Citation Nr: 21029978 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 15-03 965 DATE: May 17, 2021 REMANDED Entitlement to service connection for blood in urine (hematuria), to include as due to exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran served in the United States Navy from February 1965 to February 1968. In June 2018, The Veteran testified at a Travel Board hearing before the undersigned Veterans' Law Judge. A transcript of the hearing was prepared and associated with the claims file. The appeal was previously before the Board in September 2018 and September 2020 where it was remanded for further evidentiary development. As part of the Board's September 2020 remand directives, the Agency of Original Jurisdiction (AOJ) was instructed to conduct additional development and determine if the USS Ticonderoga was within 12 nautical miles from the shores of the Republic of Vietnam from May 1965 to January 1968; and to obtain an addendum opinion regarding the etiology of the Veteran's blood in urine disorder. The matter has returned to the Board for an appellate review. In a November 2020 Memorandum, the AOJ stated that exposure to herbicides is conceded based on the Veteran's nautical service in one or more of the approved Republic of Vietnam bays or harbors, and the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23. Entitlement to service connection for blood in urine (hematuria) to include, as due to exposure to herbicide agents is remanded. While the Board regrets the delay, additional development is necessary prior to the adjudication of the issue on appeal. In the September 2020 remand, the Board sought an addendum medical opinion to address the etiology of the Veteran's blood in urine disorder, including whether it was due to exposure to herbicide agents. An addendum opinion was obtained from a VA examiner in December 2020. The examiner opined that the condition claimed was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner's rationale was that blood in urine (hematuria) is a disease with no specific etiology; that the Veteran did not have hematuria in service; that it is unlikely any hematuria is related to/due to the 1966 in-service testicle event (as this type of injury is not likely to cause hematuria many years later); that herbicide exposure has not been mentioned to cause hematuria many years later; and that the Veteran has stated that his two sons have the same disability so therefore, this would more likely support some type of inherited disease process, rather than another etiology. See December 2020 C&P Examination. The Board finds the December 2020 addendum opinion inadequate. First, the examiner did not properly address the Veteran's lay statements regarding the onset of his symptoms immediately after service but rather relied on lack of documentation in proffering an opinion. In this regard, the examiner did not discuss the significance, if any, of a September 2008 VA treatment record noting that the Veteran had reported a 40 year history of blood in his urine. Thus, on remand, an addendum opinion should be obtained to determine the nature and etiology of any blood in urine disorder that considers the Veteran's reported history of blood in his urine dating back to approximately 1968. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding private and VA medical records. 2. After completing the foregoing development, obtain a medical opinion from a qualified clinician. Please provide the complete file to the examiner. After reviewing the claims file, the examiner should state whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed blood in urine (hematuria) is causally or etiologically related to his military service, to include exposure to herbicide agents. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) For purposes of this opinion, the examiner is to presume that the Veteran was exposed to herbicide agents in service. The examiner should not rely solely on the fact that VA regulations do not recognize the Veteran's blood in urine disorder as being presumptively related to exposure to herbicide agents. Furthermore, the examiner should discuss the significance, if any, of the Veteran's report of a 40 year history of blood in his urine during treatment in September 2008. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Thereafter, readjudicate the Veteran's claim. If the claim remains denied, then issue to the Veteran and his representative a Supplemental Statement of the Case and allow an appropriate time for response. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. M. Rogers, 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.