BLADDER NEOPLASM OF

Summary

The Veteran, who served in the Army National Guard of Oklahoma from January 1962 to April 1964, including active duty training from March 1962 to September 1962, appeals the denial of service connection for bladder cancer, GERD, and COPD. The Veteran asserts these conditions are due to in-service events, stressors, or toxic exposure, citing a July 2025 TERA memorandum for bladder cancer and COPD, and in-service events for GERD. The Board reviewed evidence of record up to the August 2025 AOJ decision and evidence submitted by the hearing date. For bladder cancer, the Board found the evidence weighed against service connection, noting the Veteran's attorney did not assert in-service onset and that the VA examiner's opinion, which found less likelihood of service connection due to lack of evidence linking TERA to bladder cancer and the Veteran's smoking history, was uncontroverted and highly probative. For GERD, the Board found the evidence weighed against service connection, noting the Veteran's inconsistent reporting of onset and the VA examiner's opinion finding less likelihood of service connection due to lack of evidence linking TERA to GERD and the Veteran's smoking history, which was also uncontroverted. For COPD, the Board acknowledged a private opinion linking fuel exhaust exposure to COPD but found it lacked probative value due to insufficient explanation and failure to address the Veteran's smoking history. A VA examiner's opinion finding less likelihood of service connection due to lack of evidence linking TERA and the Veteran's smoking history was also noted. The Board found no probative opinion establishing a link for COPD. In all three claims, the Board found the evidence did not support service connection and was not in approximate balance, thus denying the claims.

Rationale

No assertion of in-service onset; VA examiner opinion found less likelihood of service connection; Opinion based on lack of evidence linking TERA to bladder cancer; Veteran has extensive smoking history

Full Decision Text

Citation Nr: A26040611
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250919-578529
DATE: April 30, 2026

ORDER

Service connection for bladder cancer is denied.

Service connection for gastroesophageal reflux disease (GERD) is denied.

Service connection for chronic obstructive pulmonary disease (COPD) is denied.

FINDING OF FACT

The competent and probative evidence of record persuasively weighs against finding that bladder cancer, GERD, and/or COPD began during active service or are otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for bladder cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for GERD have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran had service in the Army National Guard of Oklahoma from January 1962 to April 1964, with a period of active duty training from March 1962 to September 1962 that is now considered active duty service based on a grant of service connection for bilateral hearing loss.

The rating decision on appeal was issued in August 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the September 19, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 15, 2025. 

Given this procedural history, the Board may only consider the evidence of record at the time of the August 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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. 

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf;
 Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), exposure to burn pits and other toxins (BPOT) is presumed for "covered veterans," i.e., those who served in specific locations on or after specific dates. 38 U.S.C. § 1119. Any veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Bahrain; Iraq; Kuwait; Oman; Qatar; Saudi Arabia; Somalia; the United Arab Emirates; the neutral zone between Iraq and Saudi Arabia; the Gulf of Aden; the Gulf of Oman; the Persian Gulf; the Arabian Sea; or the Red Sea will be presumed BPOT exposed, as will any veteran who, on or after September 11, 2001, performed active military, naval, air, or space service while assigned to a duty station in and/or airspace above Afghanistan; Djibouti; Egypt; Jordan; Lebanon; Syria; Yemen; or Uzbekistan. 38 U.S.C. § 1119; VBA Letter 20-22-10 at 7, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). Certain diseases will be presumed related to service for veterans with in-service toxic exposure, including BPOT exposure. 38 U.S.C. § 1120.

The Veteran's military personnel records do not show the Veteran had service in a location with presumed BPOT exposure. Therefore, the Veteran is not a "covered veteran" for whom BPOT exposure is presumed pursuant to 38 U.S.C. § 1119. However, the record contains VA memoranda dated in January 2024, June 2025, and July 2025 that establish the Veteran participated in a toxic exposure risk activity (TERA) based on his military occupation specialty; therefore, service connection may be established with proof of actual direct causation. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

1. Service connection for bladder cancer.

The Veteran seeks service connection for bladder cancer, which he asserts is due to in-service events/stressors and/or is related to exposure per a July 2025 TERA memorandum. See August 2025 VA Form 21-526EZ. At the time of an August 2025 VA urinary tract conditions Disability Benefits Questionnaire (DBQ), the Veteran reported that bladder cancer onset in 2025 following evaluation for hematuria. The Board points out that at the December 2025 hearing, the Veteran's attorney made it clear that there was no assertion that the condition began in service.

