Citation Nr: 20009766 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 18-11 184A DATE: February 5, 2020 REMANDED Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from November 1969 to May 1998. The Veteran died in November 2010. The Appellant is the Veteran’s surviving spouse. This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). While a VA form 8 notes that a VA form 9 was received in March 2018, a review of the claims file is negative for a substantive appeal (VA form 9) received in response to the December 2017 statement of the case (SOC). However, based on the actions of the RO, it appears that a correspondence from the appellant received on that date may have been accepted in lieu of a VA form 9. Further, the RO sent a letter to the appellant in October 2018 that her appeal had been certified and transferred to the Board. The Board therefore finds that VA has waived the requirement for a substantive appeal and the service connection claim for the cause of the Veteran’s death is properly before the Board. See Percy v. Shinseki, 23 Vet. App. 37 (2009). Entitlement to service connection for cause of death is remanded. The Appellant contends that the Veteran died due to bladder cancer caused by exposure to Agent Orange. The Veteran’s death certificate shows that he died from malignant neoplasm of the bladder. The Veteran had service in Vietnam and thus, he was presumed to have been exposed to Agent Orange. Bladder cancer is not currently included on the list of diseases associated with exposure to certain herbicide agents under 38 C.F.R. § 3.309 (e) that trigger presumptive service connection. However, the National Academies of Sciences (NAS) has reclassified bladder cancer as a disease that has "limited or suggestive evidence of an association" with exposure to herbicides. NAS, Veterans and Agent Orange: Update 2014 (March 10, 2016). Thus, a remand is necessary to obtain a medical opinion to address whether the Veteran's diagnosed bladder cancer was at least as likely as not caused by his exposure to herbicide agents in Vietnam. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Provide the appellant an opportunity to submit additional medical evidence related to the etiology of the Veteran's bladder cancer. Then, forward the claims file to an appropriate VA clinician to obtain a medical opinion. The provider should review the claims file and note that review in the report. Following review of the claims file, the provider should opine as to whether it is at least likely as not (a 50 percent or greater probability) that the Veteran's bladder cancer was incurred in, related to or caused by service, including exposure to herbicide agents, such as such as Agent Orange, during service in Vietnam. The examiner's attention is directed to the conclusion of the NAS that there is "limited or suggestive evidence of an association" between herbicide exposure and bladder cancer, in the Veterans and Agent Orange: Update 11 (2018). In answering this question, the examiner is asked to disregard whether the disorder is one for which a "presumption" is established and, instead, to answer whether the condition is a result of Agent Orange exposure even though it is not on the list of "presumptive" diseases. It is essential that the examiner offer a detailed rationale for all conclusions and opinions provided. If the provider cannot give an opinion without resorting to speculation, the provider should explain why this is so and note what, if any, additional evidence would permit such an opinion to be made. (Continued on the next page)   2. Then, readjudicate the claim. If the benefit sought on appeal remains denied, the Appellant and her representative should be provided a supplemental statement of the case. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Briana Cavallaro, 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.