Citation Nr: 22016497 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 17-47 419 DATE: March 22, 2022 REMANDED Entitlement to service connection for tonsillar basaloid squamous cell carcinoma with lymph node metastases, claimed as the result of herbicide agent exposure, is remanded. REASONS FOR REMAND The Veteran had active service from April 1969 to February 1971. He served in the Republic of Vietnam and was awarded the Combat infantry Badge and the Air Medal. Entitlement to service connection for tonsillar basaloid squamous cell carcinoma with lymph node metastases, claimed as the result of herbicide agent exposure, is remanded The Veteran asserts that service connection for tonsillar cancer is warranted as his treating Department of Veterans Affairs (VA) physicians have related the disability to his presumed exposure to herbicide agents in the Republic of Vietnam. In his March 2017 Notice of Disagreement, VA Form 21-0958, the Veteran indicated that "I developed cancer of the lymph nodes and throat cancer" and "my VA doctors advised me to file a claim for service connection for those cancers as they felt it was due to my exposure to Agent Orange." Clinical documentation of the cited VA medical opinions is not of record. VA should obtain all relevant VA treatment records which could potentially be helpful in resolving the Veteran's claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The report of a July 2016 VA throat examination states that the Veteran was diagnosed with tonsillar basaloid squamous cell carcinoma with right lymph node metastases. The examiner concluded that "the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness." The VA physician assistant opined that "the basaloid squamous cell carcinoma with marker of human papillomavirus is not a presumptive of Agent Orange;" "it is not believed by this examiner that there is a nexus of the Veteran's cancer and Agent Orange;" and "therefore, the Veteran's tonsillar cancer (which is not a laryngeal cancer) is less likely than not (<50%) due to Agent Orange or active service duty." The examiner did not provide a rationale for her conclusion that the diagnosed disability was not related to the Veteran's presumed herbicide agent exposure other than "it is not a presumptive of Agent Orange." She did not note or otherwise address the Veteran's subjective history of being told by his treating VA physicians that the tonsillar cancer was related to his presumed herbicide agent exposure. Therefore, the Board of Veterans' Appeals (Board) finds that the examination report to be of essentially no probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further VA throat evaluation is needed. The matters are REMANDED for the following action: 1. Associate with the record any VA clinical documentation that is not already of record. 2. Schedule the Veteran for a VA examination conducted by an appropriate physician to assist in determining the relationship between the tonsillar basaloid squamous cell carcinoma and active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should opine whether it is at least as likely as not (50 percent probability or greater) that the tonsillar basaloid squamous cell carcinoma had its onset during active service or is related to any incident of service to include the Veteran's presumed exposure to herbicide agents while in the Republic of Vietnam. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Smith, 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.