Citation Nr: 20035331 Decision Date: 05/20/20 Archive Date: 05/20/20 DOCKET NO. 18-18 973A DATE: May 20, 2020 ORDER Entitlement to service connection for squamous cell carcinoma of the left cheek is granted. Entitlement to service connection for cancer of the hands is denied. REMANDED Entitlement to service connection for cancer of the neck is remanded. FINDINGS OF FACT 1. The Veteran’s squamous cell carcinoma of the left cheek is related to sun exposure during service. 2. The Veteran does not have cancer of the hands. CONCLUSIONS OF LAW 1. The criteria for service connection for squamous cell carcinoma of the left cheek have been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for cancer of the hands have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1969 to February 1971 to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from 2016 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). While the Veteran initially requested a hearing before the Board, he withdrew that request in July 2019. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as malignant tumors. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). 1. Face (Left Cheek) The Veteran contends that while serving in Vietnam, he had to conduct patrols and spend a lot of time outside, which led to heavy sun exposure. He contends that he suffered from sunburns due to heavy sun exposure and from a lack of sun block which was not readily issued. He contends that after returning from Vietnam sun exposure was minimal as he lived in the Northeast and worked indoors his entire life. The Veteran was diagnosed with squamous cell carcinoma of the left cheek in June 2015. Thus, the remaining question is whether this cancer is related to service. In September 2018, a physician noted that while serving in the Republic of Vietnam the Veteran suffered from numerous sunburns without any form of sun protection, following service he rarely had severe sun exposure, the main risk factor for squamous cell cancer of the skin is long term exposure to the sun, and risk factors include recurrent sun burns, especially as a youth. The physician concluded that it was more likely than not that excessive sun exposure in service caused the Veteran’s squamous cell carcinoma of the skin. In April 2019, another physician offered a similar opinion. There is no medical opinion or competent and credible evidence in significant conflict with these medical opinions. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s squamous cell carcinoma of the left cheek is related to service. Accordingly, the Board finds that service connection for squamous cell carcinoma of the left cheek is warranted. 2. Hands The Veteran contends that he has cancer on his hands. In this case, service connection for cancer of the hands must be denied as there is no current disability. Cancer of the hands has not been diagnosed. The Veteran did not submit, and there is no evidence of diagnosis, complaint, or treatment of a current cancer as it related to the hands. As there is no current disability, service connection for cancer of the hands is denied. REASONS FOR REMAND Remand is necessary to obtain an opinion regarding the Veteran’s cancer of the neck. The Veteran submitted private medical opinions indicating that in addition to sun exposure and herbicide exposure during service, the Veteran smoked cigars and a pipe for about 10 years, discontinuing in 1990, and that he also used to drink alcohol heavily, up to 10 ounces of gin per week, and discontinuing this around 1986. The opinions do not adequately address the significance of each risk factor. As such, remand is required to obtain an opinion to ascertain the significance of the Veteran’s smoking and alcohol history as compared to his exposure to sun and herbicide agents during active service. The matters are REMANDED for the following action: The claims file should be sent 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 current cancer of the neck is related to an in-service injury, event, or disease, to include sun and herbicide agent exposure. The Board recognizes that squamous cell carcinoma is not presumed by VA to be related to herbicide agent exposure. However, the Board requests an opinion as to whether this particular Veteran developed squamous cell carcinoma of the neck due to in-service sun and herbicide agent exposure. In offering the opinion, the examiner is asked to consider the private medical opinions submitted in April 2019 and September 2018 discussing the Veteran’s smoking and alcohol history as well as exposure to herbicide agents and sun during service in the Republic of Vietnam. 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 A. J. Kim, 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.