Citation Nr: 21076571 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 18-46 487 DATE: December 27, 2021 ORDER Entitlement to service connection of renal cell carcinoma is granted, to include as secondary to toxic herbicide exposure. Entitlement to service connection of a large abdominal scar as a residual of surgery for renal cell carcinoma is granted. Entitlement to service connection of abdominal numbness as a residual of surgery for renal cell carcinoma is granted. entitlement to service connection of bone cancer, as secondary to renal cell carcinoma, is granted. Entitlement to service connection of lung cancer, as secondary to renal cell carcinoma, is granted. Entitlement to service connection of liver cancer, as secondary to renal cell carcinoma, is granted. Entitlement to service connection of lymphatic cancer, as secondary to renal cell carcinoma, is granted. FINDINGS OF FACT 1. The Veteran has a present diagnosis of renal cell carcinoma which is more likely than not related to in-service herbicide exposure. 2. The Veteran has a large abdominal scar, as a residual of surgery to treat his service-connected renal cell carcinoma. 3. The Veteran experiences abdominal numbness, as a residual of surgery to treat his service-connected renal cell carcinoma. 4. The Veteran has a present diagnosis of bone cancer, as a metastatic residual of renal cell carcinoma. 5. The Veteran has a present diagnosis of lung cancer, as a metastatic residual of renal cell carcinoma. 6. The Veteran has a present diagnosis of liver cancer, as a metastatic residual of renal cell carcinoma. 7. The Veteran has a present diagnosis of lymphatic cancer, as a metastatic residual of renal cell carcinoma. CONCLUSIONS OF LAW 1. The criteria for service connection for renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a large abdominal scar as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for abdominal numbness as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for bone cancer as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 5. The criteria for service connection for lung cancer as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 6. The criteria for service connection for liver cancer as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 7. The criteria for service connection for lymphatic cancer as secondary to renal cell carcinoma are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1965 to January 1967. He has confirmed service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of that hearing is of record. Service Connection The law provides that service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) 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 Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). Further, if a veteran was exposed to a herbicide agent during active military, naval, or air service in Vietnam, then certain diseases shall be service connected even though there is no record of such disease during service. For the purposes of this section, the term "herbicide agent" means a chemical in a herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.313. For purposes of adjudicating the below claims, it is noted that none of the disabilities are listed as presumptive of herbicide exposure. However, that a disability is not listed as presumptive of herbicide exposure does not preclude service connection on a direct basis. The Board does note that the Veteran has confirmed service in the Republic of Vietnam, and therefore VA has conceded herbicide exposure during active service. A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310. 1. Entitlement to service connection of renal cell carcinoma The Veteran seeks service connection of renal cell carcinoma, which he asserts is caused by his herbicide exposure during active service. The Board finds the claim should be granted. As an initial matter, the Board recognizes a present diagnosis of renal cell carcinoma. VA has conceded herbicide exposure during active service. In support of his claim, the Veteran has submitted multiple opinions by his private treating physicians. In August 2017, his treating hematologist-oncologist opined that his renal cell carcinoma was more likely than not caused by his in-service herbicide exposure. In support of this, the private physician noted the Veteran's history of herbicide exposure, and well as his history of cancer diagnosis, which based on the available medical literature were likely linked. He also noted that the Veteran had no other known risk factors or family history which might have precipitated such a diagnosis. A second August 2017 opinion from a robotic urologist also opined in favor of a link between herbicides and the present renal cell carcinoma. A third statement, dated in August 2017, also found a likely link between renal cell carcinoma and past chemical exposure during military service. The Board finds these opinions to be generally persuasive. They were given by the Veteran's treating physicians. Particularly the letter from his hematologist-oncologist applied the facts of this specific case to known medical principles and published medical treatise evidence to support the conclusion. The Board has carefully reviewed the claims file but finds no medical evidence or opinions to contradict the opinions of the Veteran's treating physicians. Particularly, the Board notes that VA has not undertaken to provide the Veteran with an examination or medical opinion in this matter, despite ample opportunity to do so. Had VA thought that the opinions of the private physicians were inadequate, it should have provided an examination and opinion to fully assess the question on appeal. In sum, the Board finds that the evidence of record is generally in the Veteran's favor as to whether or not his renal cell carcinoma is related to his in-service herbicide exposure. As such, the Board finds that the claim should be granted. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 2. Entitlement to service connection of a large abdominal scar as a residual of surgery for renal cell carcinoma 3. Entitlement to service connection of abdominal numbness as a residual of surgery for renal cell carcinoma 4. entitlement to service connection of bone cancer, as secondary to renal cell carcinoma 5. Entitlement to service connection of lung cancer, as secondary to renal cell carcinoma 6. Entitlement to service connection of liver cancer, as secondary to renal cell carcinoma 7. Entitlement to service connection of lymphatic cancer, as secondary to renal cell carcinoma The evidence of record supports a finding that the Veteran has the following residuals of renal cell carcinoma: a large abdominal surgical scar, abdominal numbness due to surgery, metastatic bone cancer, metastatic lung cancer, metastatic liver cancer, and metastatic lymphatic cancer. These residuals are the clear result of his now-service-connected renal cell carcinoma, and as such, the evidence supports a conclusion that these residuals were caused by a service-connected disability. Therefore, service connection should be granted. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Pryce, Counsel