Citation Nr: 21030747 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-31 373 DATE: May 19, 2021 REMANDED Entitlement to service connection for a skin condition, to include basal cell carcinoma and keratotic lesions, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1981 to June 1985, November 1990 to May 1991, March 2003 to May 2003, and May 2006 to September 2007, with additional service in the Reserves. In April 2019, he testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is of record. The Board most recently remanded the claim in September 2019 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The claim must be remanded again because the March 2020 and February 2021 medical opinions are inadequate. It is also unclear whether complete service treatment records (STRs) have been obtained. There is a formal finding that records related to the period March 2003 to May 2003 are unavailable. The rating action on appeal referenced STRs from "October 1983 through August 2007." The Veteran entered active duty in June 1981; there is no reference to whether related STRs are available. All appropriate action must be taken to determine that all available STRs are associated with the record. Then, a medical opinion is needed. The claim must be remanded again because the medical opinions obtained on remand are inadequate. A March 2020 examiner provided a negative on basal cell carcinoma as a result of chemical exposure but said it was "likely due to sun exposure while working a[s] a mechanic in Desert Storm." In contrast, a February 2021 VA opinion concluded that the basal cell carcinoma was not likely related to the Veteran's service in Southwest Asia, given his 5 month period in that area in 1991, that it takes "several years" to develop skin cancers, and that he had a lesion removed in 1991. That examiner also questioned whether the diagnosis was in fact basal cell carcinoma, or his keratotic lesions. The examiner did not address the Veteran's service prior to 1991 or consider all of his treatment records. The examiner noted they reviewed "the available records since 2011" and that the Veteran has not demonstrated recurrence in the "last 30 years." That statement is contradictory since 2011 was only 10 years ago. Remand is needed for a more thoroughly reasoned addendum opinion. The matters are REMANDED for the following action: 1. Ask the Veteran to identify any providers who treated him for skin complaints since 2019. Take all appropriate action to obtain records from identified providers as well as any VA treatment records since 2020. 2. Obtain the Veteran's complete service treatment records. 3. After completion of the foregoing, obtain an addendum opinion regarding the likely etiology of any diagnosed skin disability, to include basal cell carcinoma and keratotic lesions. Based on a review of the complete record, the examiner is requested to provide an opinion addressing the following: (a) Identify all skin conditions diagnosed since July 2011. (b) Is it at least as likely as not that any skin condition diagnosed since 2011, is related to the Veteran's service, to include (i) exposure to chemicals in Southwest Asia or (ii) sun exposure during service. The examiner should specifically identify the evidence relied upon in answering the above. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.E. Bresler, 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.