Citation Nr: 21002892 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 19-12 130 DATE: January 19, 2021 ORDER Service connection for basal cell carcinoma (BCC) of the right nasal sidewall is granted. FINDING OF FACT Resolving all doubt in favor of the Veteran, his currently diagnosed BCC of the right nasal sidewall is related to ultraviolet (UV) sun exposure during his military service. CONCLUSION OF LAW The criteria for service connection for BCC of the right nasal sidewall have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1970 to January 1981 and December 1981 to March 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in July 2017 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board observes that, in his April 2019 substantive appeal, the Veteran requested a hearing before a Veterans Law Judge; however, in October 2020, he withdrew such request. 38 C.F.R. §§ 20.603(e); 20.704(e). Entitlement to service connection for BCC of the right nasal sidewall. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. The Veteran claims that his currently diagnosed BCC of the right nasal sidewall is related to in-service treatment for a wart and/or as due to exposure to UV sunlight during his 27 years of service. In this regard, he reported that, for 17 years, he performed assignments in intense sun locations, such as Arizona, Thailand, Nevada, and Florida. The Veteran further indicated that, while performing duties as a jet engine mechanic and technician and aerospace propulsion superintendent, he was stationed near the flight line and engine test pad areas and, by Air Force regulation, such were designated as “no hat” areas, which restricted the wearing of a hat in order to prevent potential damage to running aircraft engines. The Board also notes that he is also currently service-connected for BCC of the right side of the head, which was diagnosed and treated in service. The Veteran’s service treatment records (STRs) reflect that, on May 6, 1989, he complained of an asymptomatic small wart-like lesion on the right side of his nose, which had been present for a few years. On May 15, 1989, a tissue examination revealed a diagnosis of verruca vulgaris. While the remainder of the Veteran’s STRs are negative for any complaints or treatment for such disorder, he later reported that, a few years after the initial diagnosis, he started experiencing increased irritation and sporadic redness that continued to be irritating with sporadic redness throughout the rest of his Air Force career. Furthermore, the Veteran’s service personnel records reflect that he served as a jet engine technician from 1970 to 1981, and an aerospace propulsion superintendent from 1981 to 1997, and was stationed in Arizona, Thailand, Nevada, and Florida. In addition, in an August 2019 statement, the Veteran’s spouse reported that she had lived with him continuously since 1972 and, throughout such time, she observed that he had mild to severe sunburns, especially on his head, face, neck, arms, and back, while performing his Air Force duties. In a September 2019 statement, a friend and coworker of the Veteran stated that he had known him since October 1997 and, during such time, he never observed him to have any type of sunburn. He further stated that the Veteran never worked or placed himself in an environment where he might get sunburned or have excessive exposure to the sun. Post-service treatment records reflect that, in April 2016, the Veteran sought treatment for a lesion, described as actinic keratosis, on the right nasal sidewall. In May 2016, he underwent Mohs surgery for nodular BCC of the right nasal sidewall. In regard to the relationship between the Veteran’s BCC of the right nasal sidewall and his military service, in May 2017, a VA examiner reviewed the record and opined that such disorder was less likely than not incurred in or caused by his in-service diagnosis of a wart of the nose. In this regard, she explained that the wart confirmed by biopsy in 1989 was located at the tip of the nose while the Veteran’s current BCC diagnosed 27 years later in 2016 was located on the right nasal sidewall. The examiner further indicated that the in-service wart was viral in etiology (verruca vulgaris) and unrelated to BCC. The examiner explained that the wart confirmed by biopsy in 1989 was noted at the tip of the nose while the current BCC diagnosed 27 years later in 2016 is located on the right nasal sidewall. Finally, she indicated that the most common cause of BCC is UV sun exposure and genetics for individuals who develop skin cancer in unexposed areas of the body. Thus, in light of the Veteran’s report of UV sun exposure during his military career, an addendum opinion from another VA examiner was obtained in January 2019. At such time, she reviewed the record and opined that the Veteran’s BCC of the right nasal sidewall is less likely than not incurred in or caused by UV sun exposure while performing his duties as a jet engine technician and aerospace propulsion superintendent during service. In this regard, the examiner noted the Veteran’s report of in-service exposure to UV sunlight, but indicated that skin cancer is recognized as the result of childhood and cumulative lifetime sun exposure. In regard to the Veteran’s specific case, she indicated that he spent 40 years with lifetime sun exposure outside of the military (59 percent) versus having spent 27 years in the military (40.3 percent). Thus, the examiner found that, extrapolation of such evidence indicates that the Veteran’s BCC is less likely than not caused by or related to military service. She also observed that additional risk factors include the Veteran’s progressive age and strong family history of skin cancer in his father, as noted in a May 2017 treatment record from the Veteran’s private dermatologist, Dr. MS. In further support of such opinion, the examiner cited a medical treatise noting risk factors for BCC, to include exposure to UV radiation in sunlight, especially during childhood, fair skin, light-colored eyes, red hair, northern European ancestry, older age, childhood freckling, geographical location near the equator, male gender, genetic variation, family history of skin cancer. However, subsequent to the receipt of the January 2019 VA opinion, the Veteran reported that his father did not have skin cancer, and any documentation to the contrary was in error. He also submitted several statements from his mother and his siblings, including five brothers and a sister, confirming that his father did not have skin cancer and there was no family history of skin cancer. Additionally, in an August 2019 private treatment record, Dr. MS corrected the Veteran’s medical record to reflect that his father did not have skin cancer and such history had been documented in error. Consequently, as the January 2019 VA examiner relied upon an inaccurate factual premise in offering her opinion, its probative weight is diminished. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (holding that medical opinions based on inaccurate factual premise are not probative). Furthermore, in contrast to the January 2019 VA examiner’s opinion, Dr. MS offered an opinion in August 2017 in which he indicated that he reviewed the Veteran’s STRs and post-service treatment records, and found that his BCC of the right nasal sidewall is at least as likely as not caused by or a result of sun exposure while serving in the military. In support of such opinion, he indicated that he reviewed the Veteran’s medical history, to include his in-service sun exposure, and found that such resulted in his diagnosis of BCC. While Dr. MS’s opinion is succinct, it is rendered by the Veteran’s treating dermatologist who is familiar with his relevant medical history, and is further supported by the May 2017 and January 2019 VA examiners’ determinations that BCC is related primarily to UV sun exposure and genetics/family history of skin cancer and, as previously discussed, the latter risk factor does not apply in the Veteran’s case. Furthermore, while the January 2019 VA examiner found that his in-service sun exposure only accounted for 40 percent of his lifetime UV sun exposure, such suggests that it still contributed to his overall UV sun exposure. Therefore, the Board resolves all doubt in favor of the Veteran and finds that his currently diagnosed BCC of the right nasal sidewall is related to UV sun exposure during his military service. Consequently, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.