Citation Nr: 21040926 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-24 193A DATE: July 7, 2021 REMANDED Entitlement to service connection for malignant basal cell carcinoma (BCC) of the right leg/thigh, to include as secondary to service-connected actinic/seborrheic keratosis, is remanded. Entitlement to an initial compensable rating prior to May 31, 2011, and in excess of 10 percent from May 31, 2011, to November 15, 2020, for paroxysmal atrial fibrillation (AFib), is remanded. REASONS FOR REMAND The Veteran had active naval service from January 1981 to January 2001. These matters come before the Board of Veterans' Appeals (Board) on appeal from June 2012 and June 2015 rating decisions issued by the VA Regional Office (RO). This case was previously before the Board in June 2018 and September 2019, at which time the issues currently on appeal were remanded for additional development. In a November 2020 rating decision, the RO granted a 30 percent rating for paroxysmal AFib, which is the highest schedular rating allowable for that disability, effective November 16, 2020. That represents only a partial grant of the benefits sought on appeal. The case has now been returned to the Board for further appellate action. 1. Service Connection BCC of the Right Leg/Thigh The Veteran has contended that her BCC of the right leg/thigh is related to her active service or secondary to her service-connected actinic/seborrheic keratosis. Specifically, she reported that 20-years of intense sun exposure combined with her service-connected actinic/seborrheic keratosis resulted in malignant BCC. The Veteran was last afforded a VA examination for her BCC of the right leg/thigh in January 2020. The examiner opined that the Veteran's BCC was less likely than not caused by her active service. The examiner found no evidence of BCC during service. Further, the examiner opined that the Veteran's BCC was less likely as not proximately due to, the result of, or aggravated by her service-connected actinic/seborrheic keratosis. The examiner stated that BCC and seborrheic keratosis (SK) were fundamentally different pathologically. The examiner added that research showed that malignant tumor development within a SK was extremely rare. The Board finds that the examiner did not address the Veteran's lay assertions, to specifically include intense sun exposure during service. Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, an addendum VA medical opinion is warranted. 2. Increased Rating Paroxysmal AFib The Veteran was last afforded a VA examination for her service-connected paroxysmal AFib in November 2020. The examiner relied on self-reported cardiac monitor results from approximately 2015. However, the Board finds that objective diagnostic test results in or around 2015 have not been associated with or referenced on the record. Furthermore, the November 2020 VA examiner did not review or address the most recent private medical records an October 2018 ECG report and an October 2019 30-day cardiac event monitor. As such, the Board finds that the Veteran should be provided an additional VA examination for rating purposes. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, return the claims file to the same VA examiner who conducted the January 2020 VA examination for an addendum opinion to determine the nature and etiology of any currently present basal cell carcinoma (right leg/thigh). The claims file must be reviewed by the examiner. Based on the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that basal cell carcinoma (right leg/thigh) had its onset during the Veteran's active service, or is otherwise etiologically related to such service. In forming the opinion, the examiner must address the Veteran's sun exposure during service. Additionally, the examiner should determine whether it is at least as likely as not (50 percent or better probability) that the Veteran's basal cell carcinoma (right leg/thigh) was caused or aggravated (chronically worsened) by her service-connected actinic/seborrheic keratosis. In forming the opinion, the examiner must address the Veteran's sun exposure during service. The rationale for all opinions expressed must be provided. If the January 2020 VA examiner is unavailable, the claims file should be forwarded to another examiner with the appropriate expertise to offer the requested medical opinions. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinions. 3. Then, schedule the Veteran for a VA examination to determine the current level of severity of all impairment resulting from her service-connected paroxysmal atrial fibrillation. The claims file must be made available to and reviewed by the examiner. Any indicated studies must be performed. The examiner should provide all information required for rating purposes, to specifically include addressing an October 2018 ECG report and an October 2019 30-day cardiac event monitor documented in the Veteran's private medical records. 4. Confirm that the VA examination reports and medical opinions provided comport with this remand, and undertake any other development determined to be warranted. 5. Then, readjudicate the appeal. If a decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ware, 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.