Citation Nr: 21072139 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 16-44 403 DATE: December 2, 2021 REMANDED Entitlement to service connection for basal skin cell carcinoma and melanoma, (skin cancer), to include as due to herbicide exposure, is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy, to include as due to herbicide exposure, is remanded. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1968 to April 1970. This case comes to the Board of Veteran's Appeals (Board) on appeal from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2014, the Veteran disagreed with this rating decision. This case was previously before the Board in November 2018 and May 2021 when it was remanded for additional development. For the reasons discussed below, another remand is required. See Stegall v. West, 11. Vet. App. 268 (1998). 1. Entitlement to service connection for skin cancer, to include as due to herbicide exposure, is remanded. In the May 2021 decision, the Board ordered the RO to obtain a new VA opinion to determine whether the Veteran's skin cancer conditions were directly related to herbicide exposure. In an August 2021 VA opinion, the examiner opined that the Veteran's condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there was insufficient medical evidence to determine if the claimed conditions were related to the Veteran's presumed herbicide exposure. The examiner noted that basal cell carcinoma and melanoma were not presumptive of herbicide exposure. The Board finds that the August 2021 opinion is in adequate because it is conclusory and contains no rationale. Just because skin cancer is not a presumptive condition for herbicide exposure does not mean that the Veteran's exposure to herbicides did not cause it. Because of this, a new VA opinion is necessary to determine whether the Veteran's skin cancer conditions are related to active service, to include his exposure to herbicide agents while in Vietnam. 2. Entitlement to service connection for right lower extremity peripheral neuropathy, to include as due to herbicide exposure, is remanded. 3. Entitlement to service connection for left lower extremity peripheral neuropathy, to include as due to herbicide exposure, is remanded. In the May 2021 decision, the Board ordered the RO to obtain a new VA opinion to determine the etiology of the Veteran's bilateral lower extremity peripheral neuropathy and whether it was related to active service, to include herbicide exposure. In a July 2021 private opinion, the Veteran's physician opined that the Veteran's peripheral neuropathy was causally related to his exposure to herbicide agents. However, for this opinion, the examiner did not review the Veteran's service treatment records (STRs), only his post-service VA medical records. Further, although the private physician provided a rationale for the exclusion of diabetes and B12 deficiency as causes of the Veteran's bilateral lower extremity peripheral neuropathy, he did not provide an explanation for how herbicide agent exposure caused the peripheral neuropathy. There is no reason provided to explain why excluding diabetes and B12 deficiency would render herbicide agents at least as likely as not the cause of the Veteran's peripheral neuropathy. Because of this, this opinion is inadequate. In an August 2021 VA opinion, the examiner opined that it was less likely than not that the Veteran's bilateral lower extremity peripheral neuropathy was incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that, according to the VA examiner, the most common causes of lower extremity radiculopathy originating from the spine include lumbar spinal stenosis, herniated lumbar discs, and degenerative lumbar spondylosis. Because of this, it was less likely than not that the Veteran's condition was due to herbicide exposure. The Board finds that the August 2021 VA opinion is inadequate because it is conclusory. While the examiner noted the most common causes for lower extremity radiculopathy, no rationale was given as to why the Veteran's peripheral neuropathy was or was not related to his conceded herbicide exposure in Vietnam. Because both the July 2021 private opinion and the August 2021 VA opinion are inadequate, a new VA opinion is necessary to determine the etiology of the Veteran's bilateral lower extremity peripheral neuropathy. The matters are REMANDED for the following actions: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), contact the Veteran for additional information about treatment for his condition and make efforts to obtain all VA and private treatment records concerning these claims. 2. Arrange for the Veteran's file to be forwarded to a VA examiner for a clarifying addendum opinion regarding the likely cause of the Veteran's skin cancer conditions, to include basal cell carcinoma and melanoma. The examiner or consulting physician must review the entire record (including all updated records obtained pursuant to the above development order). Based on his or her review, the examiner or consulting physician should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's skin cancer condition is either directly related to active military service OR represents the initial manifestation of his disease, to include as due to herbicide exposure. In reaching any conclusion, the VA examiner should know that the Veteran was exposed to herbicide agents in Vietnam. Additionally, while skin cancer is not a presumptive condition for herbicide exposure, it is still necessary to discuss whether the Veteran's exposure to herbicide agents could have caused his skin cancer conditions. 3. Arrange for the Veteran's file to be forwarded to a VA examiner for a clarifying addendum opinion regarding the likely cause of his bilateral lower extremity peripheral neuropathy. The examiner or consulting physician must review the entire record (including all updated records obtained pursuant to the above development order). Based on his or her review, the examiner or consulting physician should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's bilateral lower extremity peripheral neuropathy is either directly related to active military service OR represents the initial manifestation of his disease, to include as due to herbicide exposure. In reaching any conclusion, the VA examiner should know that the Veteran was exposed to herbicide agents in Vietnam. Additionally, while peripheral neuropathy is not a presumptive condition for herbicide exposure, it is necessary to discuss whether the Veteran's exposure to herbicide agents could have caused his skin cancer conditions. 4. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.