Citation Nr: 23017271 Decision Date: 03/20/23 Archive Date: 03/20/23 DOCKET NO. 17-47 061 DATE: March 20, 2023 REMANDED Entitlement to service connection for a skin disability, to include basal cell carcinoma and actinic keratosis is remanded. REASONS FOR REMAND The Veteran had active service from December 1985 to November 1996. This matter comes before the Board of Veterans Appeals (Board) on appeal from a rating decision issued in July 2015 by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). The Veteran testified before the undersigned Veterans Law Judge (VLJ) in May 2022. A transcript of the hearing is of record. This case was previously before the Board in August 2022 when it was remanded for additional development. It has now returned to the Board for further appellate action. The medical evidence demonstrates that the Veteran has skin disabilities including basal cell carcinoma and actinic keratosis diagnosed during the appeal period. Such has been explicitly acknowledged by the AOJ. See January 2023 supplemental statement of the case. Additionally, because the evidence indicates that the Veteran has different diagnoses than his initially claimed "skin disease Gulf War" disability, the Board has expanded the scope of the claim to encompass any diagnosis raised by the record. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board previously remanded this claim to obtain an additional examination and medical opinion to address whether the Veteran's currently diagnosed skin disability during the period on appeal (despite whether they resolved) was related to his active service. Such was to include the question of whether the Veteran's diagnosed basal cell carcinoma was related vaccinations and/or his exposure to sunlight, burn pits, and/or other environmental hazards in Southwest Asia, to include exposure to chemical and biological agents. The Veteran failed to appear for a VA examination. See November 2022 VA correspondence. However, the Exam Scheduling Request indicated that "the Veteran does need to report for all examinations for the following Contention: skin disability to include basal cell carcinoma". This comment raises the question as to whether the Acceptable Clinical Evidence (ACE) process could have been utilized to address the questions posed by the Board in its Remand. Indeed, given that basal cell carcinoma and actinic keratosis were diagnosed during the appeal period, and there is known exposures during the Veteran's service in Southwest Asia, the Board finds the information needed could be provided without an examination. On remand, an examiner should be asked to respond to the remand directive independent of a physical examination. The matters are REMANDED for the following action: Send the claims file to an appropriate clinician for review and to obtain an opinion on the etiology of the Veteran's skin disability, to include basal cell carcinoma and actinic keratosis. If an in-person physical examination is deemed necessary, the examiner should state such and provide an explanation. Following review of the claims file, the clinician should respond to the following: Is it at least as likely as not (the likelihood is at least approximately balanced or nearly equal, if not higher) that a diagnosed skin disability, to include basal cell carcinoma and actinic keratosis had its onset during service or is otherwise related to service to include vaccinations and/or exposure to sunlight, burn pits, and/or other environmental hazards in Southwest Asia? In providing an answer to the above question consideration should be given to the September 1996 Report of Medical Assessment noting recurrent dermatitis with an onset of symptoms "after duty in Gulf." A comprehensive rationale must be furnished for all opinions expressed. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. 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.