Citation Nr: 18147751 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 16-26 800 DATE: November 7, 2018 REMANDED Entitlement to service connection for kidney cancer post right total nephrectomy is remanded. Entitlement to a temporary total rating under 38 C.F.R. § 4.30 for surgery (a right total nephrectomy in October 2014) necessitating convalescence is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1969 to April 1971. This case comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for kidney cancer including a right total nephrectomy is remanded. The Veteran maintains that his kidney cancer, resulting in removal of his right kidney in October 2014, was a result of his exposure to Agent Orange during service in Vietnam. An imaging study in May 2014 showed a right renal lesion that was suspicious for neoplasm. Further workup including a pathology report from a right total nephrectomy revealed the Veteran to have papillary renal cell carcinoma. Medical records in the file do not show kidney cancer prior to 2014, and the Veteran’s type of cancer is not among the listed conditions under 38 C.F.R. § 3.309(e) for diseases presumed to be associated with herbicides agents. Nevertheless, the Veteran – a Vietnam Veteran with presumed exposure to herbicides during service – has established service connection for disabilities due exposure to Agent Orange in Vietnam, including diabetes mellitus (rated 20 percent), diabetic nephropathy (60 percent), and coronary artery disease (30 percent). Known risk factors for papillary renal cell carcinomas in the medical literature include advanced kidney disease and occupational exposures to certain herbicides, as well as older age, smoking, and obesity. Given that the Veteran meets some of the risk factors, particularly kidney disease which is service-connected, the Board finds that a medical opinion regarding the etiology of the Veteran’s kidney cancer is necessary. Private medical records pertaining to the Veteran’s treatment for kidney cancer (including the right total nephrectomy operative report) should be obtain prior to the request for an advisory opinion. 2. Entitlement to a temporary total rating under 4.30 for surgery (a right total nephrectomy in October 2014) necessitating convalescence is remanded. As this claim is inextricably intertwined with the kidney cancer issue being remanded for additional evidentiary development, its consideration must be deferred pending development and resolution of the kidney cancer matter. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for the private provider(s) who have treated him for kidney cancer. If a response to an initial authorized request for records from the private providers brings no response, follow up with a second request, unless it is clear after the first request that a second request would be futile. 2. Then, obtain an advisory medical opinion from an oncologist regarding the nature and likely etiology of the Veteran’s post right total nephrectomy papillary renal cell carcinoma. If an examination is necessary, it should be arranged. The entire record must be reviewed by the examiner. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s papillary renal cell carcinoma, requiring a right total nephrectomy, is (a) related to his presumed herbicide agent exposure in Vietnam during his period of active service from September 1969 to April 1971; or (b) proximately due to, or aggravated beyond its natural progression by, a service-connected disability, to include his diabetic nephropathy and coronary artery disease. The examiner must explain the rationale for all opinions, citing to supporting factual data. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Debbie Breitbeil, Counsel