Citation Nr: 21030672 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 18-06 552 DATE: May 19, 2021 REMANDED Entitlement to service connection for carcinoma of the bladder, including as due to Gulf War exposures is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1978 to November 1983 and from November 1988 to November 1998. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) dated in October 2017. The Board notes that the claim was denied in rating decisions dated in September 2016 and January 2017. However, the Veteran submitted new evidence within a year of each of those rating decisions. Therefore, those claims did not become final and they do not need to be reopened. The Veteran testified at a Board hearing in August 2020. A copy of the transcript has been associated with the claims file. 1. Entitlement to service connection for carcinoma of the bladder, including as due to Gulf War exposures is remanded. The Veteran contends that his bladder cancer was caused by potential in-service chemical and environmental exposures, including asbestos, engine oil, hydraulic fuel, isopropyl alcohol, beryllium, jet fuel, paint, primer, naphtha, toluene, diesel fumes, cleaning solvents, secondhand smoke, and methyl ethyl ketone. See January 2016, December 2016, and April 2017 statements. The Veteran was afforded a VA examination for his service connection claim in August 2016. The examiner provided a negative nexus opinion, and cited various literature indicating that "there was no medical evidence supporting a causal relationship...between the Veteran's bladder cancer and military exposure to toxic/hazardous chemicals during service." However, some of the literature cited seems to compete with the examiner's conclusion. For example, the Veteran reported that he was a painter for part of his service and was also working on engine and mechanical equipment, and two of the occupations noted to have an increased risk of bladder cancer include painters and transport operators or machine operators; exposure to paint, paint thinners, and automotive products was noted to increase one's risk. The Veteran reported exposure to diesel fumes and secondhand tobacco smoke, and the literature appears to indicate an association with diesel exhausts in smokers. However, the Board notes that the literature cited is inadequate to grant the Veteran's claim because his records indicate a history of using smokeless tobacco. Therefore, this evidence must be addressed before the claim can be adjudicated. Moreover, the Veteran has submitted additional evidence in the form of testimony, medical records, and articles since his August 2016 VA examination. The Board notes that the articles and November 2016 private opinion by Dr. J. Y. are inadequate to grant the claim. The articles do not directly address the Veteran's unique circumstances and Dr. Y.'s opinion does not address the Veteran's use of smokeless tobacco or use the correct medical certainty standard in that Dr. Y indicated that the Veteran's in-service exposure certainly "may have" increased the Veteran's risk of bladder cancer. Therefore, the articles, records, and testimony must be addressed on remand. The matters are REMANDED for the following action: 1. Obtain a supplemental opinion from an appropriate VA examiner to determine the etiology of the Veteran's bladder cancer. Following review of the record, the examiner should respond to the inquiry below. If the examiner determines that he or she cannot respond to the Board's inquiry as set forth in detail below without examination of the Veteran, the Veteran should be afforded such an in-person examination, or by other means if an in-person examination is not feasible. If an examination is conducted, any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. The examiner should address the following: (a.) The examiner must review and address the following evidence: (1) the Veteran's list of in-service exposures provided in the Veteran's January 2016 and December 2016 written statements; (2) the articles in support of the claim submitted in March 2016 regarding bladder cancer in Gulf War Veterans and in April 2017 regarding bladder cancer in nonsmokers and painters; (3) the Veteran's private treatment records showing a history of smokeless tobacco use, but no history of smoking; (4) the November 2016 private opinion indicating that it is unusual to see high-grade bladder cancer in a man of the Veteran's age with no history of smoking, and significant secondhand smoke and occupational inhalants and compounds in the military may have increased his risk; and (5) the Veteran's August 2020 Board testimony regarding in-service exposure to secondhand smoke, jet fuel, and diesel fumes. (b.) The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater) that the Veteran's bladder cancer is etiologically related to, incurred in, or caused by the Veteran's military service, including toxic or environmental exposures in Southwest Asia or as a painter or working in corrosion control/quality assurance. A complete explanation for all opinions expressed must be provided. A clearly stated rationale must not be based solely on lack of documentation or records. The reasons for any opinion must include a discussion of the relevant evidence and medical principles. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Smith, 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.