Citation Nr: 20069293 Decision Date: 10/27/20 Archive Date: 10/27/20 DOCKET NO. 17-27 607 DATE: October 27, 2020 REMANDED Entitlement to service connection for cutaneous neuroendocrine carcinoma, to include as due to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from April 1957 to April 1984, to include service in Vietnam. His decorations include the Vietnam Service Medal and the Republic of Vietnam Gallantry Cross with Palm. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Atlanta, Georgia. In his May 2017 substantive appeal, the Veteran indicated that he wanted to appear at a Board hearing. However, he later withdrew that request in April 2019. 38 C.F.R. § 20.704(e). Entitlement to service connection for cutaneous neuroendocrine carcinoma, to include as due to exposure to herbicide agents, is remanded. This case was previously before the Board in April 2020, when it was remanded to the agency of original jurisdiction (AOJ) for additional development. Although the Board sincerely regrets the additional delay, another remand is necessary to afford the Veteran every possible consideration. In its April 2020 remand, the Board instructed the AOJ to afford the Veteran an opportunity to identify and provide appropriate releases for any private care providers who might possess new or additional information relating to his claim, to include records from A. C., M.D. It also ordered the AOJ to obtain updated VA treatment records and to obtain a new VA opinion regarding the etiology of the Veteran’s cutaneous neuroendocrine carcinoma. It instructed the new VA examiner to consider three pieces of evidence: a June 2019 opinion by Dr. C. in which he stated that the Veteran’s exposure to herbicide agents was as likely as not to have caused his Merkel cell tumor (a form of cutaneous neuroendocrine carcinoma); an April 2014 medical treatise indicating that exposure to herbicide agents appeared to double the risk of invasive skin cancers; and the content of a March 2004 Board decision. In May 2020, the AOJ sent the Veteran a letter asking him to identify and provide appropriate releases for any treatment records from private providers. The Veteran provided the appropriate releases that same month, and the AOJ obtained and associated with the claims file the records of Dr. C., as well as other private treatment records. It also obtained updated VA treatment records. The Board therefore finds that the AOJ substantially complied with the records development ordered in its April 2020 remand. The AOJ also obtained a new VA opinion in June 2020. The examiner noted that Dr. C.’s April 2019 opinion was not available for review but indicated that he did review the April 2014 medical treatise and the March 2004 Board decision. The examiner offered a negative nexus opinion, finding that the Veteran’s cutaneous neuroendocrine carcinoma was less likely as not due to exposure to herbicide agents. He addressed the April 2014 medical treatise, noting that the article clearly stated that there “may” be an association between herbicide exposure and nonmelanotic skin cancer, but that it needed to be studied on a larger scale. He also noted that the study was not peer reviewed, not conducted on a large scale, and found no causation. The examiner also cited to other medical research and stated that exposure to herbicide agents was not listed as a medically recognized risk factor for developing cutaneous neuroendocrine carcinoma. The Board is unable to determine why the June 2020 VA examiner was unable to review Dr. C.’s April 2019 opinion. While the opinion itself is undated, it was submitted and associated with the claims file on April 14, 2019. A review of the claims file also demonstrates that a duplicate of the opinion is embedded within Dr. C.’s treatment records, which were obtained by the AOJ associated with the claims file on June 2, 2020. Because Dr. C.’s opinion is of record, and because the prior remand required the examiner to consider it, the Board finds that an addendum opinion is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). This matter is REMANDED for the following action: 1. Arrange to provide the record on appeal to the VA examiner who offered an opinion regarding the etiology of the Veteran’s cutaneous neuroendocrine carcinoma in June 2020. The examiner should review the record, to particularly include the April 2019 opinion from Dr. C. After reviewing the record, the examiner should offer an addendum opinion regarding the extent to which, if any, Dr. C.’s April 2019 statement impacts her June 2020 opinion. If the June 2020 examiner is no longer employed by VA or is otherwise unable to provide the opinion(s) requested, arrange to obtain the requested information from another qualified examiner. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinions. A complete medical rationale for all opinions expressed must be provided. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraph, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Oldroyd, 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.