Citation Nr: 21005504 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 14-34 968 DATE: February 1, 2021 REMANDED Service connection for malignant skin neoplasms (claimed as skin cancer) is remanded. Service connection for myasthenia gravis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1955 to December 1958, with additional reserve service. Historically, these appeals were denied by the Board in August 2019. Following a Joint Motion for Partial Remand (JMPR), the Court of Appeals for Veterans Claims (Court) vacated the Board’s denials and remanded the matters for further consideration in September 2020. Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the readjudication of these appeals. As noted by the parties in their JMPR, there are outstanding VA treatment records which have not yet been obtained. The JMPR also raises the possibility of outstanding and relevant private treatment records. Thus, a remand is now warranted such that reasonable efforts to obtain this evidence may be undertaken. Further, a series of April 2019 VA contract examinations are inadequate for several reasons, to include the examiner’s failure to provide a supporting rationale; address positive evidence of record; or consider all theories of entitlement. Thus, adequate opinions must now be obtained. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file all VA treatment records for the Veteran through the present, to include from Oklahoma City in approximately 1987 and 1996. All actions to obtain the requested records should be fully documented in the record. If they cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 2. Contact the Veteran and request that he identify all private providers of medical treatment for his claimed disabilities since service, including from Drs. Sash, Fadheel, Lim, and Tawfik, as identified in the September 2020 JMPR. Request that he provide authorization for release of all identified private medical records to VA. All actions to obtain the requested records should be fully documented in the record. The RO must make two attempts to obtain any private records identified, unless the first attempt demonstrates that further attempts would be futile. If private records are identified, but not obtained, the RO must notify the Veteran of (1) the identity of the records sought, (2) the steps taken to obtain them, (3) that the claim will be adjudicated based on the evidence available, and (4) that if the records are later obtained, the claim may be readjudicated. If possible, the Veteran should attempt to obtain the records himself. 3. Thereafter, obtain an addendum opinion addressing the questions below.  If the reviewing examiner determines that the opinions requested may not be offered without first examining the Veteran, then consider whether a telehealth interview may be appropriate.  Schedule an in-person examination only if deemed necessary to answer the questions below.   The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred.   In particular, the examiner must address the following: (a.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s malignant skin neoplasms or myasthenia gravis began during a period of active duty service, was caused by service, or is otherwise related to service? The skin examiner must explicitly address the Veteran’s history of in-service sun exposure. Both examiners must also explicitly address the following factors: the Veteran’s in-service exposure to asbestos, solvent, gas, and diesel fuel, including possible related nerve damage; and the circumstances of the Veteran’s in-service specialty as a boilerman, including firing boilers, changing burner tips, and cleaning with diesel oil. Both examiners must also address a series of articles submitted by the Veteran in support of his claims, including from the OSHA archives regarding solvent exposure, and additional sources addressing asbestos exposure. In formulating the opinion, the examiner is advised that the term “at least as likely as not” does not mean “within the realm of possibility.”  Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it.  A complete rationale should be provided for all opinions or conclusions expressed.  It should be noted that the Veteran is competent to attest to 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.  [CONTINUED ON NEXT PAGE] If any opinion cannot be provided without resorting to mere speculation, provide a complete explanation stating why, to include explaining whether the inability to provide a more definitive opinion is the result of a need for additional information or that you have exhausted the limits of current medical knowledge. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.