Citation Nr: 18149112 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 17-04 265 DATE: November 8, 2018 REMANDED Entitlement to service connection for bladder cancer is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to total disability individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1964 to April 1966, to include service in the Republic of Vietnam from August 1965 to April 1966. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. 1. Entitlement to service connection for bladder cancer is remanded. The Veteran contends that he incurred bladder cancer during active service, specifically as a result of herbicide agent exposure during service in the Republic of Vietnam. The AOJ denied service connection on the basis that bladder cancer is not presumptively related to herbicide agent exposure and was not otherwise noted during service or within a year of the Veteran’s discharge from service. Notwithstanding the fact that the Veteran’s bladder cancer is not a disease subject to presumptive service connection, the claim can still be substantiated on a direct basis. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The record contains a medical statement from Dr. S. S. indicating that the Veteran’s bladder cancer was as likely as not due to in-service herbicide agent exposure. As the opinion is not accompanied by any rationale, it is insufficient for adjudicating the claim. Nevertheless, it is sufficient to trigger VA's duty to assist, and this matter must be remanded to obtain a medical opinion. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for PTSD is remanded. The Veteran was afforded a VA PTSD examination in September 2015. The examiner indicated that the Veteran did not meet the diagnostic criteria for PTSD under the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Nevertheless, the September 2015 VA examiner did not acknowledge or address the July 2015 private treatment record from the Veteran’s private psychiatrist, Dr. H. J., indicating that it was at least as likely as not that the Veteran had PTSD that was incurred in or caused by his miliary service. A medical opinion may be inadequate if it rests on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The September 2015 VA examiner’s opinion is based on the inaccurate premise that the Veteran did not have a current diagnosis of PTSD. Under these circumstances, a remand is required to obtain an adequate opinion that addresses the findings described in the July 2015 report by the Veteran’s private psychologist. 3. Entitlement to a TDIU is remanded. As a decision on the remanded issues of service connection for bladder cancer and PTSD could significantly impact a decision on the issue to entitlement to a TDIU, the issues are inextricably intertwined. Accordingly, a remand of the TDIU claim is required. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain any outstanding VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Forward the Veteran’s claims file to an oncologist or other physician with expertise sufficient to render the requested opinion. Following review of the Veteran’s claims file, and examination of the Veteran, if the examiner deems such physical examination to be necessary, the examiner should opine as to whether it is at least as likely as not (that is, a 50 percent probability or greater) that the Veteran’s bladder cancer was incurred during service or was otherwise caused by his military service, to include his in-service herbicide agent exposure. In so opining, the examiner should discuss the treatise evidence from the Mayo Clinic and the opinion from Dr. S. S. A complete rationale should be provided for all opinions and conclusions expressed. 3. Schedule the Veteran for a VA PTSD examination. The claims file should be reviewed by the examiner in conjunction with the examination. All indicated tests should be conducted and the results reported. Following review of the claims file and examination of the Veteran, the examiner should identify all psychiatric disorders present and then respond to the questions presented: (a.) If the Veteran is diagnosed with PTSD, the examiner should indicate the stressor(s) upon which the diagnosis is based. (b.) For any diagnosed psychiatric condition other than PTSD, state whether it is at least as likely as not that the condition arose during service or are otherwise related to the Veteran’s military service. In rendering the above requested opinions, the examiner should discuss the July 31, 2015 treatment record from Dr. H. J., indicating that the Veteran had PTSD that was incurred in or caused by his miliary service. A complete rationale should be provided for all opinions and conclusions expressed. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs