Citation Nr: 21030218 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 14-43 880 DATE: May 18, 2021 REMANDED Entitlement to service connection for malignant melanoma is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1984 to October 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in August 2018. The transcript is of record. This matter was previously before the Board in May 2019, at which time it was remanded for development. It has been returned to the Board for appellate review. 1. Entitlement to service connection for malignant melanoma is remanded. Although it regrets the additional delay, the Board finds a remand necessary to afford the Veteran an adequate VA medical examination and opinion as to etiology in this case. The May 2019 Board remand ordered a VA examination and directed the examiner to comment as to etiology, to include opinions as to whether malignant melanoma was etiologically related to groundwater contamination at Camp Lejeune, and whether the condition was related to in-service sun exposure. The opinion furnished by the examiner who conducted the February 2021 examination indicated only that "[t]he medical literature does not support the claim that malignant melanoma is due to environmental exposures such as was seen at Camp Lejeune," without further explanation, adding that "[t]here is an increased risk...with sun exposure, [but] risks and associations do not rise to the level of causation that is needed in order to connect one condition to another." The examiner then produced a journal article (in full) related to causative factors associated with malignant melanoma, which appears to indicate that sun exposure is a prominent factor in the development of the condition, and that other skin conditions are also associated with the development of malignant melanoma. Critically, the examiner's opinion, to include the copied and pasted journal article, does not address the Veteran's specific contentions in this case, particularly with respect to in-service sun exposure. The medical record reveals the Veteran has no family history of malignant melanoma. He has credibly averred that he has been judicious about minimizing harmful sun exposure since separation. Most importantly, he carries another skin-related diagnosis, private treatment records showing the Veteran has been diagnosed with actinic keratosis. As noted above, the article produced by the VA examiner specifically notes that other skin conditions may be associated with malignant melanoma, but the possibility of such a link in the Veteran's case, including whether his actinic keratosis may be service-related, is never explored by the VA examiner. On remand, a new VA examination must be conducted and an adequate medical opinion obtained. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, update the file with any VA or private treatment records relevant to the Veteran's claims. If any requested records are unavailable, the Veteran should be notified to that effect. 2. Then, schedule the Veteran for a VA examination to explore the etiology of his malignant melanoma. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request. The examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that malignant melanoma began in service or is otherwise related to service, to include as a result of contaminated water at Camp Lejeune, or as a result of in-service sun exposure. The examiner should afford due consideration to and consider as credible the Veteran's lay statements, both as offered at the examination and as reflected in the documentary evidence of record, and both with respect to exposure to contaminated water at Camp Lejeune, and to in-service sun exposure and post-service sun exposure. The examiner should also comment on whether, on an at least as likely as not basis, malignant melanoma is related to actinic keratosis in the Veteran's case, and if so, whether actinic keratosis is etiologically related to active service on any of the bases enumerated above, or any other basis. A thorough rationale should be offered for all opinions expressed. 3. Review the opinion and any examination report to ensure that it is in complete compliance with the directives of this remand. 4. If the benefit sought on appeal is not granted, the Veteran and his representative must be furnished a supplemental statement of the case GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sahraie, 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.