Citation Nr: 18157398
Decision Date: 12/12/18	Archive Date: 12/12/18

DOCKET NO. 16-60 143
DATE:	December 12, 2018
REMANDED ISSUE
Entitlement to service connection for skin cancer is remanded.  
REASONS FOR REMAND
The Veteran served on active duty from December 1965 to October 1969, including confirmed Vietnam service.  In December 2016, he withdrew a pending Board videoconference hearing request. 
Current diagnoses is established as treatment records document diagnosed residual basal cell carcinoma and squamous cell carcinoma.  See August 2015 VAMC Records.  The record also establishes that the Veteran was exposed to herbicide agents as result of having service in Vietnam during the Vietnam era.  Further, while basal cell carcinoma and squamous cell carcinoma are not on the list of diseases presumed to be related to herbicide agent exposure, the Veteran is not precluded from establishing service connection with proof of actual causation.  See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).  In this regard, the Veteran has yet to be afforded a VA skin examination that addresses the etiology of all his skin disorders therefore this matter is remanded.
Additionally, acknowledgment is given to a December 2017 nexus opinion provided by the Veteran’s VA physician Dr. R. S., M.D.  Dr. S. opined that the Veteran’s cancer was more likely than not related to AO exposure.  They type of cancer was not identified. Moreover, even if it were to be accepted that the physician was referring to basal cell carcinoma and squamous cell carcinoma, no rationale was provided to support this finding. Such significantly reduces the overall probative value of the opinion.  Nevertheless, Dr. S.’s opinion is still suggestive of a correlation between AO exposure and the Veteran’s skin cancer; thus, it must be addressed on remand.
The matter is REMANDED for the following action:
1. Schedule the Veteran for a VA examination by an appropriate examiner to determine the nature and etiology of his skin cancer.  The claims file must be made available to the examiner for review.  All examination findings should be set forth in the examination report. All tests and studies deemed necessary should be conducted. After reviewing the claims folder and examining the Veteran, the examiner must:
(a.) Identify/diagnose all areas of the body affected by the Veteran’s skin cancer. 
(b.) Provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s skin cancer had its onset in service or is otherwise etiologically related to service, to include the Veteran’s presumed exposure to Agent Orange in Vietnam. 
In rendering this opinion address Dr. S.’s December 2017 opinion correlating the Veteran’s skin cancer to Agent Orange exposure. The examiner is also advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. 
A clear explanation for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board.  If the examiner is unable to provide an opinion he or she should explain why. 

 
MICHAEL A. HERMAN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. L. Burroughs, Associate Counsel