Citation Nr: 21030093 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 20-25 084 DATE: May 17, 2021 ORDER Service connection for bladder cancer is granted. Service connection for idiopathic thrombocytopenia is granted. FINDINGS OF FACT 1. The Veteran's bladder cancer is related to his presumed in-service herbicide agent exposure. 2. The Veteran's idiopathic thrombocytopenia is related to his presumed in-service herbicide agent exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for bladder cancer have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116(a)(2), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e). 2. The criteria for service connection for idiopathic thrombocytopenia have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116(a)(2), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from September 1968 to September 1972, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2019 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge in April 2021. Service Connection To establish service connection for a claimed disorder, the following criteria must be met: (1) medical evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and current disability. 38 C.F.R. § 3.303; see also, Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may be granted for a disability resulting in a disease or injury that is incurred in or aggravated by active duty military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 1. Service connection for bladder cancer. 2. Service connection for idiopathic thrombocytopenia. The Veteran contends that his diagnosed bladder cancer and idiopathic thrombocytopenia are related to Agent Orange exposure while serving in Vietnam. See Hearing Testimony, April 2021. In this case, the Veteran has both a diagnosis of bladder cancer and idiopathic thrombocytopenia. See Medical Treatment Record, June 2018. The Board notes that a March 2020 Statement of the Case found that exposure to herbicides (Agent Orange) was conceded based on the Veteran's nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019. Therefore, the Veteran's Agent Orange exposure is conceded in this case. In June 2018, a board-certified specialist in hematology and oncology, who has treated the Veteran since 2013, opined that exposure to Agent Orange while on active duty more likely than not contributed to the development of the Veteran's bladder cancer and idiopathic thrombocytopenia. The private examiner stated that in his personal experience and in the medical literature it is known that exposure to Agent Orange can be associated with thrombocytopenia and bladder cancer. In December 2018, the same private examiner submitted a second opinion stating that there is significant evidence associating Agent Orange exposure and the development of bladder cancer and thrombocytopenia, and based on this evidence, opined that the development of the disease is linked to exposure to herbicides while serving in Vietnam. The private examiner attached several references on epidemiology and risk factors for head and neck cancer to his statement. The Board notes that the board-certified specialist's opinions regarding the Veteran's claim for bladder cancer and thrombocytopenia are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data, and the Board finds the opinions highly probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, service connection may also be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents even though there is no record of such disease during service, if they manifest to a compensable degree after service, in a veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e), 3.313. Of note, the disease of bladder cancer was recently added to the list of diseases subject to presumptive service connection, via the National Defense Authorization Act for Fiscal Year 2021, effective January 1, 2021. See Pub.L. 116-283; 38 U.S.C. § 1116 (a)(2) (January 1, 2021). As noted above, the disease of cancer of the bladder was recently added to the list of diseases subject to presumptive service connection under 38 U.S.C. § 1116(a)(2) (January 1, 2021). Moreover, in the present case, the Board finds that the Veteran's bladder cancer became manifest to a compensable degree under 38 C.F.R. § 4.115A, as he has associated urinary tract infections and overactive and spastic bladder. See Hearing Testimony, April 2021. As such, the Board finds that service connection for bladder cancer may also be presumed. In addition, in light of the competent and credible lay and medical evidence, the Board finds that all three elements necessary to establish direct service connection have been met; therefore, service connection for idiopathic thrombocytopenia is warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sara Leigh, Attorney Advisor 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.