Citation Nr: 18158999 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 09-49 916 DATE: December 19, 2018 ORDER Entitlement to service connection for skin cancer, to include as a result of exposure to ionizing radiation is denied. FINDING OF FACT The weight of the evidence is against a finding that skin cancer manifested in service, manifested within a year from service, or is otherwise due to active service including as due to radiation exposure. CONCLUSION OF LAW The criteria for service connection for skin cancer have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the Navy from April 1944 to May 1946 and in the Air Force from August 1947 to June 1948. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2008 rating decision by a Department of Veterans’ Affairs (VA) Regional Office. The Veteran testified before a Decision Review Officer (DRO) in October 2009 and before the undersigned Veterans Law Judge (VLJ) in August 2011. Transcripts of both hearings are associated with the record. The Board denied the Veteran’s claim in February 2012. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court). In August 2012, the Court granted the parties’ joint motion for remand and returned the appeal to the Board for action consistent with the terms of the joint motion. In September 2013 and February 2016, the Board remanded the issue on appeal for development of the record in accordance with 38 C.F.R. § 3.311. In its February 2016 remand, the Board particularly sought a dose estimate under 38 C.F.R. § 3.311(a)(2)(iii), and referral to the Under Secretary for Benefits (designee) for consideration under 38 C.F.R. § 3.311(c). Following the Board’s remand, another does estimate was obtained in May 2017. The Under Secretary then requested an advisory opinion, which was obtained in May 2017. See 38 C.F.R. § 3.311(c)(1). In June 2017, the Under Secretary then informed the RO that there was no reasonable possibility that the Veteran’s skin cancer could be attributed to ionizing radiation exposure while in military service. The RO then continued to deny the claim. The claim was returned to the Board and in August 2017, the Board determined that the advisory opinion adequately considered the Veteran’s medial history, which included skin symptoms since 1978 but remanded the claim because the advisory opinion lacked sufficient specificity for the Board to review. 38C.F.R. §4.2 In particular, the Board noted that clarification of the May 2017 advisory opinion was necessary to address the claim. Because the record raised the possibility that that Veteran’s skin cancers are attributable to sun exposure during service, the May 2017 medical advisory opinion addressed the question of whether the Veteran’s skin cancer is attributable to sun exposure, and in pertinent part states that one “could say that, based upon our research, medical knowledge, and the history of sun exposure” that the sun exposure “alone could be causative for [the Veteran’s skin cancers.]”The opinion further emphasizes that “[a]nyone who spends time in the sun may develop skin cancer, especially if the skin isn’t protected by sunscreen or clothing.” Further, the opinion notes that chronic sun exposure is the cause of almost all skin cancers, and that one “could easily opine in the negative for skin cancers.” The Board stated in its August 2017 remand that a medical opinion expressed in terms of “may” also implies “may or may not” and is too speculative to establish a causal relationship. Bostain v. West, 11 Vet. App. 124, 127-28 (1998), quoting Obert v. Brown, 5Vet. App. 30, 33 (1993). A medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999). Here, the May 2017 opinion is equivocal. The medical doctor that wrote it states that the Veteran’s sun exposure “could be causative” for his skin cancer, but also that he could easily state otherwise. Therefore, in its August 2017 remand, the Board referred the claim to the Under Secretary for Benefits for consideration under 28 C.F.R. 3.311(c) and for an addendum to the May 2017 advisory opinion. The Board directed the Under Secretary’s addendum opinion must consider, and discuss as necessary, the Veteran’s reported onset of skin problems in 1978, his initial diagnosis of skin cancer below the lower lip in 1984, and additional diagnoses thereafter. The Board also stated that the opinion should consider the Veteran’s family history of cancer, his sun exposure while living in Florida that included his hobby of golfing, and any other relevant factors. In addition, the review must consider and discuss the Veteran’s assertions that his skin cancer is related to sun exposure in service. In response to the SSOC issued in June 2017, the Veteran submitted additional evidence in support of his appeal. With his submission, the Veteran included a letter in which he requested that entitlement to service connection for thyroid disorder, claimed as thyroid cancer due to exposure to ionizing radiation, be included in his request for compensation. In July 2016, the Board denied the Veteran’s claim for service connection for thyroid disorder. As the Veteran did not appeal the decision, the Board decision is final. 