Citation Nr: 21077242 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 17-10 859 DATE: December 29, 2021 REMANDED The issue of service connection for bladder cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1990 to November 1995. This matter comes before the Board of Veterans' Appeals (Board) from a February 2016 rating decision from a Department of Veterans Affairs (VA) regional office (RO). The Veteran requested a hearing in his appeal to the Board. A hearing was held before the undersigned Veterans' Law Judge in August 2021. A transcript of the hearing has been associated with the claims folder. The issue of service connection for bladder cancer is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE ADJUDICATOR: The Veteran asserts that his bladder cancer is due to exposure to high powered radar, service-connected testicular cancer, or a combination of the two. While VA obtained an opinion in May 2015, the opinion is not specific to the Veteran's experiences and lacks a complete rationale. The examiner states that bladder cancer is linked to ionizing radiation; however, there is no indication in the record that radar emits ionizing radiation. The Veteran submitted evidence that radar emits non-ionizing radiation. Therefore, the May 2015 opinion is incomplete in that it does not discuss the Veteran's exposure to non-ionizing radiation. Further, the Veteran has raised the issue of his bladder cancer being secondary to his service-connected testicular cancer. He has submitted evidence that people who have survived testicular cancer are twice as likely to develop bladder cancer. The Veteran's treatment records also note a possibility that the Veteran's bladder cancer was a recurrence of his testicular cancer. The May 2015 opinion indicates there is no relationship between testicular cancer and bladder cancer; however, it does not address the evidence that there is a relationship between the two. Therefore, the May 2015 opinion is incomplete as it did not consider all relevant medical evidence. Additionally, there remain outstanding records relating to an alleged high-powered radar accident in November 1992. The record contains statements from witnesses of the accident that AME1 M. T. created a record of the accident. These records are not part of the record and there have not been efforts to confirm the details of this event. Finally, the Veteran has identified private treatment from Dr. Ian Okazaki. These records have not been obtained or associated with the record. THE REMAND DIRECTIVES FOLLOW. 2. Obtain any records relating to the Veteran's exposure to active radar from a TC-4C aircraft in November 1992 at Naval Air Station Oceana, Virginia, to include any reports written by AME1 M.T. (fully identified in a July 2015 buddy statement). 3. Ask the Veteran to complete a VA Form 21-4142 for Dr. Ian Okazaki. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 4. Return the claims file to the May 2015 VA clinician, and request he again review the entire claims file and respond to the inquiry below. If the examiner is not available, arrange for another appropriately qualified VA examiner to provide an addendum medical opinion to assist in determining the etiology of the Veteran's bladder cancer. All appropriate tests, studies and consultations should be accomplished, including a new medical examination if necessary, and all clinical findings should be reported in detail in the narrative portion of the examination report. The examiner must provide the following opinions: (a.) Whether the Veteran's bladder cancer is related to exposure from radiation from active radar, to include the incident described as happening in November 1992. (b.) Whether the Veteran's bladder cancer is related to any other activities or exposures during active duty, to include exposure to vehicle exhaust. (c.) Whether the Veteran's bladder cancer is proximate to (caused by) his service-connected testicular cancer. (d.) Whether the Veteran's bladder cancer was aggravated (worsened) by his service-connected testicular cancer. Each opinion should be accompanied with a supportive statement that notes all relevant evidence, to include all lay statements, treatment records, and journal articles, considered in reaching the opinion. If it is not possible to provide a specific opinion without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION, INCLUDING: An October 1997 Journal of the National Cancer Institute indicating the observed rate of bladder cancer in testicular cancer survivors was twice as high as what is expected in the general public. A February 2015 treatment record noting the Veteran's bladder cancer may be a recurrence of his testicular cancer. A July 2015 buddy statement describing an incidence in which the Veteran was exposed to an active radar system. A March 2015 notice of disagreement where the Veteran reports that his doctor told him his cancer was rare and often seen in AWACS flight personnel. A June 2016 buddy statement describing an incident in which the Veteran was exposed to active radar from a TC-4C aircraft. A November 2017 buddy statement describing an incident in which the Veteran was exposed to active radar from a TC-4C aircraft. An August 2019 news article noting the high rate of cancer in military pilots due to higher rates of environmental exposure to UV and ionizing radiation and cock-pit exposure to non-ionizing radiation. A May 2020 news article discussing the association between military aircrew and higher rates of cancer. A July 2021 correspondence that contains an American Cancer Society article noting survivors of testicular cancer have an increased risk of developing secondary bladder cancer. An August 2021 correspondence that contains an American Cancer Society article noting that exposure to non-ionizing radiation can sometimes be associated with cancer. An August 2021 hearing transcript in which the Veteran reports a compensation and pension examiner told him his cancer is rare and only caused by high-powered radar. A November 2021 letter from a private provider indicating the occurrence of both testicular cancer and bladder cancer indicates it most likely due to an environmental exposure. 5. Thereafter, readjudicate the issue on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable period in which to respond. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Reed, Counsel The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.