Citation Nr: 21004651 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 19-09 022A DATE: January 27, 2021 ORDER Entitlement to service connection for basal cell epithelioma is granted. FINDING OF FACT Basal cell epithelioma is as likely as not due to service. CONCLUSION OF LAW The criteria for service connection for basal cell epithelioma have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from April 1966 to April 1970 and from January 1971 to September 1991. Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Certain chronic diseases, such as malignant tumors, may be presumed to be service connected if manifested to a degree of 10 percent disabling or more within one year after separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The Veteran appeals the denial of service connection for basal cell epithelioma. In December 1995, Dr. S noted that the Veteran had been under his care since August 1995 for problems of actinic keratoses which are precancerous spots that are related to cumulative sun exposure. Dr. S further noted that the Veteran is a fair individual and therefore has a quite limited capacity for sun exposure. Unfortunately, Dr. S, noted that the Veteran was stationed during his military duty in sunny places such as Texas, Hawaii and Vietnam which he believed may have filled and exceeded his sun capacity. Dr. S reiterated similar sentiments in July 2007. Dr. M stated in April 2008 that the Veteran has had persistent problems with actinic keratosis, a precancerous condition of the skin related to excessive sun exposure and sunburns overtime. The August 2009 VA examiner further opined that the incidence of actinic keratoses is directly related to the amount of sun exposure young people have and that the Veteran did spend two full summers at