The August 2025 rating decision made a favorable finding in conjunction with this claim, namely that the Veteran had a current diagnosis of bladder cancer. The Board is bound by this finding. See 38 C.F.R. § 3.104(c). The question for the Board to resolve is whether the Veteran's bladder cancer is directly related to service, to include the Veteran's participation in a TERA. 

The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's bladder cancer began during service or is otherwise related to an in-service injury, event, or disease, to include his participation in a TERA. 

The examiner who conducted the August 2025 VA examination provided an opinion that the claimed bladder cancer was less likely than not caused by the Veteran's in-service exposure to toxins after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. The rationale was based on the absence of medical or scientific evidence that provides any indication of a relationship between the development of the bladder cancer at issue and the TERA. The examiner instead cited to medical literature showing that bladder cancer risk is driven primarily by smoking and occupational aromatic amines/PAHs, with additional contributions from arsenic-contaminated water, Schistosoma haematobium, prior pelvic radiation/cyclophosphamide, hereditary mismatch-repair defects (e.g., MSH2), and tumor genomics (TERT, FGFR3, TP53/RB1) reflecting these carcinogenic processes. The examiner noted that the Veteran has a smoking history, namely that he was a smoker for 60 years smoking two packs per day. 

This opinion, which stands uncontroverted in the record, is afforded high probative value because it is based on the medical evidence specific to this Veteran, considers the assertions raised in support of the claim, and provides an explanation that
 amines/PAHs, with additional contributions from arsenic-contaminated water, Schistosoma haematobium, prior pelvic radiation/cyclophosphamide, hereditary mismatch-repair defects (e.g., MSH2), and tumor genomics (TERT, FGFR3, TP53/RB1) reflecting these carcinogenic processes. The examiner noted that the Veteran has a smoking history, namely that he was a smoker for 60 years smoking two packs per day. 

This opinion, which stands uncontroverted in the record, is afforded high probative value because it is based on the medical evidence specific to this Veteran, considers the assertions raised in support of the claim, and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

While the Veteran believes the claimed bladder cancer is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent and probative medical evidence provided by the VA examiner. 

The Board notes at this juncture that at the time of the December 2025 hearing, the Veteran's attorney intimated that a medical opinion to support the claim would be submitted within the evidentiary window of this appeal, but no such opinion has been received within the applicable timeframe. That leaves only the opinion provided by the VA examiner for consideration.

In sum, the weight of the competent and probative evidence does not support the claim for service connection for bladder cancer. The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied.

2. Service connection for GERD.

The Veteran seeks service connection for GERD, which he asserts is due to in-service events/stressors. See July 2025 VA Form 21-526EZ. At the time of an August 2025 VA esophageal conditions DBQ, the Veteran reported that GERD onset in 2015, but at the December 2025 Board hearing, he indicated he started having issues 30 or 40 years ago, which the Board notes would place the onset anywhere between 1985 and 1995.

The August 2025 rating decision made a favorable finding in conjunction with this claim, namely that the Veteran had a current diagnosis of GERD. The Board is bound by this finding. See 38 C.F.R. § 3.104 (c). The question for the Board to resolve is whether the Veteran's GERD is directly related to service, to include the Veteran's participation in a TERA. 

The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's GERD began during service or is otherwise related to an in-service injury, event, or disease, to include his participation in a TERA. 

The Board initially notes that there is no assertion that the Veteran had any in-service symptoms of GERD since he testified in December 2025 that the condition onset after 1985. In addition to the foregoing, the examiner who conducted the August 2025 VA examination provided an opinion that the claimed GERD was less likely than not caused by the Veteran's in-service exposure to toxins after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. The rationale was based on the absence of medical or scientific evidence that provides any indication of a relationship between the development of the GERD at issue and the TERA. The examiner instead cited to medical literature showing that gastroesophageal reflux is primarily a disorder of the lower esophageal sphincter but there are several factors that may contribute to its development, the most common cause being transient lower esophageal sphincter relaxations, which are brief moments of lower esophageal sphincter tone inhibition that are independent of a swallow. The examiner indicated that while these are physiologic in nature, there is an increase in frequency in the postprandial phase and they contribute greatly to acid reflux in patients with GERD. Other factors include reduced lower esophageal sphincter pressure, hiatal hernias, impaired esophageal clearance, and delayed gastric emptying. 

This opinion, which stands uncontroverted in the record, is afforded high probative value because it is based on the
 lower esophageal sphincter but there are several factors that may contribute to its development, the most common cause being transient lower esophageal sphincter relaxations, which are brief moments of lower esophageal sphincter tone inhibition that are independent of a swallow. The examiner indicated that while these are physiologic in nature, there is an increase in frequency in the postprandial phase and they contribute greatly to acid reflux in patients with GERD. Other factors include reduced lower esophageal sphincter pressure, hiatal hernias, impaired esophageal clearance, and delayed gastric emptying. 