38 U.S.C. § 7104 (b). Therefore, the Board no longer has jurisdiction over the claim. Entitlement to service connection for skin cancer, to include as due to ionizing radiation exposure Generally, service connection may be granted for disability or injury incurred in or aggravated by active military service. See 38 U.S.C. §§ 1110, 1131 (West 2014); 38 C.F.R. § 3.303 (2016). In order to establish service connection for the claimed disorder, there must be (1) competent evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Service connection for conditions claimed to be due to exposure to ionizing radiation in service can be established in any of three different ways. See Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, there are diseases that are presumptively service-connected in radiation-exposed veterans under 38 U.S.C. § 1112 (c) and 38 C.F.R. § 3.309 (d). Second, service connection can be established under 38 C.F.R. § 3.303 (d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311, if the condition at issue is a radiogenic disease. Third, direct service connection can be established under 38 C.F.R. § 3.303 (d) by showing that the disease was incurred during or aggravated by service without regard to the statutory presumptions. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). Under Combee, VA must not only determine whether a veteran had a disability recognized by VA as being etiologically related to exposure to ionizing radiation, but must also determine whether the disability was otherwise the result of active service. In other words, the fact that the requirements of a presumptive regulation are not met does not in and of itself preclude a claimant from establishing service connection by way of proof of actual direct causation. A “radiation-exposed veteran” is defined by 38 C.F.R. § 3.309 (d)(3) as a veteran who while serving on active duty or on active duty for training or inactive duty training, participated in a radiation-risk activity. “Radiation-risk activity” is defined to mean onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima, Japan or Nagasaki, Japan by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946; or internment as a prisoner of war (or service on active duty in Japan immediately following such internment) during World War II which resulted in an opportunity for exposure to ionizing radiation comparable to that of the United States occupational forces in Hiroshima or Nagasaki during the period from August 6, 1945 through July 1, 1946. 38 C.F.R. § 3.309 (b)(i), (ii) (2013). Diseases presumptively service-connected for radiation-exposed veterans under the provisions of 38 U.S.C. § 1112 (c) and 38 C.F.R. § 3.309 (d)(2) are: leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the esophagus, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin’s disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary glands, cancer of the urinary tract; bronchiolo-alveolar carcinoma; cancer of the bone; cancer of the brain; cancer of the colon; cancer of the lung; and cancer of the ovary. 38 U.S.C. § 1112 (c)(2); 38 C.F.R. § 3.309 (d). If a claimant does not qualify as a “radiation-exposed veteran” under 38 C.F.R. § 3.309 (d)(3) and/or does not suffer from one the presumptive conditions listed in 38 C.F.R. § 3.309 (d)(2), the veteran may still benefit from the special development procedures provided in 38 C.F.R. § 3.311 if the veteran suffers from a radiogenic disease and claims exposure to ionizing radiation in service. Under 38 C.F.R. § 3.311, “radiogenic disease” means a disease that may be induced by ionizing radiation. See 38 C.F.R. § 3.311 (b)(2) (2013). Under the special development procedures in § 3.311(a), dose data will be requested from the Department of Defense in claims based upon participation in atmospheric nuclear testing, and claims based upon participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946. 38 C.F.R. § 3.311 (a)(2) (2012). In all other claims, 38 C.F.R. § 3.311 (a) requires that a request be made for any available records concerning the veteran’s exposure to radiation. These records normally include but may not be limited to the veteran’s Record of Occupational Exposure to Ionizing Radiation (DD Form 1141), if maintained, service medical records, and other records which may contain information pertaining to the veteran’s radiation dose in service. All such records will be forwarded to the Under Secretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. 