Citation Nr: 22036167 Decision Date: 06/22/22 Archive Date: 06/22/22 DOCKET NO. 18-00 344A DATE: June 22, 2022 REMANDED Entitlement to service connection for squamous cell cancer of the tongue (claimed as throat cancer) is remanded. REASONS FOR REMAND The Veteran served in the United States Marine Corps June 1968 through June 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Board remanded the Veteran's claims for further development. Entitlement to service connection for squamous cell cancer of the tongue Although the Board regrets the additionally delay, a remand is necessary in order to determine whether the Veteran's squamous cell cancer (SCC) of the tongue (claimed as throat cancer) is etiologically related to his active service. He maintains that his cancer was caused by his presumed exposure to contaminated water at Camp Lejeune and/or herbicide agents while stationed in Vietnam. The Veteran was provided a VA examination in December 2015. Here, the examiner provided a negative nexus opinion. The examiner's rationale was that in the presence of a substantial smoking history and alcohol, with relatively short exposure to contaminated water at Camp Lejeune, this disease is unlikely related to exposures. However, the rationale did not discuss the Veteran's contentions that his disability is due to his presumed herbicide exposure in Vietnam nor the medical articles that the Veteran submitted. The Board remanded the case in October 2019 for a VA medical opinion regarding the etiology of the Veteran's squamous cell cancer of the tongue. In March 2020, a VA examiner provided a negative nexus opinion. The examiner supported their opinion in part with the rationale that the tongue is not anatomically a part of the throat, and that the oral pharynx structure is not associated with Agent Orange. Additionally, the examiner stated that the argument that squamous cell cancer is related to Agent Orange is "not entirely true as SCC of skin is not currently recognized as due to [agent orange]." The Board notes that while it is true that SCC of the tongues is not a disability that is presumed to be due to Agent Orange or contaminated water, that does not prevent the Veteran from making a claim for disability on a direct basis. Specifically, the Court of Appeals for the Federal Circuit has also established that when a claimed disease is not included as a presumptive disease, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during the service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Further, the medical opinions of record do not address the medical literature submitted by the Veteran. Therefore, a remand is necessary to obtain an addendum medical opinion. The matters are REMANDED for the following action: Obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's squamous cell cancer of the tongue. A physical examination should be scheduled if such is deemed necessary by the examiner. After reviewing the claims file, to include the December 2015 and March 2020 VA examination reports, the examiner must opine: Whether the Veteran's squamous cell cancer of the tongue is at least as likely as not related to his service, to include as a result of presumed exposure to herbicide agents in Vietnam and/or exposure to contaminate water at Camp LeJeune. A fully explained rationale for the requested opinions should be provided, to include review and discussion of the medical literature the Veteran submitted. (Continued on the next page) Please note that simply stating that squamous cell cancer of the tongue is not on the list of conditions presumptively related to exposure to herbicide agents or exposure to contaminated water at Camp LeJeune is not a sufficient rationale for a negative opinion. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lent, Edward 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.