This opinion, which stands uncontroverted in the record, is afforded high probative value because it is based on the medical evidence specific to this Veteran, considers the assertions raised in support of the claim, and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22 Vet. App. at 304.

While the Veteran believes the claimed GERD is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Jandreau, 492 F.3d at 1377. Consequently, the Board gives more probative weight to the competent and probative medical evidence provided by the VA examiner, which is the only opinion of record. 

In sum, the weight of the competent and probative evidence does not support the claim for service connection for GERD. The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied.

3. Service connection for COPD.

The Veteran seeks service connection for COPD, which he asserts is due to in-service events/stressors and/or MOS-related toxic exposure to fuel, benzene, exhaust fumes, gunpowder, and lead. See June 2025 VA Form 21-526EZ. During a July 2025 VA respiratory conditions DBQ, the Veteran reported that COPD onset in 1999; however, at the December 2025 hearing, he testified that he was diagnosed about five years prior, in approximately 2020. The Board points out that at the December 2025 hearing, the Veteran's attorney made it clear that there was no assertion that the condition began in service.

The August 2025 rating decision made a favorable finding in conjunction with this claim, namely that the Veteran had a current diagnosis of COPD. The Board is bound by this finding. See 38 C.F.R. § 3.104 (c). The question for the Board to resolve is whether the Veteran's COPD is directly related to service, to include the Veteran's participation in a TERA. 

The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's COPD began during service or is otherwise related to an in-service injury, event, or disease, to include his participation in a TERA. 

The Board initially acknowledges that there are two positive opinions of record. The first is a March 2025 private opinion provided by Dr. R.P., who reported that studies indicate that prolonged exposure to fuel exhaust significantly increases the risk of lung cancer, with chronic exposure contributing to long-term lung damage and respiratory diseases, and that this directly correlates with the Veteran's COPD, which is linked to prolonged exposures to these toxins. Dr. R.P. bases this finding on medical literature showing an increased likelihood for developing COPD due to "higher, "prolonged," or "long-term" exposure to such toxins; however, Dr. R.P. did not explain what the medical literature considers to be higher, prolonged, or long-term exposure to these toxins or sufficiently relate the medical literature to the Veteran's specific circumstances. The Board also notes that Dr. R.P. did not address the Veteran's medical history, which includes an extensive smoking history. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez, 22 Vet. App. at 301. Since the Board finds that this opinion does not, it is not afforded probative value. 

Similarly, there is a positive opinion provided by a VA examiner in July 2025 that the claimed COPD is at least as likely as not caused by the indicated toxic exposure risk activity after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The opinion was based entirely on cited medical literature showing that "some human and animal studies have discussed possible long-term health effects from exposure to diesel exhaust
 clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez, 22 Vet. App. at 301. Since the Board finds that this opinion does not, it is not afforded probative value. 

Similarly, there is a positive opinion provided by a VA examiner in July 2025 that the claimed COPD is at least as likely as not caused by the indicated toxic exposure risk activity after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The opinion was based entirely on cited medical literature showing that "some human and animal studies have discussed possible long-term health effects from exposure to diesel exhaust, including lung and bladder cancer and other effects on the immune, respiratory, urinary, and cardiovascular systems." However, since the VA examiner also did not address the Veteran's extensive smoking history, this opinion is also not afforded probative value. Id. 

The July 2025 VA examiner also provided an opinion that the claimed COPD is less likely than not incurred in or caused by the claimed in-service injury, event, or illness because after reviewing the available records, there is no evidence to support a finding that the Veteran's COPD was incurred in or caused by service.

The Board notes at this juncture that at the time of the December 2025 hearing, the Veteran's attorney intimated that a medical opinion to support the claim would be submitted within the evidentiary window of this appeal, but no such opinion has been received within the applicable timeframe. In other words, there is no probative opinion establishing a link between the Veteran's COPD and service, to include his participation in a TERA.

While the Veteran believes the claimed COPD is related to an in-service injury, event, or disease, including his participation in a TERA, he is not competent to provide a nexus opinion in this case since he does not have the necessary specialized medical education. Jandreau, 492 F.3d at 1377.

In sum, the weight of the competent and probative evidence does not support the claim for service connection for COPD. The evidence in this case is not in approximate balance to warrant application of the benefit-of-the-doubt rule. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claim is denied.

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Van Wambeke, 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.