Citation Nr: 21063961 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 20-20 883A DATE: October 18, 2021 REMANDED Entitlement to service connection for basal cell carcinoma, including due to herbicide exposure, is remanded. Entitlement to service connection for osteoarthritis bilateral hands is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from March 1967 to January 1971, including with confirmed service in Thailand. 1. Entitlement to service connection for basal cell carcinoma, including due to herbicide exposure is remanded. The matter of basal cell carcinoma must be remanded. The Veteran is currently diagnosed with basal cell carcinoma. The Veteran served at a Royal Thai Air Force Base that VA has acknowledged used Agent Orange for perimeter defoliation. The Veteran has submitted medical literature showing increased risks for his cancer based on exposure to Agent Orange. See May 2017 Article. This medical literature includes various increased risks based on the amount of the exposure, including those who actively sprayed the chemical, those who lived or worked in areas sprayed, and those only traveling through areas exposed to Agent Orange. Id. However, there is insufficient competent medical evidence on file addressing the study and the Veteran's contentions to make a decision without providing an examination. As such, the Board finds that the VA's duty to assist is triggered under McLendon v. Nicholson, 20 Vet. App. 79. 83 (2006). Because there is no medical examination of the Veteran's basal cell carcinoma, the Board finds one must be obtained to address the Veteran's contentions and evidence of record. 2. Entitlement to service connection for osteoarthritis bilateral hands is remanded. The matter of bilateral osteoarthritis of the hands must be remanded. The Board notes an injury to the Veteran's left middle finger in service. The Board also notes that the record contains a diagnosis of osteoarthritis, though it does not identify where in the body. The Veteran contends that that his osteoarthritis symptoms have continued since service. Additionally, there is insufficient competent medical evidence on file to make a decision without providing an examination, even if it just for the left hand. As such, the Board finds that the VA's duty to assist is triggered under McLendon v. Nicholson, 20 Vet. App. 79. 83 (2006). Because there is no medical examination of the Veteran's osteoarthritis condition of the hands, the Board finds one must be obtained to address the Veteran's contentions and evidence of record. The matters are REMANDED for the following action: 1. Invite the Veteran to submit any additional evidence he may have, including medical evidence, or details regarding his time at Udorn, including locations where he worked on aircraft, his berthing, chow hall, and any watch duties and their locations he may have been assigned. Relation of these locations to the perimeter fence may be of great significance in the Veteran's claim. 2. Schedule the Veteran for a VA examination for his basal cell carcinoma. The examiner must review the claims file. (a.) The examiner is asked to opine whether the Veteran's basal cell carcinoma is at least as likely as not related to in-service exposure to herbicide agents, including exposure to Agent Orange during service at Royal Thai Air Force Base Udorn. (b.) The examiner is asked to address the article submitted by the Veteran regarding increased risk for nonmelonatic skin cancer, including up to 40 years after exposure. (c.) Further, the examiner is advised that a negative opinion cannot be based solely on the fact that the basal cell carcinoma is not on the list of diseases that are presumptively associated with exposure to herbicide agents. The rationale for all opinions must be provided. 3. Schedule the Veteran for a VA examination for his bilateral hand disability. The examiner must review the claims file. (a.) The examiner is asked to identify all bilateral hand disabilities present since the Veteran filed his claim in September 2015, to include osteoarthritis of the hand/fingers. (b.) The examiner is asked to opine whether it at least as likely as not that the Veteran's left and/or right-hand osteoarthritis (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. (i.) The examiner's attention is drawn to the left middle finger injury in-service. (ii.) The examiner should also address the Veteran's contentions that the claimed disability(ies) is due to his assigned duties as an aviation mechanic and years of wrench turning. (iii.) The examiner should also address the Veteran's contention that the symptoms started in service and have continued since. The examiner must provide a complete rationale for all opinions. In providing the requested opinions, consider the Veteran's description of his in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Boushehri, Darjush M. 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.