Citation Nr: 21032134 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 14-30 859 DATE: May 25, 2021 REMANDED Entitlement to service connection for renal cell carcinoma, to include as secondary to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1966 to September 1968, including service in the Republic of Vietnam. This matter comes before the Board on appeal from an August 2016 rating decision by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In May 2018, the Veteran testified by videoconference hearing before the undersigned. In June 2019, the Board granted an initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD), as well as entitlement to a TDIU. The Board also remanded for additional development the claim for entitlement to service connection for renal cell carcinoma. In October 2020, the Board remanded this matter for an addendum opinion. The Board regrets the delay, but additional development is necessary. The January 2021 addendum opinion states that a nexus cannot established between the Veteran's hypertension and presumed exposure to herbicide agents and noted that the first medical evidence in the claims file showing a diagnosis of hypertension is dated as of 2004. See January 2021 Medical Opinion. The Veteran's VA treatment records in the claims file begin in 2004. See February 2, 2004 VA Treatment Record. However, the Veteran reported first receiving VA care in the late 1990s. See November 2010 VA Form 21-526. There is no memorandum in the claims file indicating that a search was conducted for non-electronic VA treatment records. On remand, the Veteran's complete VA treatment records should be secured, and a memorandum should be placed in the claims file documenting the search. Furthermore, the record indicates that the Veteran was incarcerated in 1992. On remand, the Veteran should be provided the opportunity to identify any previous medical providers, to include prison medical providers, and provide a release to allow the VA to attempt to obtain these records. Additionally, the Veteran asserted that he was initially refused admission to the Army Reserve due to his blood pressure. See January 2021 Hypertension Examination Report. However, Reserve service treatment records (STRs) are not of record, only examinations, and the Veteran's February 1977 Reserve Enlistment Examination shows blood pressure of 140/72. See STR Medical (March 30, 2018). On remand, the AOJ should ensure that the Veteran's complete Reserve STRs have been secured, and a memorandum should be placed in the claims file documenting the search. After these directives have been completed, an addendum opinion should be secured that accounts for any additional evidence received. The matters are REMANDED for the following action: 1. Secure the Veteran's complete VA treatment records. A memorandum should be added to the claims file showing attempts to secure these records. The AOJ's attention is directed to the Veteran's November 2010 claim, wherein he reported receiving VA treatment since the "late 1990s," as well as evidence that the Veteran underwent a Compensation & Pension examination in August 1992 while incarcerated. 2. With any necessary assistance from the Veteran, secure outstanding relevant private treatment records, to include prison medical records. 3. Secure outstanding Reserve treatment records, if any, and place a memorandum in the claims file documenting these efforts. 4. Then refer the claims file to the January 2021 examiner, or another examiner if the January 2021 examiner is unavailable, for preparation of an addendum opinion. No examination is necessary unless the examiner determines otherwise. Following a review of the claims file, the examiner should address the following: (a) Is it at least as likely as not (50 percent or greater probability) that hypertension had its onset in service or is otherwise related to service, to include as a result of conceded herbicide exposure therein? Please discuss the NAS 2018 update to the "Veterans and Agent Orange" study finding "sufficient evidence of an association" between hypertension and herbicides. (b) If and only if the answer to question (a) is yes, is it at least as likely as not (50 percent or greater probability) that the Veteran's renal cell carcinoma is proximately due hypertension? (c) If the answer to question (a) is yes, is it at least as likely as not (50 percent or greater probability) that the Veteran's renal cell carcinoma has been aggravated (worsened beyond natural progression) by hypertension? Please answer each sub-part separately. In addressing these questions, the examiner is advised that if the sequelae of hypertension (such as the requirement for antihypertensive therapy) cause renal cell carcinoma, then this is an adequate basis for establishing secondary service connection, even if hypertension itself is not wholly responsible for renal cell carcinoma. See January 2021 Medical Opinion. Moreover, the examiner is advised that there is no requirement that hypertension be formally service-connected to establish secondary service connection for renal cancer in relation to hypertension. The examiner should also note that it is not necessary that hypertension be service-connected, or even diagnosed, at the time that the Veteran's renal cancer is incurred to be considered due to or aggravated by hypertension, and reliance on this fact in support of a negative opinion will render it inadequate. A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.