Citation NR: 9713904	
Decision Date: 04/25/97		Archive Date: 05/01/97
DOCKET NO.  95-06 588	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. 
Petersburg, Florida


THE ISSUES

1.  Entitlement to service connection for residuals of 
exposure to Agent Orange, claimed as pharyngeal (throat) 
cancer. 

2.  Entitlement to service connection for skin disease.



REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

George E. Guido, Jr., Counsel





INTRODUCTION

The appellant-veteran served on active duty from June 1967 to 
December 1975.  

This matter is before the Board of Veterans’ Appeals (Board) 
on appeal of a July 1994 rating decision of the St. 
Petersburg, Florida, Department of Veterans Affairs (VA) 
Regional Office (RO).

In a Statement in Support of Claim, received in October 1994, 
the veteran claimed service connection for residuals of a 
neck injury, sustained in a vehicle accident.  In an August 
1995 Statement in Support of Claim, he sought an increased 
rating for sinusitis and to reopen the claim of service 
connection for gastrointestinal disease.  As none of these 
claims have been adjudicated by the RO, they are referred 
there for appropriate action.

The veteran’s service-connected disabilities include post-
traumatic stress disorder (PTSD) that is rated as 30 percent 
disabling.  He served in Vietnam in 1968 and 1969. 


REMAND

The veteran contends that he has cancer of the throat, not 
lymph node carcinoma, that was brought on by exposure to 
Agent Orange in Vietnam and that his skin condition, lichen 
simplex chronicus, is due to service-connected PTSD, not 
chemical exposure.  It does not appear that the RO has 
considered service connection on a secondary basis, including 
consideration under Allen v. Brown, 7 Vet.App. 439 (1995).

Non-VA medical records disclose that in October 1992 the 
veteran was evaluated for a left oral mass.  The lesion was 
in the left posterior gingiva in the retromolar trigone area.  
Examination of the larynx was normal.  A biopsy of the mass 
revealed squamous cell carcinoma.  The diagnosis was left 
retromolar trigone carcinoma.  In VA hospital records, dated 
in September/October 1994 and in October/November 1994, the 
cancer is referred to as left pharyngeal wall squamous cell 
carcinoma or carcinoma of the pharynx.  

In its July 1994 rating decision, the RO denied service 
connection for lymph node carcinoma as not shown by the 
evidence of record.  There was no service-connection 
determination as to left retromolar trigone carcinoma (left 
pharyngeal wall squamous cell carcinoma or carcinoma of the 
pharynx).

VA hospital records disclose a chronic rash on the right 
forearm (August/September 1993) and general pruritus 
(September /October 1994).  In the September/October 1994 
hospital summary, there is reference to a dermatology 
consultation that is not of record.

In light of the above, the Board determines that further 
development of the evidence is necessary for a proper 
appellate decision, and therefore remands the case to the RO 
for the following action:  

1.  Although neither pharyngeal (throat) 
cancer nor oral cancer qualifies for 
presumptive service connection under the 
regulations, pertaining to claims of 
Agent Orange exposure, 38 C.F.R. 
§§ 3.307(a)(6) and 3.309(e), this does 
not preclude the veteran from proving 
actual direct causation.  Such proof 
would require competent scientific or 
medical evidence that pharyngeal (throat) 
cancer or oral cancer was actually due to 
Agent Orange exposure.  Therefore, he may 
submit additional evidence and argument, 
pertaining to the claim of service 
connection for residuals of exposure to 
Agent Orange.

2.  The RO should obtain copies of 
hospital and outpatient records since 
1994 from the Gainesville, Florida, VA 
Medical Center.

3.  The RO should schedule the veteran 
for a dermatology examination to 
determine whether he has a chronic skin 
disease.  If a chronic skin disease is 
shown, the examiner is asked to express 
an opinion as to whether the service-
connected PTSD caused or aggravated the 
disease and, if PTSD did not cause but 
aggravated the skin disease, what 
percentage of the skin disease is the 
result of aggravation.

4.  After the above development, the RO 
should adjudicate the claims.  On the 
issue of service connection for residuals 
of Agent Orange exposure, the RO should 
consider service connection for left 
retromolar trigone carcinoma (left 
pharyngeal wall squamous cell carcinoma 
or carcinoma of the pharynx), including 
any evidence that pharyngeal (throat) 
cancer or oral cancer was actually due to 
Agent Orange exposure.  On the issue of 
service connection for a skin disease, 
the RO should determine whether the skin 
condition, if shown, is due to or 
aggravated by service-connected PTSD.


If any benefit sought on appeal remains denied, the veteran 
and his representative should be furnished with a 
Supplemental Statement of the Case and they should be given 
the requisite period of time to respond.  Thereafter the case 
should be returned to the Board.


		
	RENÉE M. PELLETIER
	Member, Board of Veterans' Appeals

(Continued on next page)

38 U.S.C.A. §  7102 (West 1991 & Supp. 1996) permits a 
proceeding instituted before the Board to be assigned to an 
individual member of the Board for a determination.  This 
proceeding has been assigned to an individual member of the 
Board.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the 
Board of Veterans' Appeals is appealable to the United States 
Court of Veterans Appeals.  This remand is in the nature of a 
preliminary order and does not constitute a decision of the 
Board on the merits of your appeal.  38 C.F.R. § 20.1100(b) 
(1996).


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