Citation Nr: 21042628 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 19-00 162 DATE: July 13, 2021 REMANDED The issue of entitlement to service connection for a bladder condition is remanded. The issue of entitlement to service connection for a gastrointestinal disorder, including acute gastrointestinal hemorrhage with rectal bleeding, chronic active gastritis, diverticulosis, duodenal ulcer, and gastric erosion of the stomach is remanded. THE VETERAN'S CONTENTIONS The Veteran contends that his bladder condition and gastrointestinal disorders are due to contaminated water during his service in Camp LeJeune. See November 2020 Board hearing, pp. 2-4; September 2016 claim; May 2017 notice of disagreement (NOD). At the November 2020 Board hearing, the Veteran clarified that he did not currently have bladder cancer, but he was being treated for a bladder condition. Id., p. 4. He testified that he was not able to fully empty his bladder at times and needs to be near a restroom and that he gets up multiple times in the evening. Id., p. 5. He testified that the condition began in 2015 and that if he goes on trips, he has to wear absorbent material to avoid accidents. Id., pp. 5-6. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from August 1981 to August 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at a Board hearing before the undersigned Veterans Law Judge in November 2020. A transcript of that hearing is of record. In light of the Veteran's testimony that he did not have a diagnosis of cancer, but he had other bladder symptoms, the Board has recharacterized the Veteran's claim as entitlement to service connection for a bladder condition. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Bladder condition A VA examination was not provided regarding the Veteran's bladder condition. The Veteran's service at Camp Lejeune has been confirmed. Post-service private treatment records show a diagnosis of bladder outlet obstruction. See May 2015 through November 2020 private treatment records. In light of the Veteran's contentions, the Board finds that there is sufficient indication that the Veteran's bladder symptoms may be associated with his service, to include exposure to contaminated water in Camp LeJeune. As such, a VA examination is warranted. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Gastrointestinal disorder, including acute gastrointestinal hemorrhage with rectal bleeding, chronic active gastritis, diverticulosis, duodenal ulcer, and gastric erosion of the stomach The Veteran's service at Camp Lejeune has been confirmed. A January 2017 private medical opinion from E.M. and L.I. is of record. The medical opinion states that the Veteran had a gastrointestinal bleed in May 2016 and later that month, he tested positive for helicobacter pylori. It also states that one suspected source of helicobacter pylori transmission is through contaminated drinking water, and that it is "theoretically possible" that the drinking water at Camp LeJeune could have been the source of the Veteran's helicobacter pylori infection and subsequent gastritis. See January 2017 private medical opinion. A VA medical opinion was obtained in October 2018. The clinician noted that the Veteran was diagnosed acute gastrointestinal hemorrhage with rectal bleeding, chronic active gastritis, diverticulosis, duodenal ulcer, and gastric erosion of the stomach in May 2016. However, the clinician determined that these conditions were less likely than not caused by the Veteran's exposure to Camp Lejeune contaminated water, noting the Veteran's chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) and that 31 years passed prior to his diagnosis. The clinician did not address the January 2017 private medical opinion linking the Veteran's gastrointestinal conditions to contaminated drinking water in Camp LeJeune. The Board finds that this opinion is inadequate for adjudication purposes. The Board finds that a VA opinion is warranted to address the January 2017 private medical opinion from E.M. and L.I. and state whether any of the Veteran's gastrointestinal conditions are related to his service, to include exposure to contaminated drinking water in Camp LeJeune. The matters are REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate VA clinician to issue medical opinion as to the nature and etiology of the Veteran's bladder condition(s). The entire claims file, including a copy of this Remand, must be made available to, and must be reviewed by the clinician. If the clinician determines that a physical examination is necessary, one should be provided. Thereafter, the clinician should address the following: (a.) Please identify any current bladder condition, to include bladder outlet obstruction. (b.) For each disorder identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the disorder had its onset in, was caused by, or is otherwise related to service, to include his conceded exposure to contaminated water during service in Camp Lejeune. The examiner should consider medical and lay evidence dated both prior to and since the filing of the claim. The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 2. Send the Veteran's claims file to an appropriate VA clinician to issue medical opinion as to the nature and etiology of the Veteran's gastrointestinal disorders, including acute gastrointestinal hemorrhage with rectal bleeding, chronic active gastritis, diverticulosis, duodenal ulcer, and gastric erosion of the stomach. The entire claims file, including a copy of this Remand, must be made available to, and must be reviewed by the clinician. If the clinician determines that a physical examination is necessary, one should be provided. Thereafter, the clinician must state whether it is at least as likely as not (50 percent probability or more) that any of the Veteran's diagnosed gastrointestinal disorders, including acute gastrointestinal hemorrhage with rectal bleeding, chronic active gastritis, diverticulosis, duodenal ulcer, and gastric erosion of the stomach, had its onset in, was caused by, or is otherwise related to service, to include his conceded exposure to contaminated water during service in Camp Lejeune. In providing the requested opinion, the examiner must specifically acknowledge and address the January 2017 private medical opinion of record from E.M. and L.I. , which determined that one suspected source of helicobacter pylori transmission is through contaminated drinking water, and that it is "theoretically possible" that the drinking water at Camp LeJeune could have been the source of the Veteran's helicobacter pylori infection and subsequent gastritis. The examiner should also consider all other medical and lay evidence dated both prior to and since the filing of the claim. The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Samuelson, 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.