Citation Nr: 18158344 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 15-39 193 DATE: December 14, 2018 ORDER Entitlement to service connection for renal carcinoma with kidney removal is granted. FINDING OF FACT The Veteran’s renal carcinoma with kidney removal is related to his exposure to herbicide agents in Vietnam. CONCLUSION OF LAW The criteria for service connection for renal carcinoma with kidney removal are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.307. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to January 1970, including service in the Republic of Vietnam. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, a Travel Board hearing was held before the undersigned Veteran Law Judge. As this appeal is being processed and granted under the Board’s “One Touch” program, a transcript of the hearing is not yet in the claims file but will be obtained and added to the claims file at a later time. The Veteran asserts that he has renal carcinoma, including the removal of a kidney due to his exposure to herbicide agents, to include Agent Orange, during his service in Vietnam. The Board concludes that the Veteran has a history of renal cell carcinoma resulting in the removal of a kidney that is related to his in-service exposure to herbicide agents. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran’s service personnel records reflect that he served in the Republic of Vietnam from December 1967 to January 1970. A veteran who served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent (i.e., Agent Orange). 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). For purposes of application of this legal presumption, service in the Republic of Vietnam means actual service in-country in Vietnam from January 9, 1962 through May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii). Therefore, the Veteran is presumed to have been exposed to herbicide agents. A July 2014 letter from a urologist reflects that the Veteran had renal cell carcinoma twice resulting in a left nephrectomy in 2009 and a right partial nephrectomy in 2011. In a December 2015 opinion, the private urologist opined that it is more likely than not that there is a causal relationship between the Veteran’s in-service exposure to carcinogenic compounds present in Agent Orange and his twice developing renal cancers. The urologist noted that compared to other cancers, renal cell carcinoma is relatively rare. In attempting to explain this less common cancer, the urologist found the Veteran’s risks due to recognized risk factors such as family history, cigarette smoking, obesity, and alcohol were relatively modest. The urologist stated, “After examining his medical history, I believe that the metabolic disturbances now known to be associated with [Agent Orange] exposure that he developed following his discharge from the military played a major role in his developing [renal cell carcinoma].” The urologist noted that since the kidneys function as an excretory organ and act as a conduit for many toxic substances including carcinogens present in Agent Orange to exist in the body, it is not surprising that it is a site for toxin-initiated cancers to develop. The urologist stated that multiple references cited in the Institute of Medicine 20112 Veterans Agent Orange Report show that obesity, BMI and insulin resistance is associated with Agent Orange exposure and they all increase the risk of renal cell carcinoma. The Board finds the December 2015 opinion to be highly probative as the private urologist provided a thorough rationale based on the evidence of record and medical literature. The Veteran also submitted medical articles indicating a link between renal cancer and exposure to Agent Orange. There is no medical evidence or opinion that counters the urologist’s conclusions. The Veteran is presumed to have been exposed to herbicide agents during his period of active duty in Vietnam, and the December 2015 opinion indicates that it is more likely than not that the Veteran’s renal cell carcinoma is related to exposure to herbicide agents. Accordingly, service connection for renal cell carcinoma with kidney removal is warranted. 38 U.S.C. 5107(b); 38 C.F.R. § 3.102. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Marenna, Counsel