Citation Nr: 19167883 Decision Date: 09/03/19 Archive Date: 09/03/19 DOCKET NO. 16-52 011 DATE: September 3, 2019 REMANDED The issue of entitlement to service connection for bladder cancer, claimed as the result of herbicide agent, diesel fuel, or diesel exhaust exposure, is remanded. REASONS FOR REMAND The Veteran had active service from December 1964 to September 1966. He served in the Republic of Vietnam. He earned six Air Medals and the Aircraft Crewman Badge. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania which denied service connection for bladder cancer claimed as the result of herbicide agent exposure, diesel fuel, or diesel exhaust exposure. The Veteran appeared at a March 2017 videoconference hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. In July 2017, the Board remanded the claim to the (RO) for additional development. The case was again remanded in January 2018 to complete development. The issue of entitlement to service connection for bladder cancer is remanded. The Veteran asserts entitlement to service connection for bladder cancer, claimed as the result of herbicide agent, diesel fuel, or diesel exhaust exposure. Unfortunately, the Board finds that further RO action on the claim on appeal is warranted, even though that will, regrettably, further delay an appellate decision. In testimony at the March 2017 hearing, the Veteran testified that he experienced blood in his urine for many years. Additionally, the record has indicia of hematuria many years before the March 2013 diagnosis of bladder cancer. He has stated that he has no family history of bladder cancer. The prior VA examination did not address the history of hematuria and is, therefore, incomplete. A remand is necessary to perform an additional examination. Having performed the examination, the VA examiner should address the etiology of the Veteran’s bladder cancer and specifically address the Environmental Protection Agency and the National Academy of Sciences studies cited at the Veteran’s hearing before the Board. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the evidence of record. 2. Contact the Veteran and request that he complete and return a signed authorization to allow VA to attempt to obtain all identified private medical records on his behalf. If the Veteran submits any medical authorization that is insufficient for further action, he should be notified, and any such notification should be properly documented in the claims file. On receipt of any valid medical authorization, VA must attempt to obtain any identified private records in accordance with VA regulation. 38 C.F.R. § 3.159. 3. Schedule the Veteran for an examination with an oncologist to assist in determining the current nature of any identified bladder cancer disability and any relationship to active service. The examiner must review the claims file and should note that review in the report. The examiner should address the Veteran’s history of hematuria and address the Environmental Protection Agency and the National Academy of Sciences studies cited at the Veteran’s hearing. The examiner must consider and address the Veteran’s statements about exposure to herbicide agents and diesel fuel and exhaust in service, to include diesel fuel spills and burning outhouse barrels. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all bladder cancer disabilities or residuals found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified bladder disability had its onset during active service or is related to any incident of service, including diesel fuel and diesel exhaust exposure and presumed herbicide agent exposure while in the Republic of Vietnam. (c) Opine as to whether it is at least as likely as not (50 percent or greater probability) that bladder cancer was caused by the service-connected disabilities, to include ischemic heart disease status post myocardial infarction and coronary artery bypass graft. (d) Opine as to whether it is at least as likely as not (50 percent or greater probability) that bladder cancer has been aggravated (permanently increased in severity beyond the natural progress of the disorder) by the service-connected disabilities, to include ischemic heart disease status post myocardial infarction and coronary artery bypass graft Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Duke, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.