Citation Nr: 21074313 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 18-34 059 DATE: December 14, 2021 REMANDED The issue of service connection for basal cell carcinoma, squamous cell carcinoma, and malignant melanoma (collectively referred to as "skin cancer") and residuals thereof, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1967 to March 1969, to include service in the Republic of Vietnam. His honors include a Combat Infantryman's Badge, a Bronze Star Medal with "V" Device and one Oak Leaf Cluster, and a Purple Heart. This matter comes before the Board of Veterans' Appeals (Board) from an October 2014 rating decision from a Department of Veterans Affairs (VA) regional office (RO). The Veteran had a videoconference hearing before the undersigned Veterans' Law Judge. A transcript of that hearing is part of the claims folder. Service connection for skin cancer and residuals thereof is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE ADJUDICATOR: The Veteran contends that his diagnosed skin cancer is due to herbicide and intense sun exposure during his service in Vietnam. VA has not satisfied its duty to assist the Veteran. No opinion has been provided as to whether the Veteran's diagnosed skin cancer and its residuals are related to his herbicide agent exposure and intense sun exposure. A private opinion indicates the Veteran's exposure to herbicide agents and intense sun exposure could be related to the Veteran's skin cancer. The opinion notes the Veteran's skin type, an American Society of Plastic Surgeons issue, and a Journal of American Academy of Dermatology article as evidence of a link between the two. However, there is insufficient medical evidence to decide this matter. The non-VA opinion does not come from a dermatologist and relies on general connections between sun exposure and chemical exposure to draw a conclusion. A more direct analysis of the Veteran's circumstances coupled with a specific expertise in dermatology is required to provide a sufficient medical opinion. Therefore, a remand for an examination and medical opinion is required. THE REMAND DIRECTIVES FOLLOW. 2. Schedule the Veteran for AN EXAMINATION BY A DERMATOLOGIST OR ONCOLOGIST to determine the nature, severity, and etiology of his skin cancer, to include basal cell carcinoma, squamous cell carcinoma, and malignant melanoma, and any residuals. The examiner must provide an opinion as to whether the Veteran's skin cancer is related to his service, to include exposure to herbicide agents and/or intense sun exposure while the Veteran was in Vietnam. The examiner must provide a statement to support the conclusion reached addressing all relevant lay statements, medical evidence, and medical literature considered in reaching the conclusion. The examiner is advised that the Veteran is presumed to have been exposed to herbicide agents during his combat service in Vietnam. The examiner is further advised that a negative opinion cannot be based solely on the fact that a disability is not on the list of diseases that are presumptively associated with exposure to herbicide agents. THE EXAMINER MUST REVIEW THE ENTIRE RECORD INCLUDING: An April 2002 private treatment record noting basal cell carcinoma. A June 2002 private treatment record noting basosquamous cell carcinoma. A June 2009 private treatment record noting malignant melanoma. September 2009 private treatment records noting the excisions of malignant melanoma. A September 2009 private treatment records noting basal cell carcinoma. A February 2014 issue of the American Society of Plastic Surgeons linking skin cancer to herbicide agent (Agent Orange) exposure, cited to in the September 2021 medical opinion. A November 2014 statement by the Veteran that his doctor told him to apply for service connection because herbicide agents had been linked to skin cancer. A December 2017 VA treatment record noting squamous cell carcinoma. A December 2017 VA treatment record noting basal cell skin cancer and stating that it was usually related to sun exposure. A June 2018 article in the American Academy of Dermatology discussing the occurrence of skin cancer in the military, cited to in the September 2021 medical opinion. A June 2021 hearing transcript where the Veteran reports a burning sensation after crossing streams and exposure to intense sun for long periods without sunscreen. A September 2021 nurse practitioner's opinion that the Veteran's skin cancer is related to his exposure to intense sunlight and herbicide agents, specifically considering the Veterans skin type. 3. Thereafter, readjudicate the issue on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable period in which to respond. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Reed, Counsel The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.