38 C.F.R. § 3.311 (a)(2)(iii) (2013). After the evidence is assembled, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104 (a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3 (2016). Here, the Veteran asserts that his skin cancer is due to exposure to ionizing radiation during his presence at Nagasaki, Japan for a period of five days, which was six weeks after the use of the atom bomb in August 1945, sun exposure during or service, or a combination of sun and radiation exposure during service. The Veteran’s DD-214 for his service in the Navy shows a military occupation as a gunner’s mate, signalman, and ship to shore radioman aboard an LCVP landing craft. The Veteran’s boat crew was assigned to the Armed Personnel Destroyer, USS Cofer (APD-62). The Veteran’s DD-214 and other service records establish that the Veteran was in Nagasaki from September 17 to 22, 1945 a part of a mission to retrieve prisoners of war. Specifically, the Veteran’s Navy Log lists South Pacific Invasions, Okinawa and Nagasaki, Japan, and USS Cofer DE-208/APD-62 as the Veteran’s duty stations. The Veteran was 18 years old at the time of his initial exposure to ionizing radiation. As noted in an April 2015 letter from the Veteran’s shipmate, he and the other service members sent to Nagasaki during this period “had to wait for [the POWs] so had time to go into the city and look around.” First, the Board finds that service connection under 38 C.F.R. § 3.309 (d), for diseases specific to radiation-exposed veterans is not warranted. Specifically, skin cancer is not a disease that may be presumptively service connected for radiation-exposed veterans. Therefore, service connection is not warranted on this basis. Under the criteria of 38 C.F.R. § 3.311, skin cancer is considered a radiogenic disease. The Veteran’s skin cancer first manifested more than five years after his exposure. The Veteran self-reported having had skin problems since 1978 and an initial diagnosis of skin cancer below the lower lip in 1984. He did not keep records prior to 1999. Progress notes from the North Florida Dermatology Associates show that, in addition to his initial diagnosis, the Veteran has been diagnosed with various skin cancers including, basal cell carcinoma (BCC) of the left upper lateral back (December 12, 2003), squamous cell carcinoma (SCC) of the right upper lateral temple (March 25, 2008), BCC left mid-nose (November 23, 2009), infiltrating BCC of the left lower nose (February 22, 2011), SCC of the right mid-parietal scalp (February 22, 2011), SCC in-situ of the left lower back (August 31, 2012), and SCC in-situ of upper helix left ear (January 20, 2015). In a letter dated November 2018 the Veteran’s dermatologist, Dr. L.S., stated that the Veteran has continued to receive treatment for cancerous and precancerous lesions. Specifically, in May 2018, the Veteran had 20 actinic keratoses treated with liquid nitrogen and in August 2018, he had an additional 20 actinic keratoses treated. As the Veteran was shown to have been exposed to ionizing radiation, a referral of this case to the Under Secretary for Benefits for an opinion as to whether sound scientific medical evidence can support the conclusion that it is at least as likely as not that the Veteran’s disease resulted from radiation exposure during service, and consideration of the factors as listed in 38 C.F.R. § 3.311 (e), was undertaken in September 2013. Wandel v. West, 11 Vet. App. 200, 204-05 (1998). The Deputy Chief Consultant for Post Deployment Health Services provided an advisory medical opinion in December 2015. A subsequent advisory opinion, dated May 2017, offered the same conclusion. While there were multiple advisory opinions issued prior to December 2015, they are not being considered by the Board because they were deemed inadequate by the Court for failing to include in their analysis consideration of the Veteran’s onset of skin problems in 1978 and his initial diagnosis of skin cancer in 1984. The December 2015 advisory opinion evaluated all of the Veteran’s documented skin cancers using the Interactive Radio Epidemiological Program (IREP) of the National Institute for Occupational Safety and Health (NIOSH). IREP was used to estimate the likelihood that exposure to ionizing radiation was responsible for the Veteran’s skin cancers. Using the data provided by DTRA, the program calculated a 99th percentile value for the total probability of causation of 30.22% for all the