Citation Nr: 21002276 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 12-05 100 DATE: January 13, 2021 REMANDED Entitlement to service connection for left shoulder melanoma is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps from March 1976 to April 1993, with confirmed service Southwest Asia and Camp Lejeune. This matter is on appeal from a March 2011 rating decision. In November 2018, the Veteran testified at a videoconference before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In a June 2019 decision, the Board denied entitlement to service connection for left shoulder melanoma. In May 2020, the Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court) where the Court granted a Joint Motion for Remand (Joint Motion). The Court’s May 2020 Order vacated the June 2019 Board decision and remanded matter to the Board for consideration consistent with the terms of the joint motion. The Board remanded the matter in October 2020 for additional development. Entitlement to service connection for left shoulder melanoma. In compliance with the Board’s October 2020 remand, the Veteran was afforded a VA examination and a medical opinion obtained in November 2020. However, an addendum is needed to reconcile conflicting statements made by the November 2020 VA examiner, who was the same examiner that provided the previous July 2016 VA medical opinion. Specifically, in his July 2016 VA opinion, the examiner stated, “melanomas are caused by cumulative radiation exposure (sun exposure) over a period of time, along with a genetic predisposition to develop this CA.” See Skin Diseases Disability Benefits Questionnaire (DBQ) and opinion remarks dated July 2016. In his November 2020 VA opinion, the same examiner stated, “Sun exposure is a risk factor only for the development of melanoma. A review of current literature… does not support a causal relationship between sun exposure and the development of melanoma…. It is unknown what causes melanomas at this time.” See VA Medical opinion dated November 2020. Essentially, the examiner’s statements are in conflict where he states melanomas are “caused” by cumulative sun exposure, then later states sun exposure is only a “risk” and causes are “unknown”. Consequently, clarification is needed in this regard. Furthermore, the Board notes that the Veteran’s claimed left shoulder melanoma has in fact “resolved” and “there has been no further melanoma of the left shoulder since the excision of the lesion in 2009.” See Skin Diseases DBQ dated July 2016. Nevertheless, the Veteran maintains that his left shoulder melanoma (which was diagnosed in 2009 approximately 16 years after separation) could be caused by in-service sun exposure. He also testified that during Desert Shield and Desert Storm, he was “always in the sun and always getting sunburns.” See Supplemental Post-Court Brief received May 2020; see also November 2018 Hearing Transcript at 3. To that end, the addendum opinion should be limited to the Veteran’s contention, distinguishing sun exposure during service versus sun exposure elsewhere. See VA medical opinion dated August 2015 citing dermatology note of March 2011 indicating the veteran had a “history of high degree of lifetime sun exposure to involved areas without use of protective clothing or sunscreen.” By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. The matters are REMANDED for the following action: 1. Arrange for the examiner who conducted the November 2020 VA skin examination to provide an addendum opinion. If the examiner is not available, the request may be referred to another, equally qualified medical professional, who must independently review the electronic claims folder. The electronic claims file should be made accessible to the examiner along with any other information the medical professional deems pertinent. If the reviewer determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. The examiner is to provide an addendum opinion on the following: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left shoulder melanoma is directly linked to the Veteran’s time on active duty, to specifically include in-service sun exposure during Desert Storm and Desert Shield? b) The examiner is asked to clarify the conflicting statements from July 2016 and November 2020 where one opinion states melanomas are “caused” by cumulative sun exposure, and the other states causes of melanomas are “unknown.” In rendering the opinion, the examiner should distinguish sun exposure during service versus sun exposure elsewhere. The examiner is asked to consider the Veteran’s contention that “he was constantly in the sun and experience sunburns in service.” See Supplemental Post-Brief dated May 2020 at 3. The examiner is also asked to consider VA medical opinion dated August 2015 citing dermatology note of March 2011 indicating the veteran had a “history of high degree of lifetime sun exposure to involved areas without use of protective clothing or sunscreen.” If an opinion cannot be rendered without resorting to speculation, the examiner should explain why it would be speculative to respond. (Continued on the next page)   A complete rationale for all findings and conclusions is requested. 2. Upon completion of the requested development and any additional development deemed appropriate, adjudicate the claim on appeal. If the determination remains unfavorable, the Veteran and his representative should be furnished a supplemental statement of the case which addresses all relevant evidence. The Veteran and his representative should be afforded the applicable time period in which to respond. Then, return the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, 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.