Citation Nr: 21068520 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 19-08 957 DATE: November 10, 2021 REMANDED Entitlement to service connection for a skin condition, to include melanoma, as a result of herbicide exposure is remanded. REASONS FOR REMAND The Veteran served in the United States Army from July 1961 to September 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision issued by a VA Regional Office (RO). By way of background, the Veteran timely filed her Notice of Disagreement (NOD) to the October 2018 rating decision in January 2019. Subsequently, the RO issued a Statement of the Case (SOC) in March 2019 and then the claim was certified to the Board in May 2020. As will be discussed in greater detail below, although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim and to afford her every possible consideration. Entitlement to service connection for a skin condition, to include melanoma, as a result of herbicide exposure is remanded. The Veteran contends that her various skin conditions are caused by exposure to herbicides during her service in Vietnam. Specifically, she asserts that while serving at Binh Long army base in Vietnam as a nurse, she came into repeated contact with soldiers who were exposed to Agent Orange. See January 2019 Correspondence. The Veteran's DD-214 indicates the Veteran served in the Army Nurse Corps as a Medical/Surgical Nurse. As a result of her honorable service, she was awarded the Vietnam Service Medal and Vietnam Campaign Medal with 60-device. As a result, the RO conceded the Veteran's claim of exposure to herbicides during her service in the March 2019 SOC. However, the RO ultimately denied service connection for the Veteran's skin conditions because they were not listed under 38 C.F.R. § 3.309(e) for presumptive service connection due to herbicide exposure nor was there any other evidence of a positive nexus between the skin conditions and her military service. As noted above, the Veteran was issued an SOC in March 2019. Afterwards, the Veteran submitted additional argument and supporting evidence in correspondence dated January 7, 2019. This correspondence included additional information supporting the Veteran's claimed in-service herbicide exposure during service at Binh Long Army base in Vietnam. Also included in the correspondence was private treatment records from Rosario Skin Clinic dated from May 2018 to July 2018 which indicate ongoing treatment for various skin conditions including melanoma. Lastly, the Veteran submitted a copy of a medical treatment note dated July 1984 which indicates that the Veteran had a longstanding history of a mole that was previously excised. The treatment note goes on to provide a diagnosis of "skin of arm: compound melanocytic nevus with moderate dysplasia, excised". Unfortunately, a review of the claims file indicates that these additional records were never reviewed by the RO prior to certification to the Board in May 2020. As such, a remand is required to provide the Veteran a Supplemental Statement of the Case (SSOC). 38 C.F.R. §§ 19.31, 19.37(a), 20.904(a)(2). The agency of original jurisdiction (AOJ) is required to furnish the Veteran an SSOC when additional pertinent evidence is received after a statement of the case (SOC) or the most recent SSOC has been issued. Id. The Board further notes, that a remand is also warranted to provide the Veteran a VA medical opinion as to the nature and etiology of her skin conditions. In March 2018, the RO afforded the Veteran a VA skin disabilities examination. At which time, the examiner noted that the Veteran had malignant melanomas on the back and left forearm removed in the 1980's and basal cell carcinoma on the left nostril removed in 2006. See March 2018 VA Examination. The examiner also noted that while treatment was completed, the Veteran was still in a "currently watchful waiting status" due to other skin lesions with no rendered diagnosis. Even though the March 2018 examiner noted that the Veteran had a long history of skin conditions to include melanoma, as well as current skin conditions, the examiner failed to provide any etiology or other opinion as to their cause. In light of the Veteran's conceded in-service herbicide exposure, remand for an examination and etiology opinion is warranted. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The matters are REMANDED for the following action: 1. Ask the appropriate examiner to review the Veteran's file. The necessity of an in-person examination is left to the discretion of the examiner. After examining the Veteran, if necessary, and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to: Whether it is at least as likely as not that the Veteran's skin conditions, to include melanoma had their onset in, or are otherwise attributable to, the Veteran's period of active service, to include the Veteran's presumed herbicide exposure. The examiner is reminded that the absence of documented treatment in service or thereafter is not fatal to a service connection claim, and the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Thus, the examiner is to consider the totality of the record, and not just the absence of clinical treatment, in weighing the Veteran's statements asserting symptomatology. The examiner is also reminded that a medical opinion finding no nexus based solely on the fact that the condition is not on the presumptive list of associated conditions with Agent Orange exposure is inadequate without a discussion into the claimant's specific risk factors and circumstances of service. Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). A complete and thorough medical rationale for all opinions express must be provided. (Continued on the next page) 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal and provide the Veteran with a supplemental statement of the case (SSOC) considering all the evidence of record, to include the evidence associated with the record since the March 2019 SOC. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.