Veterans skin. Based upon the documented skin cancers, the IREP evaluation concluded that “it is unlikely his [the Veteran’s] skin cancer was caused by ironizing radiation from the atomic bomb.” There is no evidence that the December 2015 advisory opinion was not competent or credible, and as the opinion was based on a review of the medical evidence and the Veteran’s lay statements. As such, the Board finds it is entitled to significant probative weight as to the etiology of the Veteran’s skin cancer at the time of the examination and during the period on appeal. Nieves-Rodriguez, 22 Vet. App. 295. The Board notes that the Veteran has submitted letters from his dermatologists and his endocrine doctor that provide a positive nexus between his exposure to radiation in Nagasaki and his skin cancer. In a letter dated January 2016, Dr. F.S., who has been the Veteran’s treating dermatologist since 2000, opined that there is “a greater than 50% likelihood that his radiation exposure during military service caused his skin cancers.” Dr. F.S. has provided the Veteran with multiple letters, dated May 2008 and May 2011, providing the same opinion. The Veteran’s endocrinologist, who has treated the Veteran for a thyroid disease since 2005, stated in a letter, dated January 2012, that “due to his other medical conditions and due to his history of skin cancer, I have to believe that certainly the radiation exposure he suffered puts him at a slightly higher risk for cancers.” While there is no basis for which to doubt the competency and credibility of the private physicians who authored these letters, their medical opinions are not adequate because they do not provide a rationale, nor do they take into account the estimated dosage of radiation to which the Veteran was exposed in Nagasaki. Therefore, the Board does not find that these letters offer probative weight for establishing a nexus between the Veteran’s skin cancer and his exposure to radiation. The Board has considered the Veteran’s assertions that his current skin cancers were caused by radiation exposure in service, including the souvenir pamphlet he obtained in and held onto since his time in Nagasaki, and the account of several of his former shipmates who were diagnosed with cancer. The Board notes that the Veteran can certainly attest to factual matters of which he has first-hand knowledge, such as his experiences during service, and his assertions in that regard are entitled to some probative weight. Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). In addition, the Board recognizes that lay persons are competent to provide opinions on some medical issues. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). However, given the Veteran’s lack of demonstrated medical expertise, and the complexity of linking radiation to a diagnosis of skin cancer, the Board concludes that in this case his statements regarding any such link between the in-service events and a skin cancer disability are not probative when compared to the advisory opinion of record as provided in response to the referral by Under Secretary for Benefits. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (“[S]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer.”). Also, the Board must assess the Veteran’s individual claim based on his experiences and medical records in and post service. Therefore, the Board cannot make a determination regarding the nexus between the Veteran’s exposure to radiation and skin cancer diagnoses, by analogy, based on accounts of his former shipmates’ cancer diagnoses. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for the benefit sought under 38 C.F.R. § 3.311. Last, as previously noted, direct service connection can be established under 38 C.F.R. § 3.303 (d) by showing that the disease was incurred during or aggravated by service without regard to the statutory presumptions. See Combee, 34 F.3d at 1043-44. The Veteran has claimed his skin cancer could also be due to sun exposure or a combination of sun exposure and radiation. In October 2018, the Deputy Chief Consultant, Post Deployment Health Services issued an advisory medical opinion concerning whether the Veteran’s skin cancer was caused by sun exposure, or a combination of sun and radiation exposure in service. The advisory opinion stated that “the cause of skin cancer is sun exposure in over 90% of cases … Skin changes such as actinic keratosis is the most common precancer; it affects more than 58 million Americans and is the main cause is sun exposure. Continuing sun exposure is not advised for those with actinic keratosis. The Veteran was 58 years old when he was diagnosed with a skin cancer on his lip and 77 years old at next