VOIDING DYSFUNCTION

Summary

The veteran, who served from November 1965 to February 1969, including service in the Republic of Vietnam, appeals the denial of a higher rating for neurogenic bladder with voiding dysfunction and the denial of a 10 percent rating based on multiple noncompensable service-connected disabilities. The veteran also appeals the denial of service connection for adenocarcinoma of the colon, claiming it is due to herbicide exposure and/or secondary to his service-connected neurogenic bladder. The Board granted an initial 10 percent rating for neurogenic bladder with voiding dysfunction, finding the veteran experienced obstructed voiding with a weak stream and diminished peak flow rate, consistent with the rating criteria. However, the Board denied a higher rating, finding the evidence did not support the criteria for increased ratings, and denied the 10 percent rating for multiple noncompensable disabilities as the neurogenic bladder was already rated. The claim for adenocarcinoma of the colon was remanded due to inadequate VA medical opinions. The examiners failed to provide sufficient rationale for negative nexus opinions regarding both direct service connection and secondary aggravation from the neurogenic bladder, and did not address the potential link to conceded herbicide exposure. A new VA etiology opinion is required to determine the nature and etiology of the colon cancer.

Rationale

Obstructed voiding with weak stream and diminished peak flow rate; Consistent with 10 percent rating criteria under DC 7542

Full Decision Text

Citation Nr: A26036250
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 251121-619214
DATE: April 17, 2026

ORDER

Entitlement to an initial rating of 10 percent, but no higher, for neurogenic bladder with voiding dysfunction, residual of prostate cancer, is granted. 

Entitlement to a 10 percent rating under 38 C.F.R. § 3.324, based on multiple non-compensable service connected disabilities is denied. 

REMANDED

Entitlement to service connection for adenocarcinoma of the colon, to include as due to herbicide agents and/or as secondary to service connected neurogenic bladder with voiding dysfunction, residual of prostate cancer, is remanded. 

FINDINGS OF FACT

1. Throughout the appeal period, the Veteran's neurogenic bladder with voiding dysfunction is manifested as obstructed voiding that consisted of a weak stream and a diminished peak flow rate of less than 10cc/second without urinary retention requiring intermittent or continuous catheterization, the use of absorbent materials, daytime voiding interval between one and two hours or awakening to void three or more times per night. 

2. The record reflects that the Veteran was in receipt of a compensable rating for a service-connected disability for the entirety of the period on appeal.  

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 10 percent, but no higher, percent for neurogenic bladder with voiding dysfunction, residual of prostate cancer, have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.115b, Diagnostic Code 7542. 

2. The criteria for a compensable rating for multiple noncompensable service-connected disabilities have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 3.324.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active air service from November 1965 to February 1969, to include service in the Republic of Vietnam.      

This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in October 2025 (as to a neurogenic bladder and a 10 percent rating based upon multiple, noncompensable, service connected disabilities) and November 2025 (as to adenocarcinoma of the colon) issued by the Department of Veterans Affairs (VA).  The rating decisions on appeal constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In August 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of a June 2025 rating decision that denied entitlement to a compensable rating for neurogenic bladder with voiding dysfunction, entitlement to a 10 percent rating based on multiple noncompensable service connected disabilities, and entitlement to service connection for adenocarcinoma of the colon.  In September 2025, the agency of original jurisdiction (AOJ) issued a supplemental claim decision, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision.  

In October 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the September 2025 decision.  In October 2025 and November 2025, the AOJ issued HLR decisions, which considered the evidence of record at the time of the prior September 2025 decision. 

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the June 2025 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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
5 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 for entitlement to service connection for adenocarcinoma of the colon, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

In the September 2025 rating decision, the AOJ found that new and relevant evidence was submitted to warrant readjudicating on the merits of entitlement to service connection for adenocarcinoma of the colon.  The Board is bound by this favorable finding.  38 C.F.R. § 3.104(c).  

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In this case, a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2) as it is more than one year from the date that the AOJ mailed notice of the decision on appeal, and it is more than 60 days of the date that the Board received the November 2025 VA Form 10182. Therefore, the Board shall proceed with adjudication.

