Citation Nr: 21008450 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 20-08 875 DATE: February 17, 2021 REMANDED Entitlement to an initial compensable evaluation for a scar, status post Mohs surgery for squamous cell carcinoma forehead, to include whether separate compensable evaluations are warranted for actinic keratosis is remanded. REASONS FOR REMAND The Veteran had active service from September 1959 to September 1961. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the electronic claims file. 1. The Claim on Appeal is Remanded. In addressing the issue on appeal, the Board has considered how the Veteran’s disability should best be characterized to most accurately reflect the disabilities at issue. In this regard, the Board recognizes the July 2018 Board decision granted service connection for a squamish cell carcinoma on the forehead based in part on a May 2018 private physician’s opinion. A review of the May 2018 and the July 2018 Board decision reflects that the private physician indicated that the Veteran’s current “skin conditions” had “their genesis” as a result of his active military service. There are multiple VA and private examinations and correspondence of record that document multiple skin disabilities. Specifically, a January 2017 private physician’s letter indicated the Veteran is diagnosed with actinic keratosis and opined that the condition was incurred during military service. Next, an August 2017 private physicians letter indicated the Veteran was diagnosed with numerous actinic keratosis (precancerous proliferations of skin) and a squamous cell carcinoma on the forehead. There are also two separate May 2018 private physician letters (both doctors have the initials J.B.). In the first letter, a private physician indicated the Veteran was diagnosed with actinic keratosis distributed on the scalp and various locations on the forehead. The physician also stated that in May 2014 the Veteran was diagnosed with a minimally invasive squamous cell carcinoma with involved margins located on the forehead and then indicated that actinic keratosis often develops into squamous cell carcinoma. The physician then added that treatment for actinic keratosis could include, but is not limited to liquid nitrogen, topical ointments, or surgical removal and that treatment for squamous cell carcinoma includes mostly Mohrs surgery, surgical excision, electrodessication, and curettage or radiation therapy. The second May 2018 letter is discussed above. In July 2018, the Board granted the claim and characterized it as entitlement to service connection for squamous cell carcinoma. An August 2018 rating decision implemented the July 2018 Board decision and assigned a non-compensable evaluation for a scar, status post Mohs surgery for squamous cell carcinoma forehead. However, as noted on the August 2018 rating decision, the Veteran field an initial claim for “ skin cancer.” The Veteran filed a timely notice of disagreement and this appeal followed. Following a Decision Review Officer Hearing, the Veteran submitted another private physician letter that indicated he was seen in the physician’s office in March, April, May, October, and November 2018, three times in 2017, and three times in 2016. A review of the record indicates these private treatment records are not part of the record. The Veteran then submitted private DBQ’s in April 2019 and May 2019 and underwent a VA examination in January 2020. The January 2020 VA examination indicated the Veteran underwent an additional biopsy for squamous cell carcinoma vs. actinic keratosis in April 2019. As an initial matter, the Board notes that in completing the DBQ’s the various VA and private examiners have documented multiple scars with varying measurements that preclude rating the disabilities at this time. Next, while the passage of time alone does not warrant a new examination, given the Veteran's complaints of worsening, reports of additional treatment, and outstanding private records, the Board finds that a current examination is necessary. Palczewski v. Nicholson, 21 Vet. App. 174 (2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Contact the Veteran and his representative and ask them to provide sufficient information and necessary authorization in order to obtain copies of any outstanding records of treatment by non-VA health care providers for the skin disabilities. The letter should invite the Veteran and his representative to submit any pertinent medical evidence in support of his claim. If the Veteran or his representative provides the necessary information and authorizations, obtain any outstanding clinical records and incorporate them into the electronic claims file. Particular efforts should be made to obtain all treatment records from Dr. Julie B. and Dr. Jeffery B. 2. Associate any outstanding VA treatment records with the electronic claims file. 3. After completion of the above-stated development. The Veteran should then be afforded a VA examination by a dermatologist to determine the current severity of his service-connected squamous cell carcinoma AND the nonservice connected actinic keratosis. The entire record must be made available to and be reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his service-connected squamous cell carcinoma and nonservice connected actinic keratosis. Any indicated evaluations, studies, and tests should be conducted. The dermatologist must comment on whether the currently diagnosed squamous cell carcinomas and actinic keratosis are part of the same disability or are separate disabilities. The examiner must address each of the following inquiries: a) The examiner should describe all symptoms associated with the Veteran's service-connected skin disabilities, to include any functional effects. b) The examiner must also determine the area (in centimeters or inches) of body coverage of all manifestations of the skin disabilities. c) The examiner should also discuss whether any treatments, including topical treatments, constitute systemic therapies, such that they affected the body as a whole. If so, the examiner must indicate whether the Veteran's skin disabilities require continuous systemic medication for control; intermittent systemic immunosuppressive therapy for control; and/or continuous immunosuppressive therapy. All examination findings/testing results, along with a complete, clearly-stated rationale for any opinion offered, must be provided. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Teague, 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.