Citation Nr: 18155493 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-54 819 DATE: December 4, 2018 REMANDED The issue of entitlement to service connection for squamous cell carcinoma is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to April 1971, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. The Board finds that it cannot yet make a fully-informed decision on the issue of entitlement to service connection for squamous cell carcinoma because the Veteran’s claims file currently lacks an adequate, competent medical opinion discussing the etiology of the claimed disability. Specifically, the Veteran has contended that his squamous cell carcinoma was caused by his exposure to herbicide agents, including Agent Orange, during his service in the Republic of Vietnam. As the Veteran has qualifying service in Vietnam, it is presumed that he was exposed to herbicide agents in service. Private treatment records associated with the claims file indicate that the Veteran’s squamous cell carcinoma was located at the base of the tongue. See, e.g., Dr. Lininger, October 2011. The RO denied the Veteran service connection on a presumptive basis under 38 C.F.R. § 3.309(e) as it concluded that the Veteran’s squamous cell carcinoma was a cancer of the digestive system and not the respiratory system. However, in his October 2014 notice of disagreement (NOD), the Veteran indicated that his squamous cell carcinoma may have impacted his larynx and other body parts considered to be a part of the respiratory system for VA purposes. See 38 C.F.R. § 3.309(e) (defining respiratory cancers as cancers of the lung, bronchus, larynx, or trachea). Accordingly, remand is warranted for the provision of a VA medical opinion by an appropriate specialist to address two questions: (1) whether the Veteran’s squamous cell carcinoma qualifies as a cancer of the respiratory system for the purposes of presumptive service connection under 38 C.F.R. § 3.309(e); and (2) if the response to part (1) is negative, whether it is at least as likely as not that the Veteran’s squamous cell carcinoma was caused by his exposure to herbicide agents in the Republic of Vietnam. The matter is REMANDED for the following action: Send the Veteran’s claims file to an ear, nose, and throat specialist—or another appropriate specialist—to issue a medical opinion as to the nature and etiology of the Veteran’s squamous cell carcinoma. The entire claims file, including a copy of this Remand, must be made available to and must be reviewed by the specialist. Thereafter, the specialist is to address the following: (a.) Please verify whether the Veteran’s squamous cell carcinoma may be considered a cancer of the respiratory system. An applicable VA regulation defines “respiratory cancers” as cancers impacting the lung, bronchus, larynx, or trachea. (b.) If the response to part (a) does not categorize the Veteran’s squamous cell carcinoma as a cancer of the respiratory system, please state whether it is at least as likely as not (50 percent probability or more) that the Veteran’s squamous cell carcinoma was incurred in, caused by, or otherwise related to service. Please specifically address whether the Veteran’s condition was caused by his exposure to herbicide agents, including Agent Orange, during service in the Republic of Vietnam. The specialist should consider medical and lay evidence dated both prior to and since the filing of the claim (March 2014), including: (a.) An August 2014 disability benefits questionnaire (DBQ) completed by Dr. Stone; and (b.) A June 2014 letter from C.T.—a family nurse practitioner at the Cheyenne VA Medical Center—telling the Veteran that he should file for service connection because his cancer was secondary to Agent Orange exposure. The specialist must provide a complete rationale for any opinion rendered. If the specialist cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). (Signature on Next Page) S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.S. Pettine, Associate Counsel