Citation Nr: 20051920 Decision Date: 08/05/20 Archive Date: 08/05/20 DOCKET NO. 15-36 135 DATE: August 5, 2020 REMANDED Entitlement to service connection for basal cell carcinoma is remanded. Entitlement to service connection for a melanoma is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1971 to January 1973 and from October 1974 to May 1977. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The Veteran testified during a December 2018 Travel Board hearing before the undersigned Veterans Law Judge. A transcript is included in the electronic claims file. In June 2019, the Board remanded the claim to obtain new medical examinations for basal cell carcinoma, melanoma, bilateral hearing loss, and tinnitus. 1. Entitlement to service connection for basal cell carcinoma. 2. Entitlement to service connection for a melanoma. The Veteran contends that his basal cell carcinoma and his melanoma are related to his service. The Veteran underwent VA examinations for melanoma and basal cell carcinoma in December 2019 and January 2020. The examiner acknowledged that basal cell cancers were treated multiple times from 2007-2019. Basal cell cancers on left leg multiple with residual scars was noted to have its onset in 2007. Malignant melanoma on right arm was noted to have its onset in 2008. The examiner stated that both excised but multiple basal cell cancers returned on the torso and leg. The examiner stated that other cancers were found and there have been multiple cancer removals, including a single melanoma excision in the right upper arm. The examiner stated that Malignant melanoma had completely resolved. Current symptoms included healing scars on the left shin and healed scars on the back, chest and legs. The examiner stated that it is well known that basal cell carcinoma is due to skin damage from sun exposure and the Veteran had to work in service in areas with strong sunlight where it was so hot that he used shorts and took off his shirt. The examiner stated that skin cancers usually come years after solar exposure. The examiner stated that since the military, the Veteran worked in indoor jobs such as barbering and office work and had no significant outdoor jobs with high solar exposure. However, the examiner stated, the Veteran admitted upon examination that for a time after he was released from active duty, he lived in Hawaii and England as well as operating a tanning salon which he admitted he used himself. The examiner further stated that the Veteran reported that, in England, he also drove in a car with right sided steering and solar exposure through the window from the right all in addition to UV light from his tanning salon. The examiner stated that the physicians in England who treated his basal cells instructed him to stop using the tanning beds himself. Based on the above, the examiner stated that is medically known that Ultraviolet light exposure like that of a tanning bed can eventually lead to basal cell carcinoma. Therefore, the examiner opined, it is less likely than not that this Veteran’s basal cell carcinoma was due to sun exposure during service, and at least as likely as not that the Veteran’s basal cell carcinoma is due to ultraviolet radiation from living in Hawaii and, in addition, using tanning beds for a number of years. In a March 2020 statement from the Veteran, he contends that his skin conditions are related to service because of the sun exposure when he was stationed at a military installation located in Hawaii. He also contends that the examination was based on incorrect information regarding his history, such as the indication that he managed a tanning salon in England and that he had been seen by an English doctor who told the Veteran not to use tanning salons. The Veteran asserts that he has never been to England nor has he ever managed a tanning salon. See June 2020 Statement in Support of Claim and May 2020 Appellate Brief. The Board sincerely regrets the further delay but finds that a remand is necessary in this appeal to afford the Veteran full consideration regarding his lay statements. Specifically, there is a discrepancy as to the facts relating to in-service sun exposure and exposure to ultraviolet light, which is the basis for the examiner’s finding. Accordingly, a new examination is needed to report accurate facts and form a conclusion based on accurate history and account of such light exposure. The issue of service-connection for melanoma should also be addressed in the new medical examination, as the opinion of record is inadequate to adjudicate the related claims. 3. Entitlement to service connection for bilateral hearing loss. 4. Entitlement to service connection for tinnitus. The Veteran contends that bilateral hearing loss and tinnitus are related to service. The Veteran underwent a VA examination for hearing loss and tinnitus in December 2019. This examination report includes unclear findings. Regarding the left ear, the examiner marked that hearing loss was likely as not related to service, but as rationale detailed evidence against a finding of service connection. The Board again seeks an adequate opinion. As this examination will evaluate both ears, the Board remands service connection for the right ear as well. The opinion for tinnitus established a link between tinnitus and hearing loss. As such, the issue is intertwined as should also be remanded for an addendum opinion. Accordingly, the matter is REMANDED for the following action: 1. Update VA treatment records. 2. After completion of directive #1, obtain an addendum VA audiology opinion with examination from an audiologist the Veteran for an examination to determine the nature and etiology of his claimed bilateral hearing loss and tinnitus disabilities. Is the Veteran’s bilateral hearing loss and tinnitus at least as likely as not (a 50 percent or greater probability) etiologically related to his active military service, to include noise exposure? The examiner is asked to address the Veteran’s lay statements and explain the impact, if any, of the Veteran’s noise exposure in the military due to his military occupational specialty (MOS). If the examiner cannot provide the requested opinions without resorting to speculation, he/she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 3. After completion of directive #1, schedule the Veteran for an examination to determine the nature and etiology of his claimed melanoma and basal cell carcinoma. The examiner should review the claims file, including a copy of this remand, in its entirety and provide an opinion answer the following question: Is the Veteran’s a) basal cell carcinoma and b) melanoma at least as likely as not (50 percent or greater probability) etiologically related to his military service, to include sun exposure? The examiner is specifically asked to consider and comment on the Veteran’s lay statements regarding excessive exposure to the sun in the military. If the examiner cannot provide the requested opinions without resorting to speculation, he/she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.