Citation Nr: 21076179 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 19-38 671 DATE: December 22, 2021 ORDER Entitlement to service connection for bladder cancer is granted. REMANDED Entitlement to service connection for hypertension, to include as secondary to his service-connected coronary artery disease, is remanded. INTRODUCTION The Veteran served on active duty in the United States Army from July 1968 to January 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2018 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. FINDING OF FACT The Veteran's bladder cancer is presumptively related to his Agent Orange exposure. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for bladder cancer due to in-service herbicide exposure have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran seeks service connection for bladder cancer which he contends was caused by his in-service exposure to Agent Orange. Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Presumptive service connection on the basis of herbicide exposure is authorized for specified diseases. 38 U.S.C. § 1116; 38 C.F.R. § 3.309. In January 2021, bladder cancer was added to the list of presumptive diseases. 38 U.S.C. § 1116(a)(2)(J). The medical evidence confirms the Veteran has a diagnosis of bladder cancer. As noted above, this condition is presumed to have been caused by service if a veteran was exposed to herbicides. The Veteran had boots on the ground service in Vietnam, thus herbicide exposure is conceded. Based on the foregoing, the Veteran's claim for service-connection for bladder cancer must be granted on a presumptive basis. REASONS FOR REMAND Initially, the Board notes the record for review may be incomplete. The Veteran testified at his August 2021 Board Hearing that he sought medical treatment for his hypertension at Savannah Cardiology, currently known as Dale Daly Memorial Heart. The VA requested and obtained medical records from Savannah Cardiology from December 2016 to April 2018. The Veteran indicated he started treatment at Savannah Cardiology in 2010. The VA does not have the Savannah Cardiology records from 2010 to 2016 or from April 2018 to present. As these records may contain information that is pertinent to the Veteran's claim on appeal, the RO must attempt to obtain or locate these treatment records. Additionally, while the Veteran's service treatment records do not show treatment or symptoms of hypertension while on active duty, the Veteran testified at his hearing that he had a history of "up and down" blood pressure readings during his service in Vietnam. He contends his hypertension may be related to his active-duty service and/or his conceded in-service exposure to Agent Orange. Further, the Veteran testified his hypertension may be secondary to his service-connected coronary artery disease. Based on the foregoing, the Board finds a medical opinion is necessary to determine whether the Veteran's hypertension was caused or aggravated by his military service, to include as due to his exposure to Agent Orange, or as secondary to his service-connected cardiac disability. Accordingly, this matter is REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's hypertension claim. Specifically, the RO should attempt to obtain/locate all of his private treatment records from Savannah Cardiology, currently known as Dale Daly Memorial Heart. If needed, the RO should contact the Veteran and ask him to submit the records. If any requested records are not available, the record should be annotated to reflect such, and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Next, a medical opinion from an examiner with sufficient expertise to address the etiology of the Veteran's hypertension must be obtained. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether the Veteran's hypertension is at least as likely as not (a 50 percent probability or greater) etiologically related to his period of active service to include his Agent Orange exposure. The examiner must also state whether the Veteran's hypertension is etiologically related to or aggravated by the Veteran's service-connected coronary artery disease. The examiner must provide a complete rationale for all proffered opinions. In this regard, the examiner must discuss and consider the Veteran's competent lay statements. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete answer as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nestander, Jessica S. 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.