Citation Nr: 21022531 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 14-04 784 DATE: April 16, 2021 REMANDED Entitlement to service connection for skin cancer, claimed as actinic keratoses and spindle cell melanoma, is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1965 to August 1969 and from December 1990 to July 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Louisville, Kentucky. The Board recognized the Veteran’s January 2014 request for a Board hearing. However, in January 2021, the Veteran cancelled his hearing request. As such, the Veteran’s hearing request is withdrawn. 38 C.F.R. § 20.704(d). The matter on appeal was remanded by the Board in June 2015. The Board’s directed that the procedures regarding preparation of a dose estimate be completed. The remand also ordered a VA examination to discuss the Veteran’s various contentions. Unfortunately, because the RO did not substantially comply with the remand directives, the matter must be remanded again. Stegall v. West, 11 Vet. App. 268, 271 (1998). While an advisory opinion was requested, the Director, Compensation Service, stated in an August 2019 letter that an advisory opinion could not be provided as there was not enough evidence for the completion of a dose estimate. The Director indicated that a request should be submitted to the service department for a dose estimate, and that the Veteran needed to have a depleted uranium examination completed. Following those actions, the matter was to be returned to Compensation Service for additional review. The RO requested the Veteran’s records related to radiation exposure, but neither forwarded the request to the service department, nor provided the Veteran with a depleted uranium examination. The RO also did not return the matter to Compensation Service. Thus, the development identified by the Director as necessary for this claim has not been completed. The March 2020 supplemental statement of the case (SSOC) did not provide any explanation for this. Further, the Veteran was afforded a VA examination in March 2020; however, the examiner did not address the Veteran’s contention, documented in his service treatment records, that he was exposed to oil fires and oil fumes. The examiner only noted that the chemicals associated with skin cancer included arsenic, coal tars, and sunlight. The Veteran’s representative noted that burning oil releases arsenic and similar chemicals to coal tar. This contention should be addressed. Finally, the examiner listed risk factors for skin cancer, but did not indicate which of those factors applied to the Veteran. Accordingly, the Board finds a remand is warranted for further evidentiary development as the examination report is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). The Veteran’s representative has also asserted that overexposure to sunlight while in service could have resulted in the Veteran’s skin cancer. This contention should also be addressed by the examiner on remand. The matters are REMANDED for the following action: 1. Conduct the development required by the Board’s prior remand, to include the requirements noted by the Director, Compensation Service, in August 2019. This should include requesting a dose estimate from the service department once all efforts have been made to obtain information related to the Veteran’s in-service exposure. (It is unclear in the record whether a DD Form 1141 was obtained, or if one is unavailable). Also, the matter should be forwarded for a “depleted uranium examination” in accordance with the August 2019 instructions from the Director, Compensation Service (this is also addressed in remand directive number 2, below). Once this action has been undertaken, the matter should be returned to the Director as indicated by the August 2019 instructions. If any of these actions cannot be completed, the reason for this should be noted within the claims file. 2. Provide the Veteran’s entire claims file to an appropriate clinician. If it is necessary for the clinician to examine the Veteran, that should be arranged. The clinician should 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 and actinic keratoses onset in, or are otherwise due to, his military service, to include: (a.) exposure to depleted uranium (this opinion is noted as necessary by the Director, Compensation Service); (b.) exposure to oil fires and oil fumes (to include addressing the contention that burning oil releases arsenic and similar chemicals to coal tar); (c.) exposure to chemical agent, specifically in Khamisiyah in 1991; (d.) overexposure to sunlight while stationed in Guam and Kuwait. A complete rationale for all opinions should be provided. The examiner must connect all opinions made to the evidence of record and any medical literature referenced. If the examiner cannot provide a requested opinion without resorting to speculation, it should be so stated, and the examiner should provide the reasons why an opinion would require speculation. 3. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. A. ADAMSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Geer, 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.