Citation Nr: 20006317 Decision Date: 01/28/20 Archive Date: 01/24/20 DOCKET NO. 17-23 570 DATE: January 28, 2020 REMANDED Entitlement to service connection for squamous cell carcinoma, to include as due to exposure to herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1967 to October 1968, to include service in the Republic of Vietnam. He is presumed to have been exposed to herbicide agents such as Agent Orange. 38 C.F.R. § 3.307(a)(6)(iii). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in November 2019. A transcript of that hearing is of record. During his hearing, the Veteran testified that he believed his squamous cell carcinoma was due to exposures during his military service such as herbicide agents and the sun. VA presumes certain diseases – such as soft tissue sarcoma and respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) – are related to herbicide agent exposure. See 38 C.F.R. § 3.309(e). A VA medical opinion was obtained in December 2014 which essentially found that the type of cancer the Veteran had is not presumed by VA to be related to herbicide agent exposure as it was not a soft tissue sarcoma. See id. This opinion did not address whether the carcinoma was directly related to exposure to herbicide agents or the sun. The Veteran submitted a June 2017 medical statement from Dr. R.B. Doctor R.B. explained that squamous cell carcinoma of the neck was discovered in 2014, but the “primary” for the carcinoma was never found. He opined that the carcinoma originated in the “upper respiratory tree” but did not provide a rationale as to why this was the case. He further noted that Agent Orange is a known carcinogen and is known to be associated with respiratory cancers including squamous cell carcinoma. The Board recognizes that squamous cell carcinoma can affect the skin or the lungs. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 295 (30TH ED. 2003). In this case, a March 2014 pathology report and October 2014 treatment note indicate the Veteran’s squamous cell carcinoma was of the skin and not the lungs. It was further noted the carcinoma metastasized to the Veteran’s lymph nodes. Simply put, the basis for a finding that the Veteran’s skin cancer originated in the lungs, metastasized to the skin, and then metastasized to the lymph nodes is unclear to the Board. Given the above, the Board finds that an addendum medical opinion is necessary to address unresolved medical questions. This matter is REMANDED for the following action: Send the claims file to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s squamous cell carcinoma is related to an in-service injury, event, or disease, to include exposure to the sun and to herbicide agents. The Board recognizes that squamous cell carcinoma is not presumed by VA to be related to exposure to herbicide agents. However, an opinion is requested as to whether this particular Veteran’s squamous cell carcinoma is related to his specific exposure. The examiner is also asked to address whether the Veteran’s squamous cell carcinoma originated in the respiratory system (lung, bronchus, larynx, or trachea) as suggested by Dr. R.B. in June 2017. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.