diagnosis in 2003. His most recent diagnosis was in 2015 at age of 89. From the record it appears the Veteran continued to have sun exposures even after diagnosis of skin cancers.” Based on this information, the advisory opinion concluded that “it is likely that skin cancer was caused by sun exposure.” However, the advisory opinion went on to say that it is not likely that the Veteran’s sun exposure during military service independently caused his skin cancers. The advisory opinion based its conclusion on the fact that “if one looks at a lifetime of sun exposure, most of the Veterans’ sun exposure would have been during his childhood, and after his service in the U.S. Navy … The Veteran’s skin cancers are more likely than not caused by a combination of genetic factors and sun exposure; of which, greater than 50% occurred outside of military duty.” Regarding sun exposure during military service in concert with exposure to ionizing radiation, the advisory opinion concluded that “said combination is, also, not likely be the cause of the Veterans’ skin cancers.” The advisory opinion based its conclusion on its previous opinion that “it is not likely that the any of the Veteran’s skin cancers (BCC and/or SCC) can be attributed to ionizing radiation exposure.” The advisory opinion was based on medical research and, also considered the Veteran’s contentions. A review of the record reflects the Veteran’s assertions that he had significant sun exposure during his service, particularly his service in the U.S. Navy on board the USS Cofer. In statements of record, the Veteran had indicated that he spent much time shirtless on the deck of this ship during his time in the South Pacific. Of record is a statement from one of the Veteran’s shipmates, Mr. D.M., who stated that he served aboard the USS Cofer (APD-62) from May 1944 to June 1946 and that from September 1944 to December 1945, he and the Veteran were in the South Pacific, mostly aboard the ship. With regards to the Veteran’s sun exposure, Mr. D.M. stated that “being a small ship while underway, we would only wear pants, no shirts and no caps. Him was in the boat division at that time so was exposed to the sun more than the rest of the crew. He later became a gunner’s mate with me. He has fair complexion, so the sun was hard on him.” The Veteran’s service records show that he was exposed to sun for over one year while serving in the Navy aboard the USS Cofer. The Veteran testified that he did not use sunscreen while in the Navy, but did use sunscreen and wore hats as a civilian following military discharge. He also stated that his employment following his discharge from the Navy was primarily indoors and that, as a result, he had very little sun exposure. The Veteran specifically stated that after his discharge from the Navy, he attended school, worked in sales, joined the Air Force in an inside staff position, and subsequently worked in management and sales position for different air conditioning manufacturing companies. The Veteran stated that following his discharge from the Navy he lived in Kentucky, Dallas, Oklahoma and Florida. The Board notes that the Veteran lived in Kentucky when he first developed pre-cancerous skin problems, lived in Oklahoma when he was initially diagnosed with skin cancer, and moved to Florida in July 1999. The Board also notes that one of the Veteran’s hobbies is playing golf. The Veteran and his shipmates are competent to report about factual matters of which they have first-hand knowledge. As there is no evidence in the record contradicting the assertions made by the Veteran and his shipmates, the Board finds their testimonies credible. However, the Veteran and his shipmates lack the demonstrated medical expertise, and the complexity of linking sun exposure to a diagnosis of skin cancer. As such, the Board concludes that in this case his statements regarding any such link between the in-service sun exposure and a skin cancer disability are not probative when compared to the advisory opinion of record as provided in response to the referral by Under Secretary for Benefits. