Citation Nr: 18156126 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 17-42 926 DATE: December 7, 2018 ORDER Entitlement to service connection for bladder cancer, to include as due to herbicide exposure, is denied. FINDING OF FACT The Veteran’s bladder cancer is not related to service or any incident of service, to include presumed in-service exposure to herbicides. CONCLUSION OF LAW The criteria for entitlement to service connection for bladder cancer, to include as due to herbicide exposure, have not been met. 38 U.S.C. § 1110, 1112, 1116, 1131; 38 C.F.R. § 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1963 to January 1967, and served in the Republic of Vietnam. In April 2018, the Veteran testified before the undersigned at a Board videoconference hearing. A transcript of the hearing has been associated with the record. The claim on appeal was remanded by the Board of Veterans’ Appeals (the Board) in June 2018 to obtain a VA medical opinion. Entitlement to service connection for bladder cancer, to include as due to herbicide exposure The Veteran contends that he incurred bladder cancer as a result of herbicide exposure while serving in Vietnam. The Veteran testified at his April 2018 hearing that his treating urologist informed him that exposure to chemicals or smoking cigarettes could be a cause of bladder cancer. The Veteran contends that, because he does not smoke and has not been exposed to other toxic chemicals, his bladder cancer must have been caused by in-service exposure to herbicides. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish service connection for a current disability, a Veteran must show: the existence of a present disability; in-service incurrence or aggravation of a disease or injury; and a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Absent affirmative evidence to the contrary, there is a presumption of exposure to herbicides (to include Agent Orange) for all veterans who served in Vietnam during the Vietnam Era (the period beginning on January 9, 1962, and ending on May 7, 1975). 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). The applicable laws and regulations provide that if a veteran was exposed to herbicides in service, certain enumerated diseases will be presumed to be the result of such exposure. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(iii), 3.309(e). This presumption applies to the Veteran based upon his confirmed Vietnam service. However, bladder cancer has not been recognized as one of the enumerated diseases presumptively caused by herbicide exposure. See 38 C.F.R. § 3.309(e). Hence, presumptive service connection based on herbicide exposure is not available for the Veteran’s bladder condition. Regardless, a veteran may establish service connection based on exposure to herbicides with proof of actual direct causation. 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). In June 2018, the Board remanded this matter, finding that a VA examination and opinion was required to address whether the Veteran’s current diagnosis of bladder cancer is etiologically related to in-service herbicide exposure. Pursuant to the Board remand, the Veteran was provided with a VA medical examination in October 2018. The examiner reviewed the Veteran’s medical records and noted a current diagnosis of bladder cancer. The examiner noted that bladder cancer was first discovered by a January 2017 biopsy, more than 50 years after service. The examiner also noted that, pursuant to VA medical findings published in the Federal Register, bladder cancer is not associated with exposure to herbicides. The examiner also found no record of treatment for bladder cancer in the Veteran’s service treatment records and post-service medical records prior to 2017. The examiner concluded that the Veteran’s bladder cancer is less likely than not incurred in or caused by an in-service event, injury, or disease, or by the Veteran’s in-service herbicide exposure. The examiner reviewed the Veteran’s claims file and the examination in arriving at this conclusion. The examiner considered all pertinent and available medical facts to which the Veteran is entitled in forming his opinion. Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). Therefore, the Board places high probative weight on the October 2018 VA medical opinion. The Board has considered the Veteran’s statements that his in-service exposure to herbicide agents caused his bladder cancer. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge (i.e., experiencing symptoms either in service or after service). See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). However, as a layperson without the appropriate medical training and expertise, the Veteran is simply not competent to provide a probative opinion on a complex medical matter, such as an etiological relationship between any current disability and military service or a service-connected disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran has not submitted medical literature or statements from an appropriate clinician which support a finding that his current diagnosis of bladder cancer is related to in-service exposure to herbicide agents. In sum, the competent evidence of record weighs against the Veteran’s assertion that his current bladder cancer is etiologically related to his active service. Although grateful for the Veteran’s honorable service, the Board concludes that the preponderance of the evidence is against the claim for service connection and the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Casey, Associate Counsel