BLADDER NEOPLASM OF MALIGNANT

VICTORIA MOSHIASHWILI · 2026 · Case ID: A26027320

MIXED

Summary

The Veteran served on active duty from November 1961 to February 1966. This case involves appeals from January, March, and May 2025 rating decisions. The Veteran sought an increased rating for bladder cancer residuals and service connection for loss of teeth, with the latter claim also encompassing bone loss of the maxilla and mandibular bones due to contaminated water exposure at Camp Lejeune. Additionally, service connection for an acquired psychiatric disorder, including PTSD, was remanded due to an inadequate VA examination. The Board granted an increased rating of 40 percent for bladder cancer residuals, finding the evidence approximately balanced and resolving doubt in the Veteran's favor, though a higher rating was not warranted as the criteria for more severe voiding dysfunction were not met. Service connection for loss of teeth was granted, with the Board affording significant weight to the Veteran's credible statements and a favorable VA medical opinion linking Camp Lejeune water exposure to the dental condition. The psychiatric disorder claim was remanded for a new VA examination to determine the nature and cause of any diagnosed psychiatric disability, assess service connection, and provide detailed rationale, as the prior examination was inadequate.

Rationale

Evidence approximately balanced; Benefit of doubt resolved in favor; Criteria for higher rating not met

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7528

Docket No.

260129-619943

Full Decision Text

Citation Nr: A26027320
Decision Date: 03/26/26 Archive Date: 03/26/26

DOCKET NO. 260129-619943
DATE: March 26, 2026

ORDER

An increased rating of 40 percent (but no higher) for service-connected bladder cancer residuals is granted.

Service connection for loss of teeth, to include as due to bone loss of the maxilla and mandibular bones, is granted.

REMANDED

Service connection for an acquired psychiatric disorder (to include posttraumatic stress disorder (PTSD)) is remanded.

FINDINGS OF FACT

1. The probative evidence of record establishes that the Veteran's bladder condition, and its accompanying symptoms, more closely approximates the criteria for a 40 percent rating due to a voiding dysfunction and urinary frequency.

2. The probative evidence of record establishes that the Veteran's teeth loss is due to bone loss of the maxilla and mandibular bones, which in turn was caused by his exposure to contaminated water while service on active duty at Camp Lejeune. [The Board affords significant probative weight to the Veteran's competent (that is, "qualified") and credible statements regarding his dental treatment and when his teeth began to fall out; the Board affords significant probative weight to the January 2025 VA medical opinion and January 2025 VA addendum medical opinion, in which the examiner opined that the Veteran's exposure to contaminated waters at Camp Lejeune at least as likely as not caused deterioration of his maxilla and mandibular jaw bones which directly resulted in the loss of his teeth.]

CONCLUSIONS OF LAW

1. The criteria have been met for an increased rating of 40 percent (but no higher) for service connected bladder cancer residuals. 38 U.S.C. §§ 1110, 5107(b) (2024); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2025).

2. The criteria have been met for service connection for loss of teeth. 38 U.S.C. §§ 1110, 5107(b) (2024); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1961 to February 1966. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2025 (teeth condition) March 2025 (bladder cancer) and May 2025 (psychiatric disorder) rating decisions by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

By law, for claims appealed in this docket, the Board may only consider the evidence of record at the time of the Agency of Jurisdiction (AOJ) decision on appeal. If evidence was submitted after the AOJ decision, then, by law, the Board was not permitted to consider that evidence in this decision. 38 C.F.R. §§20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of service connection for a acquired psychiatric disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

After reviewing the evidence of record, and in light of Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has recharacterized the issue of service connection for PTSD to encompass any acquired psychological disorder, to include PTSD.

1. An increased rating of 40 percent (but no higher) for service-connected bladder cancer residuals is granted.

Legal Criteria

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects ability to function under the ordinary conditions of daily life, including employment, by comparing the symptoms that the Veteran experiences with the criteria in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C
(c)(2)(ii).

1. An increased rating of 40 percent (but no higher) for service-connected bladder cancer residuals is granted.

Legal Criteria

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7.

The Veteran's bladder cancer is rated under Diagnostic Code 7528, which provides ratings for malignant neoplasms of the genitourinary system.

Under Diagnostic Code 7528, a 100 percent rating is warranted for malignant neoplasms of the genitourinary system. The note following Diagnostic Code 7528 details that following the cessation of surgical, x-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent shall continue with a mandatory VA examination at the expiration of six months. If there has been no local recurrence or metastasis, bladder cancer residuals must be rated on voiding dysfunction or renal dysfunction, whichever is predominant. 38 C.F.R. § 4.115b.

