Citation Nr: 21029696 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 15-20 769 DATE: May 14, 2021 ORDER Service connection for skin cancer is granted. REMANDED Entitlement to service connection for intraosseous meningioma is remanded. FINDING OF FACT The Veteran's melanoma, basal cell carcinoma, and squamous cell carcinoma were at least as likely as not caused by his increased sun exposure during active service. CONCLUSION OF LAW The criteria for service connection for skin cancer have been met. 38 U.S.C. §§ 1110, 5107, 7104; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to January 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office. The Veteran testified before the undersigned Veterans Law Judge during a July 2018 hearing. A transcript of that hearing is associated with the claims file. This case was previously before the Board in August 2020 when it was remanded for additional development. 1. Entitlement to service connection for skin cancer Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). The Veteran asserts that he has skin cancer as a result of his period of active service. Specifically, he alleges that his exposure to herbicide agents while serving in the Republic of Vietnam led to his eventual diagnosis of melanoma, basal cell carcinoma, and squamous cell carcinoma. The Veteran's post-service treatment records include dermatology notes and surgical pathology reports indicating excisions of malignant skin lesions throughout the appeal period. The Veteran was afforded a VA examination in October 2020. The examiner noted that the Veteran was diagnosed with melanoma on the chest; basal cell carcinoma on the forehead, neck, left clavicle, and left posterior shoulder; squamous cell carcinoma on the left shoulder; and lentigo maligna on the right ear. The examiner indicated that the cancer was in remission at that time, but noted that the Veteran had basal cell carcinoma and squamous cell carcinoma excisions in 2013, 2014, and 2016. The examiner opined that the Veteran's diagnosed melanoma, basal cell carcinoma, and squamous cell carcinoma are skin cancers that are well known to be related to sun exposure. The Veteran's service in Vietnam is likely to have significantly increased his life-time exposure to sun and increased his risk of developing skin cancer. Further, the examiner noted that there is a growing body of evidence that Agent Orange is associated with an increased risk of skin cancers like basal cell carcinoma and squamous cell carcinoma. In a December 2020 addendum opinion, the examiner stated that the Veteran's skin cancer is at least as likely as not due to increased sun exposure in Vietnam during service. Having carefully considered the evidence of record, affording the Veteran the benefit of the doubt, the Board finds that the Veteran's diagnosed skin cancer is shown to be causally or etiologically related to sun exposure during his period of active service. Accordingly, the Board finds that service connection for skin cancer is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for intraosseous meningioma is remanded. During an October 2020 VA examination, the Veteran was noted to undergo a resection of a right retro orbital meningioma in 2010. In 2016, his vision problems returned on the right and a workup showed a recurrence of the tumor around the right optic nerve. He underwent an additional resection in 2017. The examiner opined that the Veteran's claimed condition was both "at least as likely as not" and "less likely than not" incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that it is not understood what causes meningioma, but some risk factors have been identified. However, the Veteran does not have any of the known risk factors. Further, the examiner searched for medical research and was unable to find any well-established connection between meningioma and Agent Orange, as little research had been done on the topic. As it is unclear whether the examiner found a nexus, the Board finds this opinion is insufficient to adjudicate the claim. The examiner was asked whether it was "at least as likely as not" that the Veteran's meningioma was incurred in or caused by the Veteran's active service. The examiner indicated there is no "well-established connection" but noted that there was little research on the topic. Further, the examiner stated that the Veteran did not have any of the known risk factors for meningioma. An addendum opinion should be obtained based on the available medical evidence. The matters are REMANDED for the following action: Submit the file to a VA examiner to provide an addendum opinion regarding the nature and etiology of the Veteran's intraosseous meningioma. If an additional examination is deemed warranted, one should be arranged. The examiner should review the claims file, to include a copy of this remand, and provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's intraosseous meningioma had its onset in or is otherwise etiologically related to the Veteran's period of active service, to include exposure to herbicide agents therein. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner must provide a rationale for each opinion. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.