Citation Nr: 1038993 Decision Date: 10/19/10 Archive Date: 10/22/10 DOCKET NO. 06-36 372 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUE Entitlement to service connection for cervical carcinoma. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD C. C. Dale, Associate Counsel INTRODUCTION The Veteran had active duty service from December 1986 to December 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2005 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND Additional development is deemed necessary before the instant appeal may be adjudicated. Specifically, the medical opinion contained in the January 2005 VA examination report is insufficient for adjudication purposes, as explained below. The U.S. Court of Appeals for Veterans Claims has held that once VA provides an examination in a service connection claim, the examination must be adequate or VA must notify the Veteran why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). VA is required to address all theories of entitlement raised by the record. See Robinson v. Mansfield, 21 Vet. App. 545 (2008). In this instance, the January 2005 VA examination report does not address the Veteran's assertion that in-service carcinogen exposure is related to the subsequent development of cervical carcinoma. In her February 2006 notice of disagreement and her November 2006 substantive appeal, she reports being exposed to many hazardous chemicals, including hydrozene, during active service. Personnel records show that she worked as an aircraft fuel systems specialist and earned a Southwest Asia service medal for service in the Persian Gulf. The Board finds her credible in her reports of exposure to chemicals found in jet fuel. Moreover, she submitted a statement from her private gynecologist, S.B., MD, dated in April 2006. Dr. S.B. commented that the Veteran's current gynecological problems may be related to in-service chemical exposure. The Board finds that an additional medical opinion is necessary to address the Veteran's theory of entitlement of in-service carcinogen exposure. The medical opinion must address whether in-service chemical exposure is related to the subsequent development of cervical carcinoma. Barr, supra.; Robinson, supra. The RO/AMC will contact the examiner conducting the January 2005 VA examination or, if he is unavailable, an appropriately qualified healthcare provider. The claims file and a copy of this remand must be provided to the examiner; who will acknowledge receipt and review of these materials. He or she must opine as to the following: whether it is more or less likely that her development of cervical carcinoma is etiologically related to exposure of any known carcinogen commonly found in jet fuel. The examiner must provide a rationale and cite any relevant medical studies to support his or her conclusion. Accordingly, the case is REMANDED for the following action: 1. Contact the examiner that conducted the January 2005 VA examination or, if he is unavailable, another appropriately qualified healthcare provider may respond in his place. The claims file and a copy of this remand must be provided to the examiner; who will acknowledge receipt and review of these materials. He or she must opine as to the following: whether it is at least as likely as not that the Veteran's development of cervical carcinoma is etiologically related to exposure to known carcinogens commonly found in jet fuel. The examiner must provide a clear rationale and cite any relevant medical studies to support his or her conclusion. If a medical opinion cannot be made without resort to speculation, the examiner must so state and explain why a non-speculative opinion cannot be furnished. In such event, the examiner is also asked to identify any missing information that would result in a non- speculative opinion. 2. To help avoid future remand, the RO/AMC must ensure that all requested action has been accomplished (to the extent possible) in compliance with this remand. If any action is not undertaken, or is taken in a deficient manner, appropriate corrective action should be undertaken. See Stegall v. West, 11 Vet. App. 268 (1998). 3. After completing the requested actions, and any additional notification and/or development deemed warranted, readjudicate the Veteran's claim on appeal. If any benefit sought on appeal remains denied, furnish to the Veteran and her representative an appropriate supplemental statement of the case, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ ERIC S. LEBOFF Acting Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).