Citation Nr: 18129072 Decision Date: 08/23/18 Archive Date: 08/23/18 DOCKET NO. 15-12 376 DATE: August 23, 2018 ORDER Service connection for right tonsil basaloid squamous cell carcinoma is granted. FINDINGS OF FACT 1. The Veteran was exposed to herbicide agents coincident with his service in the Republic of Vietnam. 2. Resolving all doubt in his favor, the Veteran’s right tonsil basaloid squamous cell carcinoma is related to his acknowledged in-service exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for right tonsil basaloid squamous cell carcinoma have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1968 to August 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the Veteran submitted additional evidence in support of his appeal. 38 U.S.C. § 7105(e) (as amended). Entitlement to service connection for right tonsil basaloid squamous cell carcinoma, claimed as due to exposure to herbicide agents. The Veteran contends that his right tonsil basaloid squamous cell carcinoma is related to his exposure to herbicide agents coincident with his service in the Republic of Vietnam. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Veterans who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, are presumed to have been exposed to herbicide agents. See 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). For purposes of the presumption, “herbicide agents” are 2,4-D, 2,4,5-T, and its contaminant TCDD, cacodylic acid, and picloram. 38 C.F.R. § 3.307(a)(6)(i). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, the Board notes that the Veteran has a current diagnosis of right tonsil basaloid squamous cell carcinoma. In this regard, such was first diagnosed in June 2000, and he has received ongoing treatment for such cancer and its residuals since such time. Additionally, the Veteran is presumed to have been exposed to herbicide agents coincident with his service aboard the USS REPOSE, which is acknowledged to have had crewmembers, to include the Veteran, who went ashore in Vietnam, during the Vietnam era. Further, while right tonsil basaloid squamous cell carcinoma is not a disease presumptively related to exposure to herbicide agents, the Board finds that service connection is warranted on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In this regard, the Veteran has submitted a July 2012 treatment record from his private treating physician, J.T., M.D. Dr. J.T. noted the Veteran’s squamous cell carcinoma and history of treatment, as well as his service in Vietnam and acknowledged exposure to herbicide agents. Further, he noted a review of literature provided by the Veteran that associated dioxin or Agent Orange exposure with squamous cell carcinoma, which Dr. J.T. noted all appeared to be from reputable sources. He then opined that, after reviewing the articles that the Veteran presented, and noting the fact that he was exposed to dioxin, it would be reasonable to conclude that the dioxin may have had an impact in his illness. Dr. J.T. noted it is impossible to prove without a doubt, but, given the fact that the Veteran was exposed and the literature supports the possibility, it certainly seems reasonable to conclude that the dioxin exposure may have in fact contributed to the development of his carcinoma. Two months later, in a September 2012 letter, Dr. J.T. offered a less speculative opinion. At such time, he opined that it is more likely than not that the Veteran’s cancer is related to the exposure to the dioxin Agent Orange while in service. He noted that, other than his exposure in service, the Veteran did not have any other risk factors for squamous cell carcinoma of the throat. Finally, the Veteran submitted an April 2015 letter from another treating physician, A.S. M.D., in which Dr. A.S. opined that, after reading the literature provided by the Veteran, it is more likely than not that his squamous cell malignancy of the throat may have come from his exposure to Agent Orange. The Board finds the above opinions are probative to the question of a nexus between the Veteran’s right tonsil basaloid squamous cell carcinoma and his in-service exposure to herbicide agents. In this regard, while the opinions do not provide a wealth of supporting data and rationale, they did provide a sufficient basis for the opinions proffered. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions). Notably, there is no medical opinion to the contrary. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that his right tonsil basaloid squamous cell carcinoma is related to his acknowledged in-service exposure to herbicide agents. Consequently, service connection for such disorder is warranted. 38 U.S.C. 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jonathan M. Estes, Associate Counsel