Citation Nr: 21069137 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 20-00 195 DATE: November 17, 2021 REMANDED Entitlement to service connection for squamous cell cancer of the maxillary sinus, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for chronic sinus congestion as secondary to squamous cell cancer of the maxillary sinus is remanded. Entitlement to service connection for loss of taste as secondary to squamous cell cancer of the maxillary sinus is remanded. Entitlement to service connection for left face numbness as secondary to squamous cell cancer of the maxillary sinus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1966 to March 1968, to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As an initial matter, the Board notes that additional VA treatment records were associated with the claims file after issuance of the November 2019 Statement of the Case. As the Agency of Original Jurisdiction (AOJ) will have the opportunity to review the new evidence on remand, no prejudice results to the Veteran in the Board considering such evidence for the limited purpose of issuing a comprehensive and thorough remand. See 38 C.F.R. §§ 20.800, 20.1304. 1. Entitlement to service connection for squamous cell cancer of the maxillary sinus, to include as due to herbicide agent exposure The Veteran seeks service connection for squamous cell cancer of the maxillary sinus as due to in-service herbicide agent exposure. Specifically, he asserts that because inhaled carcinogens must pass through the nasal or oral cavity to reach the respiratory system and because respiratory disorders are presumed to be based on herbicide agent exposure with qualifying Vietnam service, his maxillary sinus squamous cell cancer is also related to herbicide agent exposure. To date, the record does not include a VA examination or medical opinion addressing whether the Veteran's squamous cell cancer of the maxillary sinus is related to his active military service. As the Veteran served in the Republic of Vietnam, during the Vietnam War era, he is presumed to have been exposed to herbicide agents. See 38 C.F.R. §§ 3.102, 3.307. Although the Veteran's squamous cell cancer of the maxillary sinus is not a presumptive disability for herbicide agent exposure, a remand is warranted for a VA examination and opinion to determine whether the Veteran's disorder is related to his in-service exposure on a direct basis. Accordingly, a VA examination is necessary to fulfill the duty to assist. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Board acknowledges that the Veteran submitted private positive nexus opinions in support of his claim. See December 2017 and December 2019 private medical letters. However, the Board cannot make a fully informed decision on the Veteran's claim based on the current evidence of record because there is no opinion of record that clearly explains or connects how the Veteran's specific circumstances and current disorder are related to his service, to include his in-service herbicide agent exposure. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning"). In this regard, the Board notes that the December 2019 private opinion does not contain any rationale for the conclusion reached. Therefore, a remand is warranted for VA opinion with supporting rationale. 2. Entitlement to service connection for chronic sinus congestion as secondary to squamous cell cancer of the maxillary sinus, loss of taste as secondary to squamous cell cancer of the maxillary sinus, and left face numbness as secondary to squamous cell cancer of the maxillary sinus As the Veteran asserts that his claims for chronic sinus congestion, loss of taste, and left face numbness are secondary to his squamous cell cancer of the maxillary sinus and treatment therein these claims are inextricably intertwined with his remanded claim for service connection for squamous cell cancer of the maxillary sinus. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Therefore, adjudication of these issues is deferred pending development of his claim for service connection for squamous cell cancer of the maxillary sinus. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. The last VA treatment of record is dated October 2020. 2. Provide the Veteran with another opportunity to identify and/or submit any outstanding private treatment records relevant to his claims, to include any surgical or operative reports relating to his squamous cell cancer of the maxillary sinus, which are not already of record. The evidence also reflects that the Veteran receives ongoing private oncology treatment. After obtaining any necessary authorization from the Veteran, all outstanding, identified records should be obtained. 3. Then, schedule the Veteran for a VA examination to determine the current origin and nature of his squamous cell cancer of the maxillary sinus. The claims file, to include a copy of this Remand, must be made available to and be reviewed by the examiner. All appropriate tests or studies must be conducted, and all symptomatology and functional deficits associated with the Veteran's disorder should be reported in detail. The examiner is asked to respond to the following: (a) Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's squamous cell cancer of the maxillary sinus and chronic sinusitis (1) had an onset in service; (2) manifested within one year after discharge from service; OR (3) is otherwise related to service, to include from conceded in-service exposure to herbicide agents while serving in Vietnam. (b) If the examiner finds that the Veteran's squamous cell cancer of the maxillary sinus is not related to his service, to include in-service herbicide agent exposure, how does that reconcile with the December 2017 and December 2019 private opinions that the Veteran's disorder is related to such exposure? In support of his claim, the Veteran's representative references a study concluding that self-reported Agent Orange exposure correlates with increased risks of oropharyngeal, nasopharyngeal, laryngeal, and thyroid cancers, which can be found at https://pubmed.ncbi.nlm.nih.gov/31810040/. See October 2021 Appellate Brief. The examiner should also review this information and comment on the study and how it relates to the Veteran's claim. The mere fact that a legal presumption of service connection has not been established for a particular disorder based on herbicide exposure is not dispositive of the question of a nexus to service. Consideration must still be given to the in-service exposure. A clearly stated rationale for any opinion offered should be provided. In this regard, a discussion of the relevant facts and medical principles involved would be of considerable assistance to the Board. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Amanda Purcell, 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.