Citation Nr: 18141906
Decision Date: 10/12/18	Archive Date: 10/11/18

DOCKET NO. 16-15 092A
DATE:	October 12, 2018
REMANDED
Entitlement to service connection for renal cell carcinoma, to include as due to toxic herbicide exposure is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1968 to June 1970.
Entitlement to service connection for renal cell carcinoma, to include as due to toxic herbicide exposure is remanded.
The Veteran contends that his renal cell carcinoma was caused by his exposure to toxic herbicide agents during his active duty service in Vietnam.  
Although renal cell carcinoma is not among the diseases eligible for presumptive service connection based upon exposure to toxic herbicide agents, it does not preclude service connection on a direct basis.  38 C.F.R. §§ 3.307(a)(6), 3.309(e); see also Combee v. Brown, 34 F.3d 1039, 1942 (Fed. Cir. 1994).  Here, the Board finds that the evidence reflects that the Veteran’s renal cell carcinoma may be related to his active duty service.  Specifically, the evidence shows that the Veteran has a diagnosis of renal cell carcinoma and that the Veteran had active duty service in Vietnam from November 1968 to November 1969.  Moreover, the Veteran submitted medical literature presenting the results of a study that found that there may be a connection between exposure to herbicide agents and the subsequent development of renal cancer.  Thus, the evidence indicates that the Veteran’s renal cell carcinoma may be etiologically related to service and a VA examination to determine its nature and etiology is warranted.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).
The matter is REMANDED for the following action:
1. Obtain any and all treatment records from the Durham VA Medical Center in Durham, North Carolina since April 2014, and any other VA facility from which the Veteran has received treatment.
If the Veteran has received additional private treatment, he should be afforded an appropriate opportunity to submit the medical records of such treatment.
2. Schedule the Veteran for a VA examination by an appropriate clinician to determine the nature and etiology of his renal cell carcinoma.  The claims file must be provided to the examiner for review.  All indicated studies deemed necessary by the examiner should be performed, and all findings of those tests should be reported in detail.
The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s renal cell carcinoma had its onset in, or is otherwise etiologically related to the Veteran’s period of active duty service, to include his presumed exposure to herbicide agents in service.
The examiner is reminded that although renal cell carcinoma is not among the diseases eligible for presumptive service connection based on toxic herbicide exposure, service connection on a direct basis is not precluded.
If the examiner cannot provide any of the requested opinions without resorting to speculation, he or she should provide an explanation stating why this is so.  In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s).
 
B.T. KNOPE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Crosnicker, Associate Counsel