Citation Nr: 21021607 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 09-30 337 DATE: April 13, 2021 REMANDED The claim of entitlement to service connection for basal cell carcinoma, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 through July 1971, which includes honorable service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (BVA or Board) on appeal from a May 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2018, the Board issued a decision which denied the Veteran’s claim of entitlement to service connection for basal cell carcinoma, to include as due to herbicide exposure. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In July 2019, the Court granted a Joint Motion for Remand (JMR), which set aside the Board’s February 2018 decision and remanded the matter for further adjudication consistent with the Joint Motion. In December 2019 and October 2020, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) for additional development. The appeal has since returned to the Board. The claim of entitlement to service connection for basal cell carcinoma, to include as due to herbicide exposure, is remanded. The Veteran contends that his basal cell carcinoma, which was first diagnosed in May 2007, is related to his service, to include as due to his herbicide exposure and/or his in-service sun exposure. Specifically, the Veteran has alleged that he had “extreme” sun exposure in service. In October 2020, the Board remanded the Veteran’s claim with directions to the AOJ to obtain an additional VA examination to consider, in relevant part, whether the Veteran’s basal cell carcinoma was related to his in service sun exposure. The Board cited to the previous January 2020 VA examiner’s negative opinion, which was premised on the rationale that the Veteran had spent three years on active duty and 25 years post-service in Florida working outdoors. The January 2020 VA examiner explained that, while his time in active duty may have played a role in developing basal cell carcinoma on the left air, it is felt that the Veteran’s 25 years of living in Florida and working outdoors was the prevailing fact that more likely than not accounted for his cancer. In November 2020, a VA examiner opined that the Veteran’s basal cell carcinoma was less likely than not related to his service, to include his herbicide and sun exposure in-service. The examiner rationalized, in relevant part, that there is no available scientific and medical evidence supporting the conclusion that basal cell carcinoma is associated with extreme sun exposure and/or herbicide exposure during service. The Board finds the November 2020 VA examiner’s opinion is inadequate, as it failed to provide a thorough explanation for the opinion expressed. Specifically, the November 2020 VA examiner’s rationale generally states that there is no available medical or scientific evidence that the Veteran’s in-service extreme sun exposure is associated with basal cell carcinoma without identifying specific citations to the record or medical literature to support this conclusion. Relatedly, a May 2016 VA examiner previously opined that “it is widely known that prolonged sun exposure is a strong risk factor for skin cancer.” However, it is unclear whether the November 2020 VA examiner disagreed with the May 2016 VA examiner’s statement that prolonged sun exposure caused basal cell carcinoma, or whether the November 2020 VA examiner had made a determination that the Veteran’s “extreme” sun exposure in-service was not significant enough to cause basal cell carcinoma in formulating the negative opinion. To that point, the November 2020 VA examiner did not include any notations that would suggest that the duration or extent of the Veteran’s in-service sun exposure, and the effects thereof, was adequately considered. Lastly, the October 2020 Board remand requested that a VA examiner reconcile the Veteran’s contention that his basal cell carcinoma was caused by extreme sun exposure during service with the May 2016 and January 2020 VA examiners’ opinion that 25 years of living in Florida and working outdoors post-service is more likely than not to account for his basal cell carcinoma. However, the November 2020 VA examiner’s opinion and rationale was non-responsive to the Board’s request. As such, further development is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion as to the nature and etiology of the Veteran’s basal cell carcinoma. The clinician is asked to opine whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s basal cell carcinoma is related to his active duty service, to include his exposure to Agent Orange and/or exposure to the sun? In formulating an opinion, the examiner should specifically address the Veteran’s lay statements suggesting that he experienced “extreme” sun exposure in-service, which caused his basal cell carcinoma. The examiner is also asked to reconcile the Veteran’s contention that his basal cell carcinoma was caused by “extreme” sun exposure during service with the May 2016 and January 2020 VA examiners’ opinions that 25 years of living in Florida and working outdoors post-service is more likely than not to account for his basal cell carcinoma. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.B. Mmeje, 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.