Citation Nr: 20005696 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 17-65 949 DATE: January 23, 2020 REMANDED Entitlement to service connection for bladder cancer, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty in the United States Navy from July 1964 to March 1979, including service in the Republic of Vietnam. His commendations include the Air Gallantry Cross and the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. In his appeal to the Board dated October 2017, the Veteran requested a Board video-conference hearing. In an August 2019 letter, the Board notified the Veteran that the hearing was to be held on October 10, 2019. However, in a September 2019 letter, the Veteran’s representative withdrew the hearing request. Therefore, the request is deemed withdrawn. Additionally, at the representative’s request, the Board granted a 60-day extension effective November 5, 2019 to allow for the submission of additional evidence in support of the Veteran’s claim. The representative timely submitted additional evidence, a favorable medical opinion, along with a waiver of initial consideration by the RO, the agency of original jurisdiction. Bladder Cancer The RO has conceded the Veteran’s exposure to herbicide agents during active duty service in Vietnam but denied his service connection claim because bladder cancer is not among the diseases specified by VA for presumptive service-connection based on exposure to herbicide agents. 38 U.S.C. §§ 1113, 1116 (2012); 38 C.F.R. § 3.307(a), (d), 3.309(e) (2018). The fact that a veteran does not meet the requirements for service connection on a presumptive basis does not in and of itself preclude the establishment of service connection, as entitlement may alternatively be established on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). While the Veteran has submitted a favorable medical opinion regarding direct service connection, the Board finds deficiencies in the opinion as it includes no supporting rationale and there is no indication that the physician reviewed the Veteran’s claims file. See Letter from R.C., M.D. dated October 7, 2019; see also Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (factors for assessing the probative value of a medical opinion are the physician’s access to the claims file and the thoroughness and detail of the opinion.). Accordingly, the claim must be remanded to afford the Veteran a VA examination and obtain a medical opinion to determine the nature and etiology of his bladder cancer, to include whether the cancer is related to his exposure to herbicide agents in Vietnam. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Thereafter, schedule the Veteran for a VA examination with a qualified examiner to determine the nature and etiology of his bladder cancer or residuals thereof. Any necessary tests or studies must be conducted, and all clinical findings should be reported in detail and correlated to a specific diagnosis. The claims file, and a copy of this remand, should be made available to the examiner, who will acknowledge receipt and review of these materials. After a complete review of the claims file, the examiner is asked to respond to the following: (a) Provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s currently diagnosed bladder cancer or residuals thereof is/are a result of his military service, to include his CONCEDED EXPOSURE to herbicide agents in Vietnam. *The examiner is advised that the absence of evidence in the service treatment records cannot, standing alone, serve as the basis for a negative opinion. * Although the VA examiner should review the entire claims file, in rendering an opinion, the examiner shall discuss and weigh R.C., MD’s October 7, 2019 favorable medical opinion regarding direct service connection (see VBMS document type “Medical Treatment Record - Government Facility,” with receipt date of 11/30/2019 at PDF pg. 2). Please note that the Veteran’s service personnel records reflect that he was a Navy pilot, and he was stationed at the air base in Danang, Vietnam in 1971 (see VBMS document type “Military Personnel Record,” with receipt date of 02/11/2014 at PDF pg. 88 of 148). The VA examiner must provide a detailed rationale for all opinions rendered. 3. Thereafter, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brad Farrell, Associate Attorney 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.