Citation Nr: 21066020 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 16-55 518 DATE: October 28, 2021 ORDER Entitlement to service connection for residuals of bladder cancer is granted. REMANDED Entitlement to service connection for essential tremors is remanded. Entitlement to service connection for residuals of a cerebrovascular accident (stroke) is remanded. Entitlement to service connection for peripheral vascular disease (claimed as clogs in both legs) is remanded. FINDING OF FACT The Veteran's bladder cancer is related to presumed in-service herbicide agent exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for bladder cancer have been met. 38 U.S.C. §§ 1110, 1113, 1116; 38 C.F.R. §§ 3.102, 3.303, 3.307. 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from December 1965 to September 1967. Herbicide agent exposure, as due to service in Vietnam, has been conceded. The record reflects that the Veteran was scheduled for a Board videoconference hearing in October 2019, which was postponed. The Veteran was again scheduled for a Board videoconference in September 2021 but failed to appear and has yet to submit a request to reschedule. Thus, due to the Veteran's no-show, the hearing request is considered withdrawn. See 38 C.F.R. § 20.704 (d). Bladder Cancer Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection requires evidence showing: (1) the existence of a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a presumptive basis for diseases enumerated in 38 C.F.R. § 3.309 (e) for veterans who were exposed to certain herbicide agents during active military, naval, or air service. 38 C.F.R. § 3.307 (a)(6). A Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to an herbicide agent. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). The Board notes that the National Defense Authorization Act for Fiscal Year 2021, Pub. L. No. 116-283, amended 38 U.S.C. § 1116 (a)(2) to include parkinsonism, bladder cancer, and hypothyroidism. As such, these three disorders have been added to the list of diseases presumptively associated with exposure to herbicide agents. In this case, the Veteran served in Vietnam during the applicable period and in-service exposure to herbicide agents has been conceded. The record shows that he was diagnosed with bladder cancer and underwent surgery for removal of a tumor in September 2014. In sum, as herbicide exposure during active service in Vietnam has been conceded and the record confirms that the Veteran has been diagnosed with bladder cancer, the Veteran's claim is granted on a presumptive basis. Accordingly, entitlement to service connection for bladder cancer and residuals thereof is warranted. REASONS FOR REMAND Essential Tremors The Veteran contends that his tremors are related to herbicide exposure he experienced while on active duty in the Republic of Vietnam. In March 2015, the Veteran underwent a VA examination wherein the examiner stated that the Veteran had a diagnosis of essential tremors and did not have a diagnosis of Parkinson's disease. No etiological opinion was obtained. The Board notes that effective January 1, 2021, the National Defense Authorization Act for Fiscal Year 2021 added parkinsonism to 38 U.S.C. § 1116 (a)(2) as a condition presumed to be caused by in-service herbicide agent exposure. Parkinsonism is defined as "a group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity." Dorland's Illustrated Medical Dictionary, 1383 (32nd ed. 2012). In this regard, a remand is required for a medical opinion addressing whether the Veteran's essential tremor constitutes parkinsonism for the purposes of applying the presumptive service connection principles under 38 U.S.C. § 1116. While the May 2019 VA examiner diagnosed essential tremors with mild equivocal parkinsonism, a definite diagnosis has yet to be given. If it is determined that the Veteran's disability qualifies as parkinsonism, then the principals of presumptive service connection will apply. If it is determined that the essential tremors do not qualify as parkinsonism, the Veteran may still be awarded service connection if the in-service herbicide agent exposure directly caused the essential tremors. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Accordingly, on remand, a VA medical opinion addressing these theories of entitlement should be obtained. Residuals of a Stroke and Peripheral Vascular Disease The Veteran claims his stroke and peripheral vascular disease are related to in-service herbicide agent exposure. While the Veteran underwent VA examination for these disorders in March 2015, an etiological opinion was not provided, and should therefore be obtained on remand. The matters are REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate VA clinician for a medical opinion regarding the Veteran's claim for service connection for tremors. The examiner should address the following: (a.) Whether the Veteran's disability qualifies as parkinsonism, or Parkinson's disease. (b.) If not, whether it is at least as likely as not that the Veteran's essential tremors are related to service, to include the conceded herbicide agent exposure. For any opinion provided, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 2. Send the Veteran's claims file to an appropriate VA clinician for a medical opinion regarding the Veteran's claim for service connection for residuals of a stroke and peripheral vascular disease. The examiner should address the following: Whether it is at least as likely as not that the Veteran's residuals of a stroke or peripheral vascular disease are related to service, to include the conceded herbicide agent exposure. For any opinion provided, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.Z., 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.