Citation Nr: 22017248 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 16-17 510 DATE: March 24, 2022 REMANDED Entitlement to service connection for a left leg disorder, including bursitis, is remanded. Entitlement to service connection for a left arm disorder, including bursitis, is remanded. Entitlement to service connection for a heart disorder is remanded. Entitlement to service connection for stroke residuals is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty from March 1975 to March 1977 and from April 1981 to November 1983. This case comes before the Board of Veteran's Appeals (Board) on appeal from the August 2014 and July 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in October 2018, and the Board remanded the Veteran's claims in order for him to attend a VA examination. In June 2021, the case returned to the Board. The Board remanded the Veteran's claims for hypertension and sleep apnea for VA examinations. In addition, the Board found that the Veteran's claims for left leg bursitis, left arm bursitis, a heart disability, and multiple strokes were intertwined with the Veteran's claim for hypertension and remanded these claims until the issue of hypertension had been adjudicated. 1. Entitlement to service connection for a left leg disorder, including bursitis, is remanded. 2. Entitlement to service connection for a left arm disorder, including bursitis, is remanded. 3. Entitlement to service connection for a heart disorder is remanded. 4. Entitlement to service connection for stroke residuals is remanded. 5. Entitlement to service connection for hypertension is remanded. 6. Entitlement to service connection for obstructive sleep apnea is remanded. The Board finds the Veteran's previous VA examinations to be inadequate because the examiners have not provided a thorough and well-reasoned analysis as to whether the chemicals in the drinking water at Camp Lejeune caused the development of the Veteran's disorders. Moreover, the examiners have not specifically addressed a medical article that the Veteran submitted in September 2014 that indicated that there was limited/suggestive evidence that the water at Camp Lejeune caused neurobehavioral effects. In this case, the VA medical examiners have found that the Veteran's disabilities are not a result of his exposure to contaminated water simply because these disorders are not on the list of diseases based on exposure to contaminants present in the water supply at Camp Lejeune. Although these disabilities are not entitled to the presumption of service connection, the Veteran may still establish service connection for a disability due to contaminated drinking water at Camp Lejeune on a direct basis. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Thus, the Board finds that a remand is required to obtain a more thorough analysis as to the nature and etiology of the Veteran's disabilities. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.310; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records from November 5, 2021, to the present. 2. Obtain addendum opinions for the Veteran's left arm, left leg, heart, hypertension, sleep apnea, and strokes. An additional examination should be scheduled if the examiner determines that it is necessary to properly evaluate the Veteran's disability. The examiner must specifically address whether the chemicals identified in the drinking water at Camp Lejeune led to the development of any of the Veteran's disabilities. The examiner must specifically address the information contained in the medical article that the Veteran submitted on September 25, 2014. The examiner must discuss the evidence that indicated that there was limited/suggestive evidence that the water at Camp Lejeune caused neurobehavioral effects. The VA examination reports must include a complete rationale for all opinions expressed. 3. Thereafter, the AOJ must readjudicate the Veteran's appealed issues in light of the totality of evidence of record. If any benefit sought is not granted to the fullest extent, the AOJ must provide the Veteran and his representative with a copy of the readjudication and afford them an appropriate period to respond. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Rescan, 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.