Citation Nr: 21072411 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 18-02 979 DATE: December 3, 2021 REMANDED Entitlement to service connection for basal cell carcinoma (also claimed as actinic keratosis) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1969 to July 1971. He testified at a videoconference hearing before the undersigned in August 2021. A transcript is of record. Entitlement to service connection for basal cell carcinoma (also claimed as actinic keratosis) is remanded. The Veteran asserts that his basal cell carcinoma is due to exposure to herbicide agents while serving in the Republic of Vietnam. See August 2021 Hearing Transcript. In the alternative, the Veteran asserts that excessive sun exposure while serving in Vietnam has caused his basal cell carcinoma due to his fair complexion. In support of his claim, the Veteran has submitted letters dated December 2015 and March 2016 from Dr. M.V., his treating dermatologist, as well numerous medical articles. In her December 2015 letter, Dr. M.V. stated that numerous risk factors such as heredity, organ transplant, exposure to radiation therapy and/or environmental contaminants, and sunlight may contribute to skin cancer. However, she stated that, unfortunately, there was no way to positively pinpoint the exact cause of the Veteran's skin cancers. In her March 2016 letter, Dr. M.V. opined that the Veteran's skin cancers were due to his exposure to herbicide agents, as well as sun exposure during his military service. However, Dr. M.V. did not provide any rationale to support this opinion. While the medical articles of record suggest a link between numerous risk factors and skin cancer, they are not specific to the Veteran's case nor do they demonstrate a causal relationship between the Veteran's service and his skin cancer. The Board recognizes that the Veteran has not been afforded a VA examination related to his basal cell carcinoma. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. The threshold for finding a link between current disability and service, for the purpose of determining whether an examination is warranted, is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. In this case, the Board finds that the evidence surpasses the low threshold established by Locklear and McLendon. A remand is warranted to afford the Veteran a VA examination and to obtain a medical opinion addressing the etiology of his basal cell carcinoma. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to assess the nature and etiology of his skin disabilities. The claims file should be sent to and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his symptoms. Upon review of the record, and examination of the Veteran, the examiner should respond to the following: Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran has a skin disability, to include basal cell carcinoma and/or actinic keratosis, that had onset in, or is otherwise related to his active-duty service, to include conceded herbicide exposure and/or sun exposure while serving in the Republic of Vietnam? The examiner should consider the Veteran's report of having skin cancer removed from his upper lip in the 1970s, as well as from his nose in the 1990s. The examiner is also asked to consider and comment on Dr. M.V.'s December 2015 and March 2016 medical opinions. All opinions should be supported by a medical explanation or rationale. 2. Then, readjudicate the issue on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.