Citation Nr: 21064742 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-64 774 DATE: October 21, 2021 REMANDED Entitlement to service connection for kidney cancer, claimed as the result of herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran had active service from July 1966 to July 1968. He served in the Republic of Vietnam. Entitlement to service connection for kidney cancer, claimed as the result of herbicide agent exposure, is remanded. Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for Type II diabetes mellitus, diabetic nephropathy, right lower extremity diabetic peripheral neuropathy, and left lower extremity diabetic peripheral neuropathy. A September 2020 Department of Veterans Affairs (VA) kidney evaluation states that "it is less likely than not that the Veteran's kidney cancer is related to exposure to herbicide agents such as Agent Orange because a) the cause for renal cell cancer is not known and b) the scientific literature provides insufficient evidence of a causal connection between renal cancer and the Veteran's service connected conditions (including diabetes) and between renal cancer and Agent Orange exposure." The examiner did not address the relationship between the diagnosed kidney cancer and the service connected diabetic nephropathy. In light of such deficiency, the evaluation is of essentially no probative value. An October 2020 VA kidney evaluation states that "it is less likely than not that the Veteran's kidney cancer was aggravated by his service connected Type 2 diabetes mellitus since there is no scientific evidence that diabetes causes or aggravates kidney cancer." The examiner did not address the relationship between the diagnosed kidney cancer and the service connected diabetic nephropathy. In light of such deficiency, the evaluation is of essentially no probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that further VA kidney evaluation is needed. Clinical documentation dated after October 2020 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated any kidney disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment provided after October 2020. 3. Schedule the Veteran for a VA kidney examination conducted by a medical doctor, other than the physician who conducted the September 2020 and October 2020 kidney evaluations, to assist in determining the relationship of the diagnosed kidney cancer to active service and/or a service connected disability. The examiner must review the record, including the August 2014 private pathology report, and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Identify all kidney disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that the diagnosed kidney cancer had its onset during active service or is related to any incident of service, including the Veteran's presumed herbicide agent exposure while in the Republic of Vietnam. The examiner should specifically address the August 2014 private pathology report. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that the diagnosed kidney cancer is due to or the result of diabetic nephropathy and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that kidney cancer has been aggravated (permanently increased in severity beyond the natural progression of the disorder) by diabetic nephropathy and the other service-connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.