Citation Nr: 21041347 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 14-03 757 DATE: July 8, 2021 REMANDED Entitlement to service connection for floor-of-the-mouth cancer is remanded. Entitlement to service connection for loss of sensation of the tongue is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1964 to June 1967. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In a June 2015 decision, the Board denied the issues and the Veteran timely appealed to the United States Court of Appeals for Veterans Claims. The Court issued an August 2016 memorandum decision vacating the June 2015 decision and remanding back to the Board to obtain an adequate nexus opinion. The Board remanded the issues in January 2018, July 2019, and March 2021 to obtain missing documents, including the November 2008 initial claim for service connection and the March 2010 Notice of Disagreement, and adequate opinions. 1. Entitlement to service connection for floor-of-the-mouth cancer. 2. Entitlement to service connection for loss of sensation of the tongue. Although the Board regrets additional delay, because VA did not obtain adequate opinions following the Board's July 2019 remand directives, there has not been substantial compliance and another remand is necessary. The July 2019 Board remand directives instruct the VA examiner to specifically address whether the Veteran's floor-of-mouth cancer is related to his presumed herbicide agent exposure. The January 2020 VA examiner addressed the Veteran's presumed herbicide agent exposure, but only in a conclusory statement that the Veteran's floor-of-mouth cancer is unlikely related to presumed herbicide agent exposure. The clinician did not provide an explanation why it is unlikely herbicide agents had any role in the Veteran's floor-of-the-mouth cancer. As such, the Board finds the opinion inadequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). In addressing the Veteran's loss of sensation of the tongue, the clinician found it less likely than not related to service; however, the clinician's rationale was based solely on the conclusion that the Veteran's floor-of-the-mouth cancer was not related to service. As the Board has found the floor-of-the-mouth cancer opinion inadequate, the opinion on the Veteran's loss of sensation of the tongue is also rendered inadequate. In consideration of the above, the Board finds a remand for new VA opinions is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for new VA examinations to address the nature and etiology of his 1) floor-of-the-mouth cancer and 2) loss of tongue sensation. The examinations should include any diagnostic testing or evaluation deemed necessary. Access to the electronic claims file, including a copy of this remand, must be made available for the examiner to review. The examination report must include a notation that this record review took place. The Veteran must be interviewed. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. The VA examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. The examinations should include any diagnostic testing or evaluation deemed necessary for each specific claimed disability. The VA clinician must respond to the following inquiries: (a) Regarding the Veteran's floor-of-the-mouth cancer, the clinician should state whether it is at least as likely as not (i.e. a 50 percent chance or greater) that the cancer is due to or otherwise etiologically related to the Veteran's presumed exposure to herbicide agents. (b) If the answer to (a) is negative, the clinician should state whether it is at least as likely as not (i.e. a 50 percent chance or greater) that the cancer is due to or is otherwise etiologically related to the Veteran's military service. (c) Regarding the Veteran's loss of tongue sensation, the clinician should state whether it is at least as likely as not (i.e. a 50 percent chance or greater) that the loss of tongue sensation is due to or is otherwise etiologically-related to the Veteran's military service. (d) If the answer to (c) is negative, the clinician should state whether it is at least as likely as not (i.e. a 50 percent chance or greater) that the loss of tongue sensation is proximately due to or aggravated by the Veteran's floor-of-the-mouth cancer. (Continued on the next page) The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, the examiner must provide the reasons why an opinion would require speculation, including whether there was any further need for information or testing necessary to make a determination, or whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the specific examiner. Marissa Caylor Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lee Feldman, 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.