Citation Nr: 21009432 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 17-53 581 DATE: February 22, 2021 REMANDED Entitlement to service connection for skin cancer, to include as secondary to herbicide agent exposure and/or exposure to contaminated water at Camp Lejeune, is remanded. REASONS FOR REMAND The Veteran had active duty service from January 1958 to August 1977, to include combat duty in the Republic of Vietnam (RVN). This claim is before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veteran’s Affairs (VA) Regional Office (RO). A Travel Board hearing was held before the undersigned Veterans Law Judge (VLJ) in August 2019. A hearing transcript is of record. In October 2020, the Board most recently remanded the claim for additional development. Specifically, the Board remanded this case to obtain a supplemental medical opinion and requested that the VA examiner address and discuss the treatise articles and research study submitted by the Veteran and his representatives in June 2016, October 2017, and October 2020, which discussed Agent Orange exposure as a risk factor for developing skin cancer, and the association between skin cancer and Agent Orange exposed Vietnam era Veterans. In November 2020, the Agency of Original Jurisdiction (AOJ) procured a VA addendum medical opinion to evaluate the etiology of the Veteran’s skin cancer. The VA examiner indicated that skin cancer was not presumptively associated with Agent Orange exposure. Additionally, the examiner noted that the Veteran’s risk factors for squamous cell carcinoma included his age, fair skin, genetics, and the degree of sun exposure in the past 5 to 10 years prior to diagnosis. Ultimately, the examiner opined that the, “Veteran’s non melanotic skin cancers (SCCA-skin) is less likely than not caused by or aggravated by claimed active duty service, specifically, claimed herbicidal agent exposures while on active duty.” Nevertheless, the Board finds the VA examiner’s opinion to be inadequate. Namely, the examiner failed to address and discuss the treatise articles and research studies submitted and/or referenced by the Veteran and his representatives, which was explicitly requested in the Board’s remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, remand is warranted to obtain an addendum medical opinion. Additionally, it is noted that since November 2020 VA addendum medical opinion, the Veteran’s representative has also raised the theory that the Veteran’s skin cancer may be related to his service at Camp Lejeune. See January 2021 Written Brief Presentation. As the Veteran’s claim is being remanded for another medical opinion, the Board will also request that an opinion be provided concerning whether the Veteran’s skin cancer is etiologically related to his exposure to contaminated water at Camp Lejeune. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate VA examiner. The examiner should review the Veteran’s claims file (to include this remand) and provide an opinion as to: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin cancer is related to his active duty service, and specifically to his exposure to herbicide agents and/or contaminated water at Camp Lejeune therein. In rendering the above opinion, the examiner must specifically consider and discuss the treatise articles and research study submitted or referenced by the Veteran and his representative in June 2016, October 2017, October 2020, and January 2021 addressing Agent Orange as a risk factor for developing skin cancer and the association between the two in Agent Orange exposed Vietnam era Veterans. The examiner is also advised that the Board is cognizant that there is no VA presumption of service connection for skin cancer as due to herbicide agent exposure or as due to exposure to contaminated water at Camp Lejeune. However, the question here is what the likelihood is that this Veteran’s skin cancer is related to his exposure to herbicide agents and/or the contaminated water at Camp Lejeune, given his medical history, family history, risk factors, and etc.? (Continued on the next page)   If the examiner is unable to provide any of the requested opinions without resorting to speculation, the examiner should so specify, along with an explanation as to why that is so. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Talton, John H. 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.