Citation Nr: 21029874 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 16-04 142 DATE: May 17, 2021 ORDER Entitlement to service connection for stage IV renal cell carcinoma, to include as secondary to herbicide agent exposure, is granted. FINDING OF FACT The Veteran's stage IV renal cell carcinoma is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for stage IV renal cell carcinoma are met. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1966 to March 1968, with service in the Republic of Vietnam. The Veteran died in August 2017 while his appeal was pending, and the Board dismissed this claim in September 2017. The Appellant is his surviving spouse and was accepted as the substitute appellant in a July 2020 letter. See 38 U.S.C. § 5121A; 38 C.F.R. §§ 3.1010, 20.1302. While the Veteran had a hearing request pending at the time of the September 2017 dismissal, the Appellant declined an administrative hearing in an April 2021 letter. This matter comes to the Board of Veterans' Appeals (Board) from a December 2013 rating decision which denied service connection for stage IV renal cell carcinoma. In an April 2021 letter, the Appellant's representative requested that the agency of jurisdiction (AOJ) grant service connection for the Veteran's cause of death. This issue is not presently before the Board. The Board notes that a March 2021 rating decision denied service connection for cause of death. The Appellant has the opportunity to appeal this rating decision. The Board notes that additional evidence was added to the Veteran's claims file after the December 2015 Statement of the Case. To the extent that any of this evidence would require the Veteran to waive initial AOJ review, the Board finds that there is no prejudice in reviewing the evidence in the first instance because this decision constitutes a full grant of the benefit sought. Entitlement to service connection for stage IV renal cell carcinoma, to include as secondary to herbicide agent exposure, is granted. Service connection may be granted for a disability resulting from an injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, a veteran must establish: (1) evidence of a current disability; (2) in-service incurrence or aggravation of an injury; and (3) a causal relationship between the current disability and the injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for certain diseases associated with exposure to herbicide agents. See 38 C.F.R. §§ 3.307(a)(6), 3.309(e). While the Veteran is presumed to have been exposed to herbicide agents based on his service in the Republic of Vietnam, see 38 C.F.R. § 3.307(a)(6)(iii), service connection cannot be granted on this basis because renal cell carcinoma is not a listed disease that is associated with exposure to herbicide agents. See 38 C.F.R. § 3.309(e). A March 1966 induction examination showed no abnormalities or defects. A February 1968 separation examination showed no abnormalities or defects. The Veteran's DD 214 showed almost one year of service in the Republic of Vietnam. In an August 2013 letter, Dr. B.B., a private physician, stated that the Veteran was diagnosed with stage IV renal cell carcinoma and presented with metastatic disease in 2013. Dr. B. noted that the Veteran served in the Republic of Vietnam for approximately one year in an area where herbicide agents were used. Dr. B. stated that, while a direct associating between herbicide agents and renal cell carcinoma could not be excluded, it is possible that herbicide agent exposure could have contributed to the Veteran's malignancy. In a January 2016 letter, APRN K.W.S., a private nurse, stated that the Veteran, prior to his diagnosis of renal cell carcinoma, was not being treated for any serious medical conditions. Nurse S. stated that the Veteran reported no family history of renal cell carcinoma. After reviewing the Veteran's history and exposure to herbicide agents, Nurse S. stated that, while she could not state for sure that herbicide agent exposure caused the Veteran's renal cell carcinoma or that it could be excluded, it was her medical opinion that herbicide agent exposure was at least more likely as not the cause of the Veteran's renal cell carcinoma. In a February 2021 letter, Dr. P.M.A., a private board-certified physician with a specialty in medical oncology, opined that the Veteran's kidney cancer was at least as likely as not caused by herbicide agent exposure during military service. Dr. A. stated that his opinion was based on an objective review of the Veteran's entire claims file. As part of this review, Dr. A. noted that the Veteran reported no family history of renal cell carcinoma and noted that the Veteran reported exposure to herbicide agents in the Republic of Vietnam. Dr. A. cited two medical studies that demonstrated an increased risk for kidney cancer or other malignancies due to exposure to herbicide agents. As a preliminary matter, the Board notes that the Veteran was in sound condition at the entrance of service based on the March 1966 induction examination showing no abnormalities or defects. The Board finds that service connection for renal cell carcinoma is warranted. A current disability is established based on the August 2013 letter stating that the Veteran was diagnosed with stage IV renal cell carcinoma and presented with metastatic disease in 2013. An in-service incurrence of exposure to herbicide agents is presumed based on the Veteran's DD 214 showing service in the Republic of Vietnam. A nexus between the Veteran's current disability and an in-service incurrence is established based on Dr. A.'s opinion. The Board assigns probative weight to this opinion because it was provided by a board-certified physician with a specialty in medical oncology and was provided following a review of the Veteran's entire claim file. This opinion is also consistent with Dr. B.'s and Nurse S.'s opinions, and the Board notes that there are no negative nexus opinions. Accordingly, the Board finds that the claim of service connection for renal cell carcinoma is granted. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ormson, Associate 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.