Citation Nr: 21076791 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 15-21 057 DATE: December 27, 2021 REMANDED Service connection for skin cancer, to include basal cell carcinoma, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1966 to December 1969. This matter originally came before the Board of Veterans' Appeals (Board) from a July 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Pittsburgh, Pennsylvania. This matter has previously been remanded by the Board for further development, most recently in April 2021, and is again before the Board. The prior remand also addressed the issue of entitlement to an initial evaluation in excel of 30 percent for CAD. A statement of the case was issued per the Board's order, however the Veteran failed to submit a substantive appeal. The issue is no longer before the Board. Service connection for skin cancer, to include basal cell carcinoma, is remanded. The Veteran believes that service connection for skin cancer is warranted. See December 2021 Appellate Brief. The Board previously remanded the matter for a new VA skin cancer examination because the only prior VA skin cancer examination was found to be inadequate. See April 2021 Remand BVA. The new examination took place in September 2021. It found that the Veteran's skin cancer was not related to service because the examiner could not find a study that linked the skin cancer to herbicide agent exposure after extensive review. See September 2021 C&P Exam. The Board finds the September 2021 VA skin cancer examination inadequate, among other reasons, because it did not consider/was unable to consider all the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, among other things, the examination did not consider/was unable to consider the Veteran's report that in addition to herbicide agent exposure, the skin cancer may have been due to chemical/petroleum toxin exposure during service and/or sun exposure during service in Vietnam and links provided by the Veteran to articles, which were to show a correlation between herbicide agent exposure and skin cancer. See December 2021 Appellate Brief; January 2019 Appellate Brief. For this reason, among others, a remand is needed for a new VA examination. The matter is REMANDED for the following action: 1. Inform the Veteran and the Veteran's representative that the second article link provided in the January 2019 Appellate Brief does not seem to work any longer. Invite them to submit an updated link and/or to submit copies of the articles themselves. 2. Update VA and private treatment records. VA treatment records appear current up to June 2021. 3. Schedule one or more appropriate VA examinations for the Veteran's skin cancer condition. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all skin cancer related disabilities existing at any point during the appeal period (i.e., since January 2012) even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability had its onset in or is otherwise related to the Veteran's service, including but not limited to, conceded herbicide agent exposure during service in Vietnam, chemical/petroleum toxin exposure during service, and sun exposure during service in Vietnam? (Whether a disability is a presumptive condition under 38 C.F.R § 3.309(e) is irrelevant for purposes of this question). (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by any or all of the Veteran's service-connected disabilities (including but not limited to medications taken for the service-connected disabilities)? (D) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was aggravated beyond its natural progression by any or all of the Veteran's service-connected disabilities (including but not limited to medications taken for the service-connected disabilities)? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (E) Is it at least as likely as not (a 50 percent or greater probability) that any or all of the Veteran's service-connected disabilities (including but not limited to medications taken for the service-connected disabilities) caused or aggravated the Veteran's obesity/being overweight including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (F) If yes, is it at least as likely as not (a 50 percent or greater probability) that the obesity/being overweight caused or aggravated any or all of the Veteran's skin cancer related disabilities including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. If yes, which ones? In addition to the other relevant evidence of record, the reviewing examiner is asked to consider and address as appropriate the following information with a caution that this list is not a substitute for a review of the record: (1) A list of the Veteran's service-connected disabilities. See April 2021 Rating Decision Codesheet. (2) The Veteran's report that his skin cancer was due to herbicide agent exposure during service in Vietnam, chemical/petroleum toxin exposure while serving as an engine mechanic on a ship during service, and/or sun exposure during service in Vietnam. See December 2021 Appellate Brief. (3) A medical record from 2021 showing diagnoses of basal cell carcinoma and a scar from basal cell carcinoma. The onset was in 2011 when the Veteran noticed small reddish skin lesions. See September 2021 C&P Exam. (4) The Veteran's report of exposure to chemical and petroleum toxins while conducting maintenance and repairs on a ship during service. See March 2021 Appellate Brief. (5) The Veteran's report that he was submitting links to articles which show a direct correlation between herbicide agent exposure and skin cancer. The links are found in this document. See January 2019 Appellate Brief. (6) Service records showing that the Veteran was an engine mechanic during service. See June 2018 DD 214. (7) The Veteran's report that his skin cancer was due to herbicide agent exposure. It was his understanding that recent studies showed a link between the two. See June 2015 Form 9. (8) Medical records from 2014 showing that the Veteran was a diesel mechanic during service, a body mass index of about 27, and that being overweight carried the risk of getting certain cancers. See January 2015 CAPRI. (9) Service records showing that the Veteran went to hydraulics school during service. See March 2013 Military Personnel Record. (10) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions. Review and address the articles which the Veteran submitted links for. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community's knowledge or due to the limits of the examiner's medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 4. Readjudicate the issue on appeal. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Dougan, 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.