Increased Rating Criteria

Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity.  38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating.  Otherwise, the lower rating applies. 38 C.F.R. § 4.7.  After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran.  38 C.F.R. § 4.3.  

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings.  Francisco v. Brown, 7 Vet. App. 55 (1994).  However, the Board must also consider staged ratings.  Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). 

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases.  38 C.F.R. § 4.21.  Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision.  Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment.  38 C.F.R. § 4.10.

The veteran is competent to report symptoms and experiences observable by his senses.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007
, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision.  Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment.  38 C.F.R. § 4.10.

The veteran is competent to report symptoms and experiences observable by his senses.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value.  38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999).  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence).  Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claims.

Additionally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is not clear from the record. However, the Veteran has not alleged that he was unable to secure and maintain substantially gainful employment due to his neurogenic bladder with voiding dysfunction during the period on appeal. As such, a Rice claim is not raised.

1.  Entitlement to an initial rating of 10 percent, but no higher, for neurogenic bladder with voiding dysfunction, residual of prostate cancer, is granted. 

The Veteran generally asserts that he should have a higher rating for his neurogenic bladder with voiding dysfunction, residual of prostate cancer as it is worse than contemplated by the currently assigned rating. See November 2025 VA Form 10182. 

This appeal stems from a claim for service connection and the assignment of an initial rating, effective January 24, 2025.  During the period on appeal, the Veteran's neurogenic bladder with voiding dysfunction is assigned a noncompensable rating under 38 C.F.R. § 4.71a, Diagnostic Code 7542. 38 C.F.R. § 4.115a, Diagnostic Code 7542.  Diagnostic Code 7542 instructs the rater to evaluate the disability as a voiding dysfunction. Diagnostic Code 7542 provides that neurogenic bladder should be rated as voiding dysfunction.  Voiding dysfunction is rated as either urine leakage, frequency, or obstructed voiding.  38 C.F.R. § 4.115b, Diagnostic Code 7542.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of those.  38 C.F.R.             § 4.115a.  While the diagnostic code refers to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes.  

Diagnostic code 7542 provides that neurogenic bladder should be rated as voiding dysfunction.  Voiding dysfunction is rated as either urine leakage, frequency, or obstructed voiding.  38 C.F.R. § 4.115b, Diagnostic Code 7542.

For urinary frequency, a 10 percent rating is assigned with a daytime voiding interval between two and three hours, or; awakening to void two times per night. A 20 percent rating is assigned with a daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 40 percent rating requires a daytime voiding
 specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes.  

Diagnostic code 7542 provides that neurogenic bladder should be rated as voiding dysfunction.  Voiding dysfunction is rated as either urine leakage, frequency, or obstructed voiding.  38 C.F.R. § 4.115b, Diagnostic Code 7542.

For urinary frequency, a 10 percent rating is assigned with a daytime voiding interval between two and three hours, or; awakening to void two times per night. A 20 percent rating is assigned with a daytime voiding interval between one and two hours, or; awakening to void three to four times per night. A 40 percent rating requires a daytime voiding interval of less than one hour, or; awakening to void five or more times per night. 38 C.F.R. § 4.115a.

For obstructed voiding, a zero percent rating is assigned for obstructive symptomatology with or without stricture disease requiring dilation one to two times per year. A 10 percent rating is assigned for marked obstructive symptomatology (hesitancy, slow or weak stream, decreased force of stream), with any one or combination of the following: (1) post-void residuals greater than 150cc; (2) uroflowmetry; markedly diminished peak flow rate (less than 10cc/second); (3) recurrent urinary tract infections secondary to obstruction; or (4) stricture disease requiring periodic dilation every two to three months. A 30 percent rating applies to urinary retention requiring intermittent or continuous catheterization. 38 C.F.R. § 4.115a.

For urine leakage, a 20 percent rating is warranted when the wearing of absorbent materials which must be changed less than two times per day is required. A 40 percent rating is warranted when absorbent materials must be changed two to four times per day. A 60 percent rating is assigned when the use of an appliance is required, or absorbent materials must be changed more than four times per day. 38 C.F.R. § 4.115a.

Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported neurogenic bladder symptoms that are worse than those noted below. 

