Citation Nr: 21029023 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 19-37 068 DATE: May 12, 2021 REMANDED Entitlement to service connection for residuals of sinus cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1972 to September 1974. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that this matter has been advanced on the docket pursuant to 38 C.F.R. § 20.900(c). Entitlement to service connection for sinus cancer is remanded. The Veteran contends that he developed maxillary sinus squamous cell cancer due to his exposure to contaminated drinking water at Camp Lejeune and due to sinus infections he suffered during active duty service. Remand is required for a VA examination. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (2016). VA's duty to assist includes providing a medical examination when necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). The RO did not provide the Veteran with an examination for his maxillary sinus squamous cell cancer residuals. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a diagnosed disability or symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). The Board notes that the evidence is clear that the Veteran was diagnosed with maxillary sinus squamous cell cancer in October 2013 and had surgery for the removal of such. VA treatment records and the Veteran's lay statements reflect that the Veteran has been cancer free since the October 2013 surgery but that he suffers from residuals as a result of the surgery. The Veteran provided a September 2016 Journal of Clinical & Diagnostic Research article titled "Carcinoma of Maxillary Sinus Masquerading as Odontogenic Infection" which provides that the most common risk factors for maxillary sinus cancer are smoking and a history of chronic sinusitis and that other risk factors include air pollution or occupational exposure to chemical substances, such as formaldehyde, chromium, and nickel. The Veteran was stationed at Camp Lejeune and has been presumed to have been exposed to contaminated water while stationed there. In addition, February 1972 and April 1973 service treatment records indicate that the Veteran had sinus related symptoms. Remand is required to determine whether the Veteran's maxillary sinus squamous cell cancer and residuals are etiologically related to his exposure to contaminated drinking water or to his in-service sinus complaints. On remand, the VA examiner should also consider the Veteran's other reports contained in VA treatment records pertaining to his sinus problems. A July 2013 VA treatment record notes that the Veteran reported sinus problems for the past year and had recent dental work. The Veteran also reported that his sinus problems may be related to his work as an artist and inhalation of granite, marble, and dust thru his mask. September 2013, November 2013, January 2014, March 2014, and May 2014 VA treatment records note that the Veteran reported that his sinus symptoms began after he suffered a hydrochloric acid burn to his intranasal cavity one year prior. And, a September 2014 VA treatment record notes that the Veteran was a smoker for 7 years before quitting in 1975. Accordingly, the Veteran's claim for sinus cancer with residuals thereof is remanded. By this remand, the Board makes no determination, express or implied, concerning the credibility of the Veteran's statements and contentions. The matters are REMANDED for the following action: 1. Schedule a VA examination to determine the nature and etiology of the Veteran's sinus cancer and residuals. The Veteran's claims file, to include a copy of this remand, must be made available to the examiner in conjunction with the examination along with any other information the medical professional deems pertinent. A note that it was reviewed should be included in the opinion. The examiner is asked to provide an opinion addressing the following: Is it at least as likely as not (50 percent probability or more) that the Veteran's sinus cancer and residuals are causally or etiologically related to his military service, to include the Veteran's exposure to contaminated drinking water at Camp Lejeune and his reports of sinus problems during active duty service? The VA examiner should also consider the Veteran's reports contained in the July 2013, September 2013, November 2013, January 2014, March 2014, and May 2014 VA treatment records, as mentioned above. 2. Then, readjudicate the claim. If the determination of the claim remains unfavorable to the Veteran, then issue a Supplemental Statement of the Case and afford him a reasonable period of time to respond before returning the case to the Board. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Palombi 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.