Citation Nr: 19155683 Decision Date: 07/18/19 Archive Date: 07/18/19 DOCKET NO. 16-16 428 DATE: July 18, 2019 REMANDED Entitlement to service connection for basal cell carcinoma is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1965 to September 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). The issue of entitlement to service connection for early stage Parkinson’s Disease has been raised by the record, but not adjudicated by the Agency of Original Jurisdiction (AOJ). The Veteran and his representative are advised that effective March 24, 2015, VA requires claims to be submitted on a standard application form prescribed by the Secretary. See 38 C.F.R. §§ 3.1(p), 3.155, 3.160. This matter is referred to the AOJ as an intent to file a claim. See 38 C.F.R. § 3.155(b). Entitlement to service connection for basal cell carcinoma is remanded. The Veteran contends that his basal cell carcinoma is related to his military service, specifically herbicide agent exposure. The Board finds that additional development is necessary prior to adjudication of the claim. First, the Board finds that a remand is warranted in order to obtain a VA examination and opinion. The evidence of record shows that the Veteran has had basal cell carcinoma on multiple areas of his body, which have all been excised. Most recently, a June 2014 private treatment record shows that a biopsy revealed basal cell carcinoma on the right shoulder. The Veteran’s exposure to herbicide agents has been conceded in light of his service in Vietnam from September 1966 to September 1967. The Veteran contends that his basal cell carcinoma is related to his herbicide agent exposure. Private physicians have also indicated that the two could be related. His representative has also cited multiple studies that report a positive association between skin cancer and exposure to herbicide agents. See April 2016 Statement of Accredited Representative in Appealed Case (VA Form 646). The Veteran has not been afforded an examination to determine the etiology of his skin cancer. The Board finds that a medical examination and opinion is necessary to decide this claim. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). The Board acknowledges the statements provided by private physicians, Dr. K.S. and Dr. R.S. However, the Board finds they are insufficient to grant this claim. While Dr. K.S. provided a positive opinion, he opined that depending on the duration and extent of the Veteran’s herbicide agent exposure, it was “very possible” that there is a relationship between the Veteran’s skin cancer and herbicide agent exposure. The Board interprets this opinion as saying the Veteran’s skin cancer could be related to his herbicide agent exposure, but it depends on a variety of factors. Additionally, it is unclear what degree of certainty Dr. K.S. meant by “very possible” and as such, it is unclear whether it meets the standard of at least as likely as not. Thus, Board finds this opinion to be speculative. With regards to the statement provided by Dr. R.S., while he indicated that the Veteran is classified as being at higher risk for developing cancer, he did not necessarily provide an etiological opinion and rationale regarding the Veteran’s basal cell carcinoma. Moreover, there may be outstanding, relevant private treatment records. During the March 2019 Board hearing, the Veteran testified that he sees his private physician, Dr. K.S., approximately every six months for cancer check-ups. However, the only record from Dr. K.S. associated with the Veteran’s claims file is a June 2014 pathology report. Accordingly, a remand is required to allow VA to obtain authorization and request any outstanding records. Evidence also indicates that there may be outstanding VA treatment records. During the March 2019 Board hearing, the Veteran testified that he has been treated at a VA Medical Center. However, no VA treatment records are associated with the Veteran’s claims file. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. The matter is REMANDED for the following action: 1. Obtain all of the Veteran’s VA treatment records through the present. 2. Ask the Veteran to complete a VA Form 21-4142 for Dr. K.S. Make two requests for the authorized records from Dr. K.S., unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his basal cell carcinoma. The examiner must review the claims file and a copy of this Remand. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s basal cell carcinoma had its onset in, or is otherwise related to, active service, to include his presumed exposure to herbicide agents. In so doing, the examiner should address the studies cited by the Veteran’s representative in the April 2016 VA Form 646. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mortimer, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.