identified recurrent disability manifested by "neurobehavioral effects" and any relationship to active service and the service connected disabilities. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all recurrent disabilities manifested by "neurobehavioral effects" found. (b) If myopathy of the upper and lower extremities is identified, the examiner should expressly state whether such disability constitutes a recurrent disability manifested by "neurobehavioral effects." (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified recurrent disability manifested by "neurobehavioral effects" had its onset during active service or are related to any incident of service, including the documented service at Camp Lejeune, North Carolina; and presumed exposure to contaminated water at that facility. (d) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified recurrent disability manifested by "neurobehavioral effects" was caused by the PTSD with major depressive disorder, pain disorder, and alcohol and substance abuse and the other service connected disabilities. (e) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified recurrent disability manifested by "neurobehavioral effects" has been aggravated (increased in severity beyond the natural progress of the disorder) by PTSD with major depressive disorder, pain disorder, and alcohol and substance abuse and the other service connected disabilities. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. R. Bobb, 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.