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) The Veteran provided the names of several of his shipmates, most of whom were top side sailors like the Veteran, that were diagnosed with some form of cancer following their service alongside the Veteran in the South Pacific. Two of the individuals listed by the Veteran died from skin cancer. In November 2017, the Veteran submitted a letter from the daughter of one of these former shipmates who also worked with the Veteran as part of the Boat Crew. The letter stated that the Veteran’s shipmate had been diagnosed with skin cancer and that his dermatologist concluded that the skin cancers were as a result of being aboard the USS Cofer during WWII. As mentioned earlier, the Board must assess the Veteran’s individual claim based on his experiences and medical records in service and after service. Therefore, the Board cannot make a determination regarding the nexus between the Veteran’s sun exposure and skin cancer diagnoses, by analogy, based on accounts of his former shipmates’ skin cancer diagnoses. The Veteran’s medical records from September 2006 reflect that he has a family history of cancer, including two brothers who died from cancer, one of whom was a heavy smoker and died from lung cancer. Of record is a May 2016 letter from the Veteran’s most recent dermatologist, Dr. L.S. The dermatologist’s letter reflects a history of skin cancer removals, and numerous precancerous actinic keratoses. The dermatologist concluded that, in his professional opinion, he felt that the Veteran’s exposure to both radiation from the atomic bomb and the “twelve months he spent in the South Pacific sun” made it a “more than 50% likelihood that his radiation and sun exposure during his military service caused his skin cancers and pre-skin cancers.” While there is no basis for which to doubt the competency and credibility of Dr. L.S., his medical opinion is not adequate because it does not provide a rationale. Therefore, the Board does not find that Dr. L.S.’s medical opinion has probative weight for establishing a nexus between the Veteran’s skin cancer and his sun exposure. There are no other medical opinions in the record from the Veteran’s VA or private physicians providing a positive nexus between the Veteran’s sun exposure and skin cancer diagnoses. Most notably, aside from Dr. L.S., the Veteran’s initial dermatologist who had treated him since 2000, did not conclude that the Veteran’s skin cancer was due to sun exposure during military service. By contrast, the Board finds the October 2018 advisory opinion of record to be of great probative value because the conclusion is supported by a medical rationale and is supported with verifiable facts in the Veteran’s record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value to a medical opinion). Although the Board notes that the Veteran’s sun exposure following discharge from the military was reduced by virtue of the nature of his profession and his use of sunscreen as a preventative measure against skin cancer, the Veteran was an avid golfer and continued to have consistent sun exposure after the initial onset of his skin problems in 1978. With the exception of his initial skin cancer diagnosis in 1984, all of the Veteran’s skin cancer diagnoses occurred following his relocation to Florida in 1999. As noted by the advisory opinion, “continuing sun exposure is not advised for those with actinic keratosis”. It is also notable, that most of the Veteran’s sun exposure was outside his military service, as he only spent about one year aboard the USS Cofer in the South Pacific. As the Board noted earlier that the estimated dosage of the Veteran’s exposure to iodizing radiation was insufficient to cause his skin cancer, the Board finds that there is no probative evidence to support the assertion that the Veteran’s skin cancer was due to a combination of the Veteran’s exposure to iodizing radiation and sun. Thus, the preponderance of the evidence is against the finding of direct service connection under 38 C.F.R. § 3.303 (d), with the probative evidence of record going against a showing that the Veteran’s skin cancers were incurred during or aggravated by service without regard to the statutory presumptions. See Combee, 34 F.3d at 1043-44 (Fed. Cir. 1994). For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim of service connection for skin cancers, claimed as due to sun exposure, or a combination of exposure to ionizing radiation and sun, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Although there is insufficient medical evidence for the Board to grant the Veteran’s claim for service connection of his skin cancer, the Board commends the Veteran for his significant and honorable service on behalf of the United States in the South Pacific. The heroism and sacrifice shown by the Veteran and his shipmates on the USS Cofer, including the numerous missions that they conducted, are not discounted by the Board. Indeed, we are humbled by the sacrifices made by the Veteran and comrades and salute their place in the history of our Nation. We are unfortunately precluded under VA laws and regulations from awarding benefits when the preponderance of the evidence is against a claim. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. White, Associate Counsel