Citation Nr: 18148913
Decision Date: 11/08/18	Archive Date: 11/08/18

DOCKET NO. 16-60 495
DATE:	November 8, 2018

REMANDED
Entitlement to service connection for squamous cell cancer, to include as secondary to herbicide agent exposure, is remanded.
Entitlement to service connection for hearing loss is remanded.
Entitlement to service connection for tinnitus is remanded.
REASONS FOR REMAND
1. Entitlement to service connection for squamous cell cancer, to include as secondary to herbicide agent exposure, is remanded.
The Veteran submits that his squamous cell cancer is etiologically related to herbicide agent exposure from his service in Vietnam during the Vietnam War.  In August 2014, the Veteran submitted a letter from his doctor stating that exposure to Agent Orange increased the Veteran’s risk of developing cancer.  However, the physician provided no explanation for the rationale of that statement.  The Board nevertheless finds that the physician’s statement has triggered VA’s duty to assist.  38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c).  Therefore, the Board will remand this matter for a medical opinion. 
2. Entitlement to service connection for bilateral hearing loss and tinnitus are remanded.
The Veteran submits that his hearing loss is etiologically related to service, and specifically to his exposure to noise trauma therein.  The Veteran was provided a VA examination in December 2014.  The VA examiner opined that the Veteran’s hearing loss was not etiologically related to service and explained that his separation audiogram indicated normal hearing bilaterally.  However, the examiner did not address the 15 decibel shift at the 4000 Hz level in the Veteran’s right ear between his induction examination and his separation examination.  Therefore, the Board will remand this matter for an addendum opinion.  
The December 2014 VA examiner opined that the Veteran’s tinnitus is etiologically related to his hearing loss.  As the issue of service connection for tinnitus is inextricably intertwined with the issue of bilateral hearing loss, the Board will remand this matter as well.  See Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).
The matters are REMANDED for the following actions:
1. Schedule the Veteran for an appropriate examination by a VA clinician to determine the nature and etiology of his squamous cell cancer.  Based on the examination and a review of the record, the examiner should provide an opinion as to whether it at least as likely as not (50 percent or better probability) that the Veteran’s squamous cell cancer is related to his service, to include his exposure to herbicide agents therein.  A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate.
2. Obtain an addendum opinion from an appropriate clinician concerning the Veteran’s bilateral hearing loss and tinnitus.  Based on a review of the record, the examiner should provide an opinion as to whether it at least as likely as not (50 percent or better probability) that the Veteran’s hearing loss and tinnitus are related to service.  The examiner must specifically address the 15 decibel shift at the 4000 Hz level in the Veteran’s right ear between his induction examination and his separation examination.  A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate.  Additionally, if the examiner determines that a VA examination is necessary to provide the requested opinion, such should be scheduled.
 
A. ISHIZAWAR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	N. Shah, Associate Counsel