Citation Nr: 21008958 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 20-10 402 DATE: February 18, 2021 REMANDED Entitlement to service connection for penile and urethral cancer, claimed as due to Agent Orange exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from August 1964 to July 1966, including service in Vietnam. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a February 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video conference hearing. A transcript of the hearing is of record. Entitlement to service connection for penile and urethral cancer, claimed as due to Agent Orange exposure, is remanded. The Veteran is currently diagnosed with penile and distal urethral cancer. The Veteran contends that his cancer is due to his military service, specifically to his exposure to Agent Orange. Service personnel records confirm his service in Vietnam, therefore, his exposure to Agent Orange is conceded. In December 2018, the Veteran submitted an August 2019 private opinion from his provider stating that it is at least as likely as not that the Veteran’s penile and urethral cancer was caused by his Agent Orange exposure. In December 2020, the Veteran submitted an addendum to the 2018 private opinion. In linking the Veteran’s cancer to his service, the provider pointed to “ample evidence to support the link between Agent Orange exposure and the development of urologic malignancy years later.” However, the provider did not offer any rationale in support of her opinion and did not cite to any specific medical literature in support of the link between the two. As such, the Board cannot use either of the private opinions as a basis to grant service connection. The Board notes that penile and urethral cancers are diseases that have been found to be presumptively associated with exposure to herbicide agents. See 38 C.F.R. § 3.309 (e). However, service connection may be available on a direct basis if there is evidence that the Veteran's penile and urethral cancer is related to herbicide agent exposure. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Thus, the Board finds that the issue must be remanded so that a VA examination can obtained to determine the nature and etiology of the Veteran’s penile and urethral cancers. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, the matter is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to address the nature and etiology of his penile and urethral cancer. The entire claims file to include a copy of this REMAND, must be viewed by the examiner. The examiner should answer the following: Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s penile and urethral cancer is causally related to his active service, to include exposure to herbicide agents, including Agent Orange? In answering this question, attention is invited to the August 2018 and December 2020 private opinions stating that it is at least as likely as not that the Veteran’s cancer is due to his in-service Agent Orange exposure. A detailed rationale for the opinion must be provided. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. It should be noted that a lack of documented treatment for the given disability in service, while probative, cannot serve as the sole basis for a negative finding. The examiner must provide a complete rationale for any opinion expressed, citing to the examiner's clinical experience, medical expertise, and established medical principles, as necessary. If the examiner is unable to provide an opinion without resorting to speculation, he or she should fully explain why that is so and what, if any, additional evidence would be necessary before an opinion could be rendered. (Continued on the next page)   (Continued on the next page) LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Gates 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.