Citation Nr: 19100613 Decision Date: 01/03/19 Archive Date: 01/03/19 DOCKET NO. 16-59 613 DATE: January 3, 2019 REMANDED Entitlement to service connection for loss of tonsils, residual from lymph node cancer, as due to asbestos exposure is remanded. Entitlement to service connection for loss of voice box, residual from lymph node cancer, as due to asbestos exposure is remanded. Entitlement to service connection for loss of tongue, residual from lymph node cancer, as due to asbestos exposure is remanded. Entitlement to service connection for loss of teeth, residual from lymph node cancer, as due to asbestos exposure is remanded. REASONS FOR REMAND The Veteran had active service from November 1972 until September 1975. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural history, in a May 2014 rating decision, the RO denied service connection for residuals of lymph node cancer, to include loss of teeth, loss of taste, loss of smell, loss of a voice box, loss of tongue and loss of tonsils, due to asbestos exposure. That same month, the Veteran and his representative submitted a letter requesting a reconsideration of the May 2014 rating decision denying “his squamous cell carcinoma due to exposure to asbestos.” The RO issued another rating decision in June 2015 denying the claims based on the finding that the Veteran did not submit new and material evidence. The Veteran, then, submitted a Notice of Disagreement (NOD) in September 2015; however, the RO did not find the NOD until September 2016. The RO issued a Statement of the Case (SOC) in September 2016 acknowledging the late finding of the NOD; the RO then adjudicated the claims based on four of the issues set forth in the May 2014 rating decision. The Veteran and his representative clarified in the July 2017 brief that they were seeking service connection on the issues enumerated in the SOC. In light of the procedural history of this case, the Board will liberally construe the May 2014 submission as an NOD with consideration of the four issues enumerated in the September 2016 SOC. The Veteran’s DD 214 reflects that he served on the USS Mullinnix. His in-service military personnel record reflects that he served as a gunner’s mate on the ship. The Veteran submitted an article inferring that the USS Mullinnix was one of the ships that contained asbestos. See May 2014 correspondence. The Veteran’s medical records reflect that he had surgery on his left neck to treat the lymph node cancer. As such, the Veteran contends that he has residuals from the cancer, and that the cancer was related to his military service. An August 2002 VA treatment record reflects that the Veteran was using tobacco, and he was interested in quitting. A December 2009 private oncology report reflects that the Veteran had a history of dipping snuff for 40 years. In his May 2013 Statement in Support of Claim, the Veteran certified that he never smoked, but he did not mention that he had previously used tobacco. In the February 2013, May 2013, October 2014, and February 2017 medical opinions addressing whether the Veteran’s cancer was related to asbestos exposure during service, the private medical physician did not account for the Veteran’s use of tobacco. Since the medical opinions did not take into consideration of the Veteran’s full medical history, the Board finds that the opinions are not adequate. An adequate examination and opinion should include the medical history, the disability and associated symptoms in detail, and support all conclusions with analyses based on objective testing, observations and prior medical history. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran should be requested to supplement the record with an additional medical opinion that addresses the foregoing deficiency. Additionally, in light of additional relevant medical evidence that has been added to the record since the October 2013 VA medical opinion, an addendum opinion should be obtained as well. Accordingly, the matters are REMANDED for the following action: 1. Undertake efforts to obtain an addendum opinion from Dr. N.A. While in opinions dated in February 2013, May 2013, October 2014, and February 2017 Dr. N.A. found that it was more likely that the Veteran’s cancer was caused by asbestos exposure, the opinions do not account for his tobacco use as documented in an August 2002 VA treatment record and December 2009 private oncology report. Dr. N.A. is requested to specifically address whether there is any change in his opinion in light of the Veteran’s history of tobacco use. 2. Obtain a VA medical opinion from an oncologist physician. The Veteran’s claims file, including this remand, should be made available for review by the VA physician. The physician should review the claims folder, including the October 2013 VA medical examination and opinion and the February 2013, May 2013, October 2014 and February 2017 medical opinions by Dr. N.A., and this fact should be noted in the accompanying medical report. The examiner should address the following: (a) Is it as least as likely as not (50 percent probability or greater) that the Veteran’s residuals of lymph node cancer, to include loss of tonsils, loss of voice box, loss of tongue, and loss of teeth, are related to the Veteran’s reported exposure to asbestos as a gunner’s mate? (b) In so opining, the examiner should also address whether the Veteran’s use of tobacco (as documented in an August 2002 VA treatment record and December 2009 private oncology report) was in any way related to the Veteran’s lymph node cancer. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lee, Associate Counsel