Citation Nr: 18144292 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 16-37 579 DATE: October 25, 2018 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) including as due to exposure to herbicides and/or Benzene or as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for bladder cancer including as due to exposure to herbicides and/or Benzene or as secondary to service-connected PTSD is remanded. Entitlement to service connection for hypertension including as due to exposure to herbicides and/or Benzene is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to August 1969. The Veteran served in the Republic of Vietnam from March 1967 to March 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board when he submitted a VA Form 9, Substantive Appeal in August 2016. In correspondence dated in May 2018, the Veteran was advised that he was scheduled for a hearing before the Board in June 2018. In a May 2018 statement, the Veteran withdrew his request for a hearing. As such, there is no outstanding request for a hearing. The Veteran last executed a VA Form 21-22, Appointment of Veterans Service Organization as Claimant’s Representative in favor of The American Legion in November 2015. In a statement received in August 2016, the Veteran revoked his appointment of The American Legion. As such, the Veteran is not represented by any service organization. COPD, Hypertension, and Bladder Cancer A review of the claims file reveals that a remand is necessary before a decision on the merits of the remaining claim can be reached. The Veteran contends that his claimed COPD, hypertension, and bladder cancer were due to exposure to Agent Orange or Benzene (a main chemical in Napalm). With regard to the claims for COPD and bladder cancer, the Veteran alternatively claimed that the disabilities were due to service-connected PTSD because he smoked cigarettes to cope with his service-connected PTSD. The Veteran’s in-service exposure to herbicides (Agent Orange) is presumed in light of his Vietnam service. 38 C.F.R. § 3.307(a)(6). COPD, hypertension, and bladder cancer are not specifically listed as a disease presumptively associated with exposure to Agent Orange. 38 C.F.R. § 3.309(e). The availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, a regulatory established presumption is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. The Veteran submitted a November 2014 statement from F. Vargo, M.D., and indicated that the Veteran had a diagnosis of COPD, hypertension, and bladder cancer. Dr. Vargo opined that there is sufficient clinical evidence to suggest at least a 50/50 probability that Agent Orange is contributory to his present health problems. Dr. Vargo noted that the Veteran’s pulmonologist F. Chaves, M.D., classified the Veteran’s COPD as severe requiring medication. The Veteran was reported to have quit smoking in 2012. Dr. Vargo reported that the Veteran supplied supportive evidence. Dr. Vargo did not provide any rationale for his conclusion. The Veteran was afforded several VA examinations for the claims on appeal. An October 2016 VA examiner opined that the Veteran’s COPD, hypertension, and bladder cancer were less likely than not related to exposure to herbicides because none of the claimed disabilities were diseases for which presumptive service connection may be granted. The examiner also opined that the claimed disabilities were less likely than not related to Benzene (and other chemicals used in Napalm) and he provided a rationale for those opinions. However, none of the opinions of record addressed whether the Veteran’s COPD, hypertension, or bladder cancer were directly due to his presumed in-service herbicide exposure. Whether there is a potential relationship between the Veteran’s COPD, hypertension, and bladder cancer and herbicide exposure must be addressed by an examiner. Stefl, supra; Combee, supra. With regard to the claim for bladder cancer, no examination or opinion as to the Veteran’s contention that his bladder cancer was caused by his service-connected PTSD was obtained. Specifically, while VA examinations were conducted for the Veteran’s contention that his COPD was due to his service-connected PTSD in July 2017, no opinion was requested with regard to the claim for bladder cancer. The Board notes that the October 2016 VA examiner opined that it is more likely than not that the etiology of the Veteran’s bladder cancer was smoking cigarettes. As such, an addendum etiology opinion should be obtained for the claim for bladder cancer as secondary to PTSD. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the VA examiner who rendered the October 2016 opinions, if available. The claims file should be provided to the examiner for review prior to rendering the opinion and such review should be noted in the examination report. Otherwise the opinion must be rendered by a similarly qualified provider. An explanatory rationale must be provided for all opinions expressed. If the examiner determines that another VA examination is necessary, an examination should be scheduled. Please state whether the Veteran’s COPD, hypertension, and bladder cancer are at least as likely as not (a 50 percent or greater probability) related or otherwise attributable to his presumed herbicide exposure regardless of whether the conditions are listed diseases under 38 C.F.R. § 3.309(e). 2. With regard to the claim for bladder cancer, obtain an addendum opinion from the VA examiner who rendered the July 2017 PTSD opinion, if available. The claims file should be provided to the examiner for review prior to rendering the opinion and such review should be noted in the examination report. The VA examiner is requested to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s cigarette smoking was proximately due to the service-connected PTSD. An explanatory rationale must be provided for all opinions expressed. If the examiner determines that another VA examination is necessary, an examination should be scheduled. 3. Then, readjudicate the Veteran’s claims. If the benefits sought on appeal remain denied, the Veteran should be furnished an appropriate supplemental statement of the case and be provided an opportunity to respond. The case should be returned to the Board for further appellate consideration, as appropriate. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Cryan, Counsel