Citation Nr: 21061419 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 16-55 659 DATE: October 4, 2021 ISSUES 1. Entitlement to service connection for a skin disability, claimed as malignant skin neoplasm. 2. Entitlement to service connection for hearing loss disability. REMANDED Entitlement to service connection for a skin disability, claimed as malignant skin neoplasm is remanded. Entitlement to service connection for hearing loss disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1958 to October 1962. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was afforded a hearing before the undersigned Veterans Law Judge (VLJ) in April 2019; a copy of the transcript is of record. When this case was before the Board in July 2019, it was decided in part and remanded in part for additional evidentiary development. The matter of entitlement to service connection for malignant skin neoplasm was remanded by the Board in July 2019 and October 2020. Pertinently, entitlement to service connection for hearing loss disability was denied in the July 2019 Board decision. The Veteran timely appealed the Board decision to the United States Court of Appeals for Veterans Claims (Court). In August 2020 the Court granted a Joint Motion for Partial Remand (JMPR). Specifically, the Court found that remand was required to obtain an addendum opinion that addressed whether the conceded in-service acoustic trauma caused the Veteran's current hearing loss, even assuming findings of hearing within normal limits at separation. When this case was most recently before the Board in May 2021, it was remanded for additional evidentiary development. It has since been returned to the Board for further appellate action. In regards to the claim for service connection for a skin disability, claimed as malignant skin neoplasm, an addendum VA opinion was received in June 2021 in which the examiner stated that actinic keratosis was diagnosed in 2008, almost five decades after exposure and was not related to active military service; basal cell carcinoma of the right hand was diagnosed in 2015, almost five decades after exposure and was not related to active military service; squamous cell carcinoma of the back and right mild helix was diagnosed in 2015, almost 5 decades after exposure and was not related to active military service. The examiner stated that there was no medical literature that expressed a causal factor of this time span for the occurrence of actinic keratosis, basal cell, or squamous cell to present after a long period of time with little mention of significant exposure. The examiner stated that prolonged or repeated exposure of trichloroethylene did not cause skin cancer. In regards to the claim for service connection for hearing loss disability, an addendum opinion was obtained in April 2021 in which the examiner stated in pertinent part that because the Veteran's hearing was normal at separation, there was no evidence that his military noise exposure caused a permanent hearing loss. The examiner stated that in order for hearing loss to be service connected, a significant worsening or threshold shift must be noted on in service audiograms. The examiner stated that there was no evidence of such a shift, and hearing was well within normal limits at separation. Subsequently, in September 2021 the Veteran's representative argued that service records showed that the Veteran's primary duties in service were Gas Generating Plant Operator and Cryogenic Fluids Production Specialist. It was argued that the Veteran's claimed skin disabilities and hearing loss were related to his job duties to include his involvement in a liquid oxygen spill and fire during his station overseas in Okinawa. The Board finds that clarification is required from the April and June 2021 examiners. Initially, the Board notes that the mere absence of in-service evidence of a hearing loss disability during service is not fatal to a service connection claim. See Ledford v. Derwinski,3 Vet. App. 87, 89 (1992). Moreover, the Veteran's service personnel records confirm that he was a Gas Generating Plant Operator, was a Cryogenic Fluids Production Specialist, and was involved in a fire in July 1961. As such, addendums addressing the September 2021 argument should be obtained on remand. The matters are REMANDED for the following action: 1. Provide access to the electronic claims file to the June 2021 examiner or an appropriate substitute if this individual is not available. An examination should be performed if deemed necessary by the examiner providing the requested opinion. Based on review of the files, the examiner should state a medical opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's skin disabilities diagnosed during the pendency of this claim to specifically include actinic keratosis in 2008, basal cell carcinoma of the right hand in 2015, and squamous cell carcinoma of the back and right mild helix in 2015 are related to his primary duties in service as a Gas Generating Plant Operator, duties as a Cryogenic Fluids Production Specialist, and his involvement in a liquid oxygen spill and fire. A complete rationale for the opinion expressed must be included in the examination report. 2. Provide access to the electronic claims file to the April 2021 examiner or an appropriate substitute if this individual is not available. An examination should be performed if deemed necessary by the examiner providing the requested opinion. Based on review of the files, the examiner should state a medical opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's claimed hearing loss disability is related to his period of active duty service; to include in-service acoustic trauma, to include acoustic trauma related to his primary duties in service as a Gas Generating Plant Operator and Cryogenic Fluids Production Specialist. The examiner is also advised that the mere absence of in-service evidence of a hearing loss disability during service is not fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). A complete rationale for the opinion expressed must be included in the examination report. 3. Thereafter, readjudicate the issues on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case. The Veteran and his representative should be afforded the applicable time period to respond. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M.K., 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.