Turning to the evidence, the Veteran was afforded a VA examination in April 2025, and the examiner noted a diagnosis of neurogenic bladder due to prostate cancer.  At that time, the Veteran reported that he often did not have the urge to urinate and that he had to schedule urination times.  The Veteran reported that he did not use any medication to alleviate symptoms.    On examination, the examiner reported that the veteran's voiding dysfunction did not cause urine leakage, increased urinary frequency, obstructed voiding, or require use of an appliance.  There was no evidence recurrent urinary tract infections or of catheterization. The examiner reported that the Veteran's neurogenic bladder did not impact his ability to work.  

At a September 2025 VA examination, the Veteran reported that his condition had stayed the same since its onset in 2016.  The Veteran indicated that he still had to urinate on a schedule.  The examiner indicated that the Veteran experienced obstructed voiding and had to schedule urination times.  On examination, the examiner reported that the veteran's voiding dysfunction did not cause urine leakage, increased urinary frequency, or require use of an appliance.  There was no evidence of recurrent urinary tract infections, urethral infections, or of catheterization. The examiner noted that the Veteran had a malignant neoplasm that was in remission. The examiner reported that the Veteran's neurogenic bladder did not impact his ability to work.  

Following a review of the record, the Board finds that a 10 percent rating is warranted for the Veteran's neurogenic bladder with voiding dysfunction, residual of prostate cancer.  In this regard, the Veteran submitted a June 2016 treatment record showing that he experienced a large bladder capacity of 1203 cc, minimal involuntary bladder contractions, and a weak stream of 3cc per second with weak voluntary voided pressure and incomplete emptying.  While this is before the period on appeal, the Board notes the Veteran's report at the September 2025 VA examination that his condition had stayed the same since 2016.  Therefore, the Board finds that the Veteran experienced obstructed voiding that consisted of a weak stream and a diminished peak flow rate of less than 10cc/second.  See 38 C.F.R. § 4.115a.

Next, the Board finds that a rating in excess of 10 percent is not warranted.  To that end, the record does not show that the Veteran experienced urinary retention
 cc, minimal involuntary bladder contractions, and a weak stream of 3cc per second with weak voluntary voided pressure and incomplete emptying.  While this is before the period on appeal, the Board notes the Veteran's report at the September 2025 VA examination that his condition had stayed the same since 2016.  Therefore, the Board finds that the Veteran experienced obstructed voiding that consisted of a weak stream and a diminished peak flow rate of less than 10cc/second.  See 38 C.F.R. § 4.115a.

Next, the Board finds that a rating in excess of 10 percent is not warranted.  To that end, the record does not show that the Veteran experienced urinary retention requiring intermittent or continuous catheterization, use of absorbent materials, daytime voiding interval between one and two hours, or; awakening to void three or more times per night.  See 38 C.F.R. § 4.115a.

The Board has also considered the other Diagnostic Codes pertaining to the genitourinary system.  Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability.  Esteban v. Brown, 6 Vet. App. 259 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017).  Disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them.  Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333 (2015)).  Unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms.  Finally, the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected disability exhibiting distinct manifestations, even when service connection has also been granted for another disability listed in the rating schedule.  Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016)).  

Here, the Veteran's neurogenic bladder symptoms are specifically listed under the rating schedule and therefore cannot be rated under any different Diagnostic Code. In this instance, the Veteran's neurogenic bladder symptomatology is compensated under the rating criteria noted under Diagnostic Code 5242, specifically applying to voiding dysfunctions with obstructed voiding.  Additionally, the evidence of record does not indicate that the Veteran has any other compensable service-connected genitourinary disability symptoms outside of those listed that would warrant a separate rating under a different Diagnostic Code.  The evidence indicates that the Veteran experiences obstructed voiding that consisted of a weak stream and a diminished peak flow rate of less than 10cc/second.  The 10 percent rating currently assigned under the criteria utilized in rating obstructed voiding noted under Diagnostic Code 7542 contemplates such disability.  38 C.F.R.                §§ 4.115a, 4.115b, Diagnostic Code 7542.

