Citation Nr: 21016218 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 20-03 136 DATE: March 22, 2021 REMANDED Entitlement to service connection for skin cancer, to include malignant melanoma, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1965 to August 1968. The Veteran had nautical service in the offshore eligible waters of the Republic of Vietnam; accordingly, he is presumed to have been exposed to herbicide agents pursuant to the Blue Water Navy Vietnam Veterans Act of 2019. See 38 U.S.C. § 1116A. This appeal comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Board remanded the claim for further development. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7 107(b). Entitlement to service connection for skin cancer, to include malignant melanoma, is remanded. The Veteran, and his representative, contends that his skin cancer is related to a Navy initiation process, in which, he developed severe sunburn. Additionally, the Veteran has raised the argument that his disability is secondary to in-service exposure to herbicide agents. See Correspondence (February 2018). For reasons explained below, the Board finds that remand is necessary. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). As an initial matter, the Board notes that, in September 2020, the claim was remanded for a VA medical opinion. The record reveals that VA obtained a medical opinion in November 2020, and addendum medical opinions in December 2020, and in January 2021. First, although a medical opinion was obtained, the medical opinion, however, is inadequate because it does not fully answer the Board’s questions. Specifically, the September 2020 Board remand directed the agency of original jurisdiction to obtain a medical opinion on the question of whether the Veteran’s skin disability stemmed from in-service exposure to herbicide agents, only if the Veteran was found to have been exposed to herbicide agents while in service. A November 2020 VA memorandum, subsequently, conceded that the Veteran was exposed to herbicide agents. In December 2020, VA requested an opinion on the following: Does the Veteran have a diagnosis of (a) skin cancer, that is at least as likely as not (50 percent or greater probability) incurred in or caused by (the) exposure during service? See C&P Exam (January 2021). Of note, the restatement of the requested opinion does not mention conceded in-service exposure to herbicide agents. The ensuing medical opinion additionally does not show that in-service exposure to herbicide agents was considered in concluding that: The diagnosis of (a) skin cancer was less likely than not incurred in or caused by (the) exposure during service. Id. Indeed, a review of the rationale provided in the opinion does not reference or even mention in-service exposure to herbicide agents. Given the above, the Board may not rely upon the opinion in its present form and, therefore, finds the opinion is inadequate for adjudicative purposes. Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, as the Board has a duty to ensure compliance with the terms of its remand, remand is again required. Stegall, 11 Vet. App. 268. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. The matter is REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical seen for symptoms, diagnosis, and treatment of his skin disability, to include from Arlington Dermatology. Make two requests for the authorized records from all identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s skin disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran’s reported symptoms, including the nature, onset, progression and severity of any symptom consistent with any skin disability. The clinician must opine on: (a) Whether any skin disability, to include malignant melanoma, at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease. Consider and expressly address (a) the Veteran’s theory that his disability stems from a Navy initiation process, in which, he developed severe sunburn, and (b) conceded in-service exposure to herbicide agents. The opinion must identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). Further, the rationale must reflect an analysis based on causation rather than association. It is noted that direct service connection requires a causal relationship (not an association) between the current disability and the in-service disease or injury. 3. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.