Citation Nr: 21073425 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 12-17 851A DATE: December 8, 2021 ORDER Service connection for squamous cell carcinoma of the tongue is granted. REMANDED The issue of service connection for a skin disorder is remanded. FINDING OF FACT Squamous cell carcinoma of the tongue was caused by the Veteran's in-service exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for squamous cell carcinoma of the tongue have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.326(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Army from July 1968 to March 1971. He served in the Republic of Vietnam and his military decorations include the Bronze Star Medal, the Purple Heart, and the Combat Infantryman Badge. In August 2016, the Veteran was afforded a videoconference hearing before a Veterans Law Judge. In September 2021, the Veteran was informed that the Veterans Law Judge who conducted his Board hearing was no longer employed at the Board and he, therefore, had a right to an additional hearing before a different Veterans Law Judge. The letter stated that if the Veteran did not respond within 30 days, the Board would assume he did not want another hearing. The Veteran did not respond and, therefore, the Board will proceed to adjudicate the appeal. Entitlement to service connection for squamous cell carcinoma of the tongue. Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran had squamous cell carcinoma of the tongue. The Veteran served in the Republic of Vietnam and is, therefore, presumed to have been exposed to herbicide agents. A January 2021 VA medical opinion states that the Veteran's squamous cell carcinoma of the tongue was at least as likely as not caused by his in-service exposure to herbicide agents. The examiner explained that herbicide agents are a known carcinogen and that studies have shown that herbicide agent exposure can increase the likelihood of developing mouth, nose, and thyroid cancers. Therefore, the Board finds that service connection is warranted and the appeal is granted. REASONS FOR REMAND The issue of service connection for a skin disorder is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: In April 2020, the Board remanded the appeal for a VA examination and medical opinion which addressed whether a diagnosed skin disorder was caused by service. A January 2021 VA examination report stated a diagnosis of only squamous cell carcinoma of the tongue. An examination addendum stated that no other skin disorders were addressed during the examination and "were not diagnosed according to this examiner." The record indicates, however, that the Veteran had diagnoses of actinic keratosis with hypopigmentation; basal cell carcinoma of the left neck, behind the ear, and of the chest; and basal cell carcinoma and squamous cell carcinoma of the upper extremities. The examiner failed to provide an opinion regarding any of these diagnosed skin disorders. The VA examination and medical opinion are inadequate and, therefore, remand is necessary. THE REMAND DIRECTIVES FOLLOW. 2. Schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of each identified skin disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Identify each skin disorder which the Veteran has or has had during the pendency of this appeal. (b.) Whether each of the following was caused by any in-service event, injury, disease, or disorder, or in any way originated during serviceincluding because of exposure to herbicide agents: i. actinic keratosis with hypopigmentation. ii. basal cell carcinoma of the left neck and behind the ear. iii. basal cell carcinoma of the upper extremities. iv. basal cell carcinoma of the left chest. v. squamous cell carcinoma of the upper extremities. vi. any other identified skin disorder. The April 2020 Board remand directed that the VA examiner specifically address the medical literature submitted by the Veteran which suggested that his skin disorders may have been caused by herbicide agents. The examiner is again directed to specifically address this evidence in providing the above-requested opinions to comply with the Board's directive. The examiner's attention is drawn to the following: *October 1970 service treatment record (STR) indicating a healed left knee surgical scar. VBMS Entry 9/23/2014, p. 14. *March 1971 physical examination for service separation on which the Veteran's skin was normal and on which the Veteran wrote "I am in poor health." VBMS Entry 9/23/2014, p. 26-27. *June 2009 informal claim on which the Veteran reported markings on his skin. *July 2009 correspondence consisting of scientific journal articles and reports on the medical effects of herbicide agents. *July 2009 statement from the Veteran that his skin disorder began in service. *August 2009 VA scars examination in which the examiner stated that the Veteran had scarring on the legs, skin lesions on the forearms, patches of hypopigmentation, and actinic keratosis; the Veteran reported that the skin symptoms began in service. *September 2010 notice of disagreement (NOD) on which the Veteran reported that his skin symptoms began as red marks near his eyes shortly after his return from Vietnam, and that he believed they were caused by in-service exposure to herbicide agents. *July 2012 VA Form 9 on which the Veteran reported that his skin symptoms began in service. *August 2015 VA treatment record stating that the Veteran had an excision of basal cell carcinoma on the left side of his neck. VBMS Entry 11/24/2015, p. 11. *November 2015 VA treatment record stating that the Veteran recently had basal cell carcinoma and had a toe fungus. VBMS Entry 11/24/2015, p. 1. *May 2016 private treatment record stating that the Veteran has had skin cancer. VBMS Entry 6/19/2017, p. 16. *August 2016 VA treatment record stating that the Veteran had an excision of a basal cell carcinoma lesion behind his ear in 2015 and that he currently had a lesion on his left upper extremity near the elbow. VBMS Entry 12/23/2016, p. 5. *January 2017 VA Agent Orange registry examination report stating a history of basal cell carcinoma. VBMS Entry 2/14/2017. *June 2017 VA treatment record stating that the Veteran had a history of basal cell carcinoma and squamous cell carcinoma on the bilateral arms. VBMS Entry 8/15/2017, p. 3. *September 2017 correspondence from the Veteran in which he reported that he had been diagnosed with porphyria cutanea tarda. *February 2020 VA treatment record stating that the Veteran had a skin cancer history of basal cell carcinoma of the left neck in June 2015, squamous cell carcinoma of the left forearm in February 2017, and basal cell carcinoma of the left upper chest in February 2018. VBMS Entry 4/28/2020, p. 1. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Miller, Counsel The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.