Citation Nr: 18150699 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-43 588 DATE: November 15, 2018 REMANDED Entitlement to service connection for renal cell carcinoma, status post left partial nephrectomy, claimed as kidney disability, is remanded. REASONS FOR REMAND The appellant served on active duty in the Army from December 1971 to December 1974, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The appellant filed a timely Notice of Disagreement (NOD), received in October 2014. A Statement of the Case (SOC) was issued in July 2016. A timely substantive appeal was received in September 2016. As noted in the July 2016 SOC, the RO has conceded that the appellant set foot in the Republic of Vietnam, based upon a Vietnam postmark on a letter the appellant sent to his wife while on active duty. Absent evidence to the contrary, the is thus legally presumed to have been exposed to herbicide agents on active duty. The appellant has been diagnosed with renal cell carcinoma, status post left partial nephrectomy. Such is not an enumerated disease deemed to be associated with exposure to herbicide agents. See 38 C.F.R. §§ 3.307; 3.309(e). Although the legal criteria for presumptive service connection have not been met, a claimant may establish service connection based on exposure to Agent Orange with proof of actual direct causation. 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); Brock v. Brown, 10 Vet. App. 155 (1997). In this case, the appellant contends that he has no family history of kidney problems, including renal cell carcinoma. In addition, he has no risk factors or other exposure to any environmental hazards, other than Agent Orange. He had never smoked, had not been significantly overweight, did not consume alcohol regularly, and his past work would not have put him in contact with hazards which could have caused renal cell carcinoma. In light of the appellant’s contentions and the clinical evidence of record, the Board finds a medical opinion is necessary to address the question of whether the appellant’s renal cell carcinoma, status post left partial nephrectomy, may be related to his presumed exposure to herbicide agents. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician as to the nature and etiology of the appellant’s renal cell carcinoma, status post left partial nephrectomy. Access to the appellant’s VA claims file should be made available to the examiner for review in connection with the examination. After reviewing the record, the clinician should opine as to whether it is at least as likely as not that the appellant’s current renal cell carcinoma, status post left partial nephrectomy, was incurred during service, or was a result of an in-service disease, event, or injury, to include presumed exposure to herbicide agents, including Agent Orange. The examiner’s attention is directed to the appellant’s competent reports that he does not smoke, does not currently consume alcohol and was not a heavy drinker previously, and that his weight was consistently between 150 and 155 pounds. A rationale for all opinions is required. If an examination is deemed necessary by the clinician, one should be scheduled. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Behlen, Associate Counsel