Citation Nr: 21061892 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 18-15 622 DATE: October 5, 2021 REMANDED Entitlement to service connection for cancer of the bladder, on a direct basis and as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1982 to November 1985 and from March 1986 to September 1992. The current matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision in which a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for bladder cancer. In July 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. Service Connection for Bladder Cancer The Veteran contends that she developed bladder cancer as a result of exposure to herbicide agents and other chemicals while completing her basic training at Fort McClellan, Alabama, during her first period of active service. Review of her VA treatment records reveals that she was diagnosed with bladder cancer in January 2014, and that she continued to have a bladder disorder diagnosis in March 2017. With respect to the Veteran's reported service at Fort McClellan, while her service treatment records indicate that she received treatment at Fort McClellan in November 1982, service personnel records confirming the time period that she was stationed at Fort McClellan have not been associated with the claims file. The Board observes that service connection may be awarded for bladder cancer on a presumptive basis based on a veteran's exposure to contaminants during service at Camp Lejeune, North Carolina. Notably, however, current VA laws and regulations do not allow for presumptive service connection for any disability based on service at Fort McClellan. Further, while service connection for bladder cancer may be awarded based on exposure to herbicide agents, including as a result of presumptive exposure [see 38 U.S.C. § 1116(a)], the Veteran's exposure to contaminants, including herbicide agents, may not be presumed based on her service at Fort McClellan. Nonetheless, VA acknowledges that some service members may have been exposed to one or more several hazardous materials, likely at low levels, during service at Fort McClellan, which could have included radioactive compounds, chemical warfare agents, and airborne polychlorinated biphenyls. Claims based on service at Fort McClellan are decided on a case-by-case basis. See Potential Exposure at Fort McClellan, U.S. DEPT OF VETERANS AFFAIRS, PUBLIC HEALTH (Sep. 28, 2021), https://www.publichealth.va.gov/exposures/fort-mcclellan/index.asp. Also, in July 2021, the Veteran's representative provided a document from a private attorney website which lists multiple additional chemical contaminants to which service members stationed at Fort McClellan would have been potentially exposed, including multiple herbicide agents. An April 2017 VA-contracted examination specifically considered the Veteran's bladder cancer, and the examiner provided a negative opinion as to the etiology of this disorder (as related to the Veteran's urinary tract infection and incontinence issues during service), given her apparent service at Fort McClellan and possible exposure to contaminants, remand is warranted to obtain a new VA opinion addressing the etiology of her bladder cancer in relationship to possible exposure to contaminants at Fort McClellan. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159. Additionally, with respect to the Veteran's reported exposure to herbicide agents at Fort McClellan, VA's Adjudication and Procedures Manual, M21-1, provides that, for claimed exposure to herbicide agents in locations other than Vietnam, the Korean Demilitarized Zone, Thailand, and Johnston Island, VA should attempt to verify potential exposure on a factual basis. See M21-1, VIII.i.1.A.6.a. The AOJ does not appear to have made any attempt to verify the Veteran's reported exposure to herbicide agents. Accordingly, this matter is hereby REMANDED for the following action. 1. Obtain the Veteran's complete service personnel records, to include specifically records identifying the period of time that she was stationed at Fort McClellan. Follow the procedures set forth in 38 C.F.R. § 3.159(c) for requesting records from Federal facilities. 2. In light of evidence of record indicating that herbicide agents were stored at Fort McClellan, undertake all indicated action(s) to attempt to verify the Veteran's exposure to herbicide agents during her service at Fort McClellan. Document all attempts to verify such exposure in the claims file. 3. If the Veteran's likely exposure to herbicide agents is not confirmed, after directives 1 and 2, above, have been completed, arrange for the Veteran's claims file to be reviewed by an appropriate VA examiner to obtain a new opinion as to the etiology of her claimed bladder cancer. The claims file and a copy of this REMAND should be made available to the examiner for review. If the examiner finds that a new examination is warranted to provide the requested etiology opinion, arrange for the Veteran to be afforded such examination. If the Veteran is examined, any and all indicated studies and tests deemed necessary by the examiner should be completed. After review of the record, and completion of any examination (including any necessary tests and studies), the examiner should: (a.) opine as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that the Veteran's current bladder cancer, including residual disability, had its onset during her active service, or is otherwise medically-related her service, to include specifically as a result of likely exposure to any chemical contaminant(s) while she was stationed at Fort McClellan. (b.) If the bladder cancer disability is deemed to not be at least as likely as not etiologically related to the Veteran's service on a direct basis, then the examiner should also provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent probability or greater) that the disability was caused, or aggravated (made worse) beyond its natural progression by any of the Veteran's service-connected disability(ies), to include her endometriosis and anxiety disorder with panic attacks, including by way of any medications used to treat the service-connected disability(ies). In addressing the above, the examiner must consider and discuss all pertinent medical evidence, to include treatment records reflecting treatment for multiple urinary tract/gynecological conditions during service and all available evidence addressing potential/likely exposure of service members to multiple chemical contaminants stationed at Fort McClellan, including evidence from VA's website (cited above) and the document submitted by the Veteran's representative in July 2021. The examiner must also consider and discuss all pertinent lay evidence of record, to include all assertions as to the nature, onset, and continuity of the Veteran's bladder cancer symptomatology. If lay assertions in any regard are discounted, the examiner should clearly so state, and explain why. A clear rationale must be provided for all opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. No action is required of the Veteran until she is notified by VA. However, she is advised of her obligation to cooperate in ensuring that the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). Her failure to report for a VA medical examination, if scheduled, may impact determinations made. 38 C.F.R. § 3.655. The Veteran also is advised that she has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Wilson, 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.