Citation Nr: 21029329 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 15-12 524 DATE: May 13, 2021 REMANDED The appeal regarding entitlement to service connection for a skin condition, to include actinic keratosis and residuals of basal cell carcinoma, is remanded. REASONS FOR REMAND The Veteran, who is the Appellant in this case, had active service from July 1959 to August 1962, followed by service in the Naval Reserves. This matter comes before the Board of Veterans' Appeals (BVA or Board) from a November 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in October 2017. In a decision issued in October 2019, the Board denied entitlement to service connection for a skin condition. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In April 2020, the Court issued an order granting a Joint Motion for Remand (Joint Motion) which vacated the Board's October 2019 decision and remanded the matter for adjudication consistent with the instructions outlined in the Joint Motion. The April 2020 Joint Motion found that the February 2018 VA examination and opinion upon which the Board relied in its October 2019 decision was inadequate, in that the examiner relied on the lack of documentation of significant sunburns requiring medical attention in the service treatment records that would predispose him to the current skin conditions. In October 2020, the Board remanded the case to obtain a VA opinion that properly addressed the Veteran's statements regarding treatment, sun exposure, and sunburns during active service. While the Board regrets the additional delay, another remand is required. Review of the December 2020 VA examination and opinion and the February 2021 addendum report reveals that the examiner again relied on the absence of documentation of sunburn during active service in formulating the negative nexus opinion; while noting the Veteran's reports of sunburn in service, the examiner stated that the service treatment records were negative for sunburn. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). The Board observes that the Veteran's service personnel records corroborate his statements regarding his duties in service, which consisted of diving and would likely involve extensive sun exposure. He has stated that his service treatment records do not document the sunburns he experienced in service as the medical corpsman imbedded with his unit would treat his symptoms so that he could continue performing his duties, and that sunburn was just an accepted part of his job. The Veteran is competent to describe his sunburn in active service and there is no reason for the Board to doubt the credibility of his statements regarding experiencing sunburn in service, particularly as his diving duties would likely predispose him to sunburn. Therefore, the Board finds that a remand is necessary to obtain a VA examination and opinion regarding the nature and etiology of the skin condition, to include actinic keratosis and basal cell carcinoma, that considers the Veteran's competent and credible statements regarding experiencing sunburn in active service. The examiner should also consider the Mayo Clinic article submitted by the Veteran in July 2020 which states that basal cell carcinoma affects mainly sun-exposed areas, and that common risk factors for skin cancer include excessive UV ray exposure, a history of sunburns, particularly one or more blistering sunburns as a child or teenager, and sunburns in adulthood. The matters are REMANDED for the following action: Afford the Veteran the opportunity to attend a VA examination with an appropriate specialist to address the nature and etiology of his skin conditions. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished, and a rationale for any opinion expressed should be provided. The claims file must be made available to the examiner for review of the history in conjunction with the examination, and the examination report should reflect that such review was accomplished. The examiner should offer the following opinion: Is it at least as likely as not (i.e., to at least a 50/50 degree of probability) that the Veteran's skin conditions, to include actinic keratosis and basal cell carcinoma, were incurred during or caused by active service? The examiner should assume that the Veteran's statements regarding experiencing sunburn during active service are competent and credible and should not rely on the absence of documentation of sunburn in the service treatment records in formulating his/her opinion. The examiner should also address the Mayo Clinic article stating that basal cell carcinoma affects mainly sun-exposed areas, and that common risk factors for skin cancer include excessive UV ray exposure, a history of sunburns, particularly one or more blistering sunburns as a child or teenager, and sunburns in adulthood, as well as the skin conditions documented in the Veteran's Reserve physical examination reports in August 1976, June 1977, and September 1978. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Sherrard, 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.