Citation Nr: 21061344 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 17-04 240 DATE: October 1, 2021 REMANDED Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for prostate cancer and residuals is remanded. Entitlement to service connection for skin cancer and residuals is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1990 to August 1991, with additional Army and Air National Guard service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by an agency of original jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In July 2021, the Veteran testified at a virtual hearing before the undersigned. At the Board hearing, the Veteran explained that he was seeking service connection related to exposure to chemicals in service. He testified that he was a firefighter and during drills was frequently exposed to a firefighting chemical known as "balm," also known as "AFFF" or aqueous film forming foam. See Board Hearing Transcript at 3-5. Moreover, the Veteran testified that a doctor or medical professional had told him about a relationship between his diseases and his exposures in service. See id. at 8-9. The evidence shows current diagnoses of coronary artery disease, prostate cancer, and skin cancer. Moreover, exposure to firefighting chemicals is conceded as consistent with the circumstances of the Veteran's service. While the Veteran has not submitted any articles or other competent medical evidence suggesting a link between his diseases and these exposures, he is competent as a layperson to report diagnoses and other information that he has been told by competent medical professionals. The Board finds that the duty to provide the Veteran with an examination and secure a medical opinion has been triggered. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). On remand, updated VA treatment records and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Secure the Veteran's complete VA treatment records. 2. With any necessary assistance from the Veteran, secure outstanding relevant private treatment records. 3. After completing #1 and #2, schedule the Veteran for an examination to determine the nature and etiology of his coronary artery disease. The claims file should be made available to and should be reviewed by the examiner. The examiner should address the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's coronary artery disease had its onset during or is otherwise etiologically related to his conceded chemical exposures during active service, to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? (b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's coronary artery disease is etiologically related to his conceded chemical exposures during active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA), to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 4. After completing #1 and #2, schedule the Veteran for an examination to determine the nature and etiology of his prostate cancer. The claims file should be made available to and should be reviewed by the examiner. The examiner should address the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's prostate cancer and residuals had its onset during or is otherwise etiologically related to his conceded chemical exposures during active service, to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? (b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's prostate cancer and residuals are etiologically related to his conceded chemical exposures during active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA), to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 5. After completing #1 and #2, schedule the Veteran for an examination to determine the nature and etiology of his skin cancer. The claims file should be made available to and should be reviewed by the examiner. The examiner should address the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's skin cancer and residuals had their onset during or are otherwise etiologically related to his conceded chemical exposures during active service, to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? (b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's skin cancer and residuals are etiologically related to his conceded chemical exposures during active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA), to include exposure to firefighting chemicals, including aqueous film forming foam (AFFF) also known as "balm" or "P-Fast" or "P-Foss" foam? A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.