Citation Nr: 21062474 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 12-33 926A DATE: October 7, 2021 REMANDED Entitlement to service connection for skin cancer is remanded. Entitlement to service connection for skin lesions and ulcers is remanded. Entitlement to service connection for thyroid disease is remanded. Entitlement to service connection for birth defects is remanded. Entitlement to service connection for allergies is remanded. Entitlement to service connection for arthritis with bone disease is remanded. Entitlement to service connection for a respiratory disability (to include chronic obstructive pulmonary disease (COPD)) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1965 to September 1968. In October 2014, a hearing was held before a Decision Review Officer (DRO) at the RO, and a transcript of the hearing is associated with the record. In April 2019, a videoconference hearing was held before the undersigned Veterans Law Judge, and a transcript of the hearing is associated with the record. In September 2019, the case was remanded for additional development. 1. Entitlement to service connection for skin cancer. 2. Entitlement to service connection for skin lesions and ulcers. 3. Entitlement to service connection for thyroid disease. 4. Entitlement to service connection for birth defects. 5. Entitlement to service connection for allergies. 6. Entitlement to service connection for arthritis with bone disease. 7. Entitlement to service connection for a respiratory disability (to include COPD). The Veteran contends that she currently has skin cancer, skin lesions and ulcers, and thyroid disease related to her military service, to include as a result of her ionizing radiation exposure therein and/or her polychlorinated biphenyl (PCB) chemical exposure therein. She also contends that her two children were born with birth defects related to her military service, to include as a result of her ionizing radiation exposure therein and/or her PCB chemical exposure therein. She additionally contends that she currently has allergies and arthritis with bone disease related to her military service, to include as a result of her PCB chemical exposure therein. She further contends that she currently has a respiratory disability related to her military service, to include as a result of exposure to asbestos therein. The Board cannot make a fully-informed decision on these issues at this time, because the record reflects that there are outstanding treatment records not currently associated with the claims file that may be pertinent to these claims on appeal. Specifically, the Veteran's VA treatment records dating through January 2020 have documented that she has been treated by private providers in the time since her private treatment records were last obtained in 2011, including for primary care (Dr. Stewart), orthopedics (Dr. Williams), and gynecology (Dr. Darby). In addition, it was noted at her March 2021 VA thyroid examination that she recently had labwork done in June 2020, and it was also noted at her March 2021 VA skin examination that she last saw her dermatologist in January 2021. On remand, all outstanding treatment records must be associated with the claims file. In addition, for the claimed skin cancer, skin lesions and ulcers, thyroid disease, birth defects, allergies, and arthritis with bone disease, the VA examiner who conducted pertinent March 2021 examinations of the Veteran opined that each of these claimed conditions was less likely than not incurred in or caused by in-service exposure to either ionizing radiation or PCB chemicals, with the rationale noting that there was no documentation found from the Department of Defense confirming the Veteran's in-service exposure to either ionizing radiation or PCB chemicals. However, as outlined in a January 2021 memorandum from the Director of VA's Post-9/11 Era Environmental Health Program and in a January 2021 memorandum from the Director of VA's Compensation Service, VA has conceded that the Veteran did have in-service exposure to ionizing radiation and PCB chemicals. In addition, the VA examiner did not consider or address any of the Veteran's potentially pertinent service treatment records (STRs), including with regard to her skin, allergies, and arthritis claims, when rendering the above-noted opinion for each of those conditions. On remand, after all outstanding treatment records have been associated with the claims file, an addendum medical opinion should be obtained in order to adequately address the theories of service connection raised with regard to the Veteran's claimed skin cancer, skin lesions and ulcers, thyroid disease, birth defects, allergies, and arthritis with bone disease. The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated her for her claimed disabilities on appeal, including Dr. Stewart, Dr. Williams, and Dr. Darby. Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records for the period from January 2020 to the present. 3. After all requested records have been associated with the claims file, obtain a medical opinion from an appropriate clinician(s), after review of the electronic claims file, in order to address the following: For any skin cancer, skin lesions and ulcers, thyroid disease, birth defects affecting her two children, allergies, and arthritis with bone disease diagnosed during the pendency of the appeal period, the clinician must provide an opinion as to whether it is at least as likely as not that each such disability began during the Veteran's active service (or within one year of service discharge), or is otherwise related to any incident of her active service (with specific consideration given to all pertinent STRs and to her conceded in-service exposure to ionizing radiation and PCB chemicals). A complete rationale for all opinions must be provided. If the clinician(s) cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician(s) must provide the reasons why an opinion would require speculation. The clinician(s) must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician(s) must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. If the clinician(s) determines that an examination is necessary to respond to the above question(s), then the Veteran should be scheduled for such (or a telehealth interview if an in-person examination is not feasible). C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. B. Yantz, Counsel The Board's decision in this case is binding only with respect to the instant matter(s) decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.