Citation Nr: 21026632 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 20-10 856 DATE: May 3, 2021 REMANDED Entitlement to service connection for a skin disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1967 to July 1970, including service in the Republic of Vietnam from October 1968 to December 1970. The Veteran had additional service in the United States Army Reserves, to include periods from July 1970 to November 1973, and from April 1976 to March 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an August 2017 rating decision, which denied service connection for squamous cell carcinoma. The Veteran filed a timely Notice of Disagreement (NOD), received in August 2018. A Statement of the Case (SOC) was issued in January 2020. A timely substantive appeal was received in March 2020. In May 2020, the Board remanded this matter for additional development. The Board finds that there has not been substantial compliance with the Board's previous remand directives regarding the Veteran's claim for service connection for squamous cell carcinoma. As such, another remand for further development is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a skin disorder is remanded. The Veteran contends that service connection is warranted for squamous cell carcinoma, to include as due to herbicide exposure. The Board notes that herbicide exposure has been conceded by virtue of the Veteran's service in Vietnam. See January 2020 SOC and May 2020 BVA Decision. Private treatment records dated June 2009 show a biopsy proven diagnosis of squamous cell cancer, which was noted on the Veteran's left temple. In July 2009, the Veteran underwent Mohs surgery to excise the skin cancer. Subsequent VA medical records show a medical history of squamous cell carcinoma. Previously, the claim was before the Board in May 2020 and was remanded for additional development, including a medical opinion to address the etiology of the Veteran's claimed skin disorder. A March 2021 VA skin diseases examination noted a diagnosis of squamous cell cancer-resolved, after excision in 2009. The Veteran continues annual skin assessments with nitrogen therapy for abnormal skin area and his squamous cell carcinoma is currently in remission. The March 2021 examiner found that the Veteran's squamous cell cancer was less likely than not incurred in or caused by an injury, event, or illness during service. The examiner stated, "The Veteran reports the skin cancer is a result of Agent Orange Exposure during military service (Vietnam). Currently, squamous cell cancer is not a presumptive disease related to Agent Orange Exposure. Therefore, squamous cell cancer is not service connected." The Board finds the examiner's opinion inadequate for adjudication purposes. The examiner failed to fully address direct service connection and did not provide an adequate rationale to support the opinion. The examiner did not discuss relevant evidence, such as the Veteran's July 2007 reports of rosacea of the face since Vietnam, and a mole on the left forehead with onset of "many yrs." An opinion based on the absence of treatment records without consideration of a Veteran's competent reports is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Additionally, the examiner did not discuss the scientific articles submitted by the Veteran's attorney in support of the contention that squamous cell carcinoma is related to herbicide exposure. See March 2020 Correspondence. The examiner's rationale merely reiterated a conceded point. An opinion which states that the Veteran's squamous cell carcinoma is less likely than not related to service because it is not presumptively related is considered inadequate. Although the Veteran is presumed to have been exposed to herbicides during service, squamous cell carcinoma is not among those diseases presumptively linked to herbicide exposure under 38 C.F.R. § 3.309(e). However, the Veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F. 3d 1039 (Fed. Cir. 1994). Therefore, the Board finds that a remand is necessary to obtain an addendum medical opinion that more thoroughly addresses direct service connection including the Veteran's contentions and the available medical evidence of record. The matter is REMANDED for the following action: Obtain an addendum medical opinion. The medical opinion should, at a minimum, reflect consideration of the documented history, the lay contentions, and medical evidence of record. The opinion should 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). The opinion must address: (a) Is it at least as likely (a 50 percent probability or greater) that the Veteran's squamous cell carcinoma was caused by, or is otherwise etiologically related to, the Veteran's active service, exposure to herbicides? (b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's squamous cell carcinoma (1) began during active service, (2) manifested within the applicable presumptive period after discharge from service, or (3) was noted during service with continuity of the same symptomology since service? The rationale for all opinions expressed must be provided. The examiner is advised that the Veteran's exposure to herbicide agents, such as Agent Orange, during his active service in Vietnam has been conceded. The examiner is further advised that a negative opinion regarding a relationship between the Veteran's squamous cell carcinoma and his exposure to herbicide agents - based solely on the fact that VA has not recognized squamous cell carcinoma as presumptive diseases related to herbicide exposure - is not an adequate opinion. Further, attention is invited to the Veteran's lay contentions noting that his squamous cell carcinoma is related to service and medical literature submitted by his representative in March 2020 suggesting that squamous cell carcinoma is related to herbicide exposure. See March 2020 Correspondence. K.R. Kardian Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.N., 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.