Citation Nr: 21073632 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 19-29 030 DATE: December 9, 2021 REMANDED Entitlement to service connection for larynx tumors is remanded. Entitlement to service connection for chronic laryngitis, to include as secondary to larynx tumors, is remanded. Entitlement to service connection for dysphonia, to include as secondary to larynx tumors, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1963 to December 1966. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Board remanded the claims in October 2020 after making a finding that there was new and material evidence to reopen the claims submitted after the January 2017 rating decision became final. 1. Entitlement to service connection for larynx tumors is remanded. 2. Entitlement to service connection for chronic laryngitis, to include as secondary to larynx tumors, is remanded. 3. Entitlement to service connection for dysphonia, to include as secondary to larynx tumors, is remanded. The Veteran presented for a VA examination in September 2021 for his larynx tumors, chronic laryngitis, and dysphonia. The examiner opined positively that the Veteran's chronic laryngitis and dysphonia were proximately related to the Veteran's larynx tumors, diagnosed as recurrent respiratory papillomatosis without pulmonary involvement. The examiner opined that the Veteran's larynx tumors were not related to herbicide agent exposure and instead were caused by the human papilloma virus (HPV) and noted that herbicide agent exposure is not a cause of HPV. However, in opining that the etiology of the tumors of the larynx were caused by HPV and not herbicide agent exposure, the examiner did not opine on the etiology of the HPV, which the Board finds would be helpful in the adjudication of the claim. On remand, the etiology of the HPV should be addressed. Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007). In the alternative, the Veteran contends that his larynx tumors stem from toxic exposures while stationed in Marine Corps Air Station (MCAS) El Toro. The Board further acknowledges that the Environmental Protection Agency has also identified Marine Corps Air Station El Toro as a Superfund Site including as a result of the presence of volatile organic compounds, primarily TCE, in groundwater there. The Veteran's military personnel records reflect that the Veteran was stationed at El Toro during his period of active duty. As the record does not reflect a diagnosis of cancer, the presumptive regulation does not avail the Veteran in his claim. 38 C.F.R. § 3.309(f). The Veteran, however, is not precluded from establishing service connection with proof of direct causation. See Combee v. Brown, 34 F. 3d 1039, 1042 (Fed. Cir. 1994); see also Stefl v. Nicholson, 21 Vet. App. 120 (2007). Finally, as the claims for chronic laryngitis and dysphonia, which have been opined on positively, are intertwined with the claim for the Veteran's larynx tumors, given his arguments, the Board will defer adjudication of the secondary claims pending the resolution of the intertwined larynx tumors. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Obtain an addendum opinion from a VA examiner other than the September 2021 VA examiner addressing the etiology of the Veteran's larynx tumors. No additional examination is necessary, unless the examiner determines otherwise. (a.) Following a review of the claims file, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed larynx tumors had its onset in or is otherwise related to service, to include as a result of conceded exposure to toxic contaminants. (b.) If the examiner opines that the Veteran's larynx tumors are caused by HPV, the examiner is to explain the etiology of the HPV. To state that the larynx tumors are not related to or caused by another disease, condition, or factor, will not be sufficient. When considering the evaluation, the examiner is to carefully consider all lay statements of record to include buddy statements, VA treatment records, and private treatment records and evaluations. The examiner's attention is directed to the February 2018 correspondences submitted by the Veteran and the February 2019 correspondence from the Veteran's ex-wife describing respiratory symptoms since service as well as the history and symptomatology reported by the Veteran in the September 2021 VA examination. The examiner should view the Veteran as a reliable historian as to his service and his reports of his activities and symptoms in and since service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Please do not rely solely on negative service treatment records (STRs) and/or the fact that presumptive service connection is not available for the condition. A complete rationale should be given for all opinions and conclusions expressed. If unable to opine without resorting to speculation, please provide a basis for that conclusion. M.W. Kreindler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.