Voiding dysfunction may be rated based on urine leakage, frequency, or obstructed voiding. For evaluations based on urine leakage, due to continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence, a 20 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed less than two times per day. A 40 percent rating is warranted for voiding dysfunction requiring the wearing of absorbent materials which must be changed two to four times per day. A 60 percent rating is warranted for voiding dysfunction requiring the use of an appliance or the wearing of absorbent materials which must be changed more than four times per day. 38 C.F.R. § 4.115a.

Renal dysfunction is rated based on multiple factors including, but not limited to, glomerular filtration rate (GFR). A 60 percent rating is warranted for chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months. An 80 percent rating is warranted for chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months. A 100 percent rating is warranted for chronic kidney disease with GFR less than 15 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient. 38 C.F.R. § 4.115a.

The Board has reviewed all evidence in the claims file, with an emphasis on the evidence relevant to these appeals. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The Board will summarize the relevant evidence as appropriate and the analysis will focus on what the evidence shows, or fails to show, as to the claims.

Factual Background and Analysis

The Veteran has asserted that his service-connected bladder condition warrants a higher disability rating.

The Veteran attended a March 2025 VA examination for his bladder condition. The examiner confirmed that the Veteran had bladder cancer and experiences residuals of the same. The examiner noted a voiding dysfunction due to TURP. The examiner indicated the Veteran must wear absorbent material. The condition causes increased daytime voiding every two to three hours and nighttime awakening at least three to four times. There are no symptoms of obstructed voiding, no bladder calculi (cystolithiasis) or urethral calculi, no history of recurrent, symptomatic bladder or urethral infections, and no other bladder conditions present. The examiner noted that the Veteran had

The Veteran has asserted that his service-connected bladder condition warrants a higher disability rating.

The remaining VA treatment records and private treatment records are consistent with the VA examination.

The Board affords significant probative weight to the March 2025 VA examination. The Board finds that affording the Veteran the benefit of doubt, the evidence is approximately balanced in favor of finding that the Veteran's bladder cancer and its residuals warrant a 40 percent rating, but no higher.

A higher rating is not warranted because the Veteran does not have local reoccurrence or metastasis of his bladder cancer, no obstructed voiding, and does not require the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day.

Based on the above, the Board finds that an increased rating of 40 percent (but no higher) for service-connected bladder cancer residuals is warranted.

2. Service connection for loss of teeth, to include as due to bone loss of the maxilla and mandibular bones, is granted.

For the reasons outlined in more detail above in the Findings of Fact section, the appeal for service connection for loss of teeth is granted.

REASONS FOR REMAND

1. Service connection for an acquired psychiatric disorder (to include posttraumatic stress disorder (PTSD)) is remanded.

The issue of service connection for an acquired psychiatric disorder is remanded to correct a duty to assist error that occurred prior to the rating decision on appeal. The AOJ obtained a November 2023 VA examination prior to the rating decision on appeal. However, this VA examination is inadequate as it does not address the Veteran's mental health symptoms or the impact the same have on any functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (2018) (despite lack of a formal diagnosis, symptoms may count as a disability for Department of Veteran's Affairs (VA) compensation purposes if they cause functional impairment).

Accordingly, a remand is required.

The matters are REMANDED for the following action:

1. The AOJ should arrange for a VA examination of the Veteran to determine the nature and likely cause of any diagnosed psychiatric disability. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with a detailed explanation (rationale) that responds to the following:

(a.) Please identify, by diagnosis, all psychiatric disabilities present during the appeal period.

(b.) For each psychiatric disability diagnosed, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that this disability was either incurred in (had its onset during) or was otherwise related to the Veteran's military service? Please explain why or why not.

The examiner is reminded that the Veteran is competent to provide information about observable symptoms and events. The examiner should assume, for the purposes of the opinions, that the Veteran's reports are both accurate and credible.

The examiner is also reminded that, by law, observable symptoms persisting since service may be sufficient to establish a causal link (nexus), absent clear and convincing medical evidence to the contrary. By law, a lack of medical evidence is not considered "clear and convincing."

The examiner is further reminded that, by law, despite lack of a formal diagnosis, symptoms may count as a disability for VA compensation purposes IF THEY CAUSE FUNCTIONAL IMPAIRMENT.

A detailed explanation (rationale) is required for all opinions provided. By law, the Board is not permitted to rely on any conclusion that is not supported by a ?

thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.

VICTORIA MOSHIASHWILI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board

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