The Board acknowledges the Veteran's assertions, and that of his representative, that his neurogenic bladder with voiding dysfunction, residual of prostate cancer disability is more severe than evaluated. The Veteran is competent to report his symptoms. See e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board finds, however, that the statements of the Veteran or his representative or clinical evidence demonstrates that the criteria for a higher rating have been met. The Board also acknowledges that the Veteran's VA treatment records note complaints of and treatment for his neurogenic bladder. However, these records do not address the specific rating criteria necessary to substantiate a higher rating. In determining the actual degree of disability, the examination findings are more probative of the degree of impairment. The criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. 

The Board also observes that the Veteran and his representative, while competent to report his observable symptoms, they are not competent to report that his neurogenic bladder with voiding dysfunction, residual of prostate cancer is of sufficient severity to warrant
 of disability, the examination findings are more probative of the degree of impairment. The criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. 

The Board also observes that the Veteran and his representative, while competent to report his observable symptoms, they are not competent to report that his neurogenic bladder with voiding dysfunction, residual of prostate cancer is of sufficient severity to warrant a higher rating under VA's tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, supra. Even after considering any contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). 

The Board notes that Diagnostic Code 7542 does not contemplate the use of medication. The Board is cognizant of the recent Court decision in Ingram v. Collins, in which the Court reaffirmed prior holdings that in rating disabilities, the Board must discount the beneficial effects of medication when the relevant rating criteria do not contemplate medication use. Ingram v. Collins, 38 Vet. App. 130 (2025).  See also Jones v. Shinseki, 26 Vet. App. 56 (2012); McCarroll v. McDonald, 28 Vet. App. 267 (2016). In this case, the Veteran reported that he did not use medication to treat his neurogenic bladder with voiding dysfunction, residual of prostate cancer in the April 2025 VA examination. As such, there are no ameliorative effects of medication to consider.

Consideration has been given to assigning a staged rating.  However, at no time during the period in question has the Veteran's neurogenic bladder with voiding dysfunction, residual of prostate cancer warranted a higher schedular rating than that assigned herein. Fenderson v. West, 12 Vet. App. 119 (1999).  Further, the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to such claim. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Accordingly, the Board finds that a rating of 10 percent, but no higher for neurogenic bladder with voiding dysfunction, residual of prostate cancer is warranted. To that extent, the appeal is granted. However, a rating higher than 10 percent is not warranted for any period during appeal.  To that extent, the appeal is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102: Lynch v. McDonough, supra

2.  Entitlement to a 10 percent rating under 38 C.F.R. § 3.324, based on multiple non-compensable service connected disabilities is denied. 

Herein, the Board has assigned a 10 percent rating for neurogenic bladder with voiding dysfunction, effective January 24, 2025.  During the time, the Veteran is also service connected for erectile dysfunction and hypertension, which are assigned noncompensable ratings, respectively, effective January 24, 2025 (erectile dysfunction and February 8, 2025 (hypertension).  The Veteran does not have any service connected disabilities prior to January 24, 2025.  

In cases involving two or more separate permanent service-connected disabilities of such character as clearly to interfere with normal employability, even when none are individually compensable, the regulations permit an alternative 10 percent rating, but not in combination with any other rating.  38 C.F.R. § 3.324.  As such, awards of a 10 percent rating under § 3.324 are predicated solely upon a non-compensable combined evaluation of all service-connected disabilities and thus any existing
 respectively, effective January 24, 2025 (erectile dysfunction and February 8, 2025 (hypertension).  The Veteran does not have any service connected disabilities prior to January 24, 2025.  

In cases involving two or more separate permanent service-connected disabilities of such character as clearly to interfere with normal employability, even when none are individually compensable, the regulations permit an alternative 10 percent rating, but not in combination with any other rating.  38 C.F.R. § 3.324.  As such, awards of a 10 percent rating under § 3.324 are predicated solely upon a non-compensable combined evaluation of all service-connected disabilities and thus any existing rating for any service-connected disability effectively moots the claim. Butts v. Brown, 5 Vet. App. 532, 541 (1993). In this case, the Board has assigned a 10 percent rating for a neurogenic bladder with voiding dysfunction throughout the appeal period.  Accordingly, there is no basis in law to award a 10 percent rating pursuant to 38 C.F.R. § 3.324.  Therefore, the appeal is denied. 

REASONS FOR REMAND

3.  Entitlement to service connection for adenocarcinoma of the colon, to include as due to herbicide agents and/or as secondary to service connected neurogenic bladder with voiding dysfunction, residual of prostate cancer, is remanded. 

The Veteran asserts that he has colon cancer that is related to his period of active service. See February 2025 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).  Alternatively, the Veteran contends that his cerebral aneurism is caused or aggravated by his service-connected neurogenic bladder with voiding dysfunction. The June 2025 rating decision made favorable findings that the Veteran had been diagnosed with colon cancer; the primary disability is service connected.  Specifically, the Veteran is service connected for prostate cancer; and that participation in a toxic exposure risk activity is conceded, as the Veteran's records concede exposure to Agent Orange while serving in the Republic of Vietnam. These favorable findings are binding on the Board. 38 U.S.C. § 5104A.

The Veteran was afforded a VA examination in April 2025 and the examiner noted an October 2024 diagnosis of malignant neoplasm of the anorectal/perianal region.  In a corresponding opinion report, the examiner indicated that the Veteran's colon cancer was less likely than not proximately due to or the result of his service-connected prostate cancer residuals.  In support of this conclusion, the examiner commented that adenocarcinoma arising from left colon, moderately differentiated, that a mucinous component was identified and that 28 lymph nodes were negative for metastatic carcinoma.  

In a November 2025 opinion report, the VA examiner opined that the Veteran's adenocarcinoma of the colon was less likely than not aggravated beyond its natural progression by his service-connected prostate cancer residuals.  In support of this conclusion, the examiner commented that colorectal cancer had a multifactorial disease process and that risk factors included genetics, environmental exposures, and inflammatory conditions of the digestive tract.  The examiner also indicated that the Veteran had a history of smoking, which is a known risk factor for developing colon cancer.  

The Board finds that it is unable to decide the claim based on the findings contained within the October 2024 and November 2025 VA etiology opinions. With regard to the October 2024 opinion, the Board is unable to interpret the opinion so as to adequately assess it.  In this regard, the examiner's opinion indicates the physical location of various aspects likely related to colon cancer but no explanation of how it related to its etiology.  Next, the October 2024 and November 2025 examiners provided inadequate supporting rationale for the negative etiological opinions.  Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Moreover, the November 2025 VA examiner did not provide an opinion related to service connection on a direct basis.  See 38 C.F.R. § 3.303.  Further, the examiners did not address whether the Veteran's colon cancer is related to his conceded in-service exposure to herbicide agents.  

Therefore, the Board finds that a new VA etiology opinion is warranted to address the nature and etiology of the Veteran's claimed adenocarcinoma of the colon. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or
 295 (2008). Moreover, the November 2025 VA examiner did not provide an opinion related to service connection on a direct basis.  See 38 C.F.R. § 3.303.  Further, the examiners did not address whether the Veteran's colon cancer is related to his conceded in-service exposure to herbicide agents.  

Therefore, the Board finds that a new VA etiology opinion is warranted to address the nature and etiology of the Veteran's claimed adenocarcinoma of the colon. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate).  The failure to provide an adequate VA etiology opinion is a pre-decisional duty to assist error. 

The matter is REMANDED for the following action:

Obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed adenocarcinoma of the colon.  The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. The need for additional physical examination or telehealth evaluation is left to the discretion of the medical professional offering the medical opinion.

Based on the review of the record, the examiner must provide an opinion as to the following:

(a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's adenocarcinoma of the colon had its onset during his active service or is otherwise etiologically related to such service, to include to include in-service exposure to herbicide agents (notwithstanding the fact that there may not be a presumed association)?  

(b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the adenocarcinoma of the colon was caused OR aggravated by his service-connected neurogenic bladder with voiding dysfunction, residual of prostate cancer?     

The examiner must consider the Veteran's statements regarding the onset and continuity of his symptoms.  The examiner should also address the medical article titled Cancer May Metastasize Without Lymph Node Involvement submitted in August 2025. 

A rationale should be provided for all opinions offered.

The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

 

KRISTY L. ZADORA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Christopher O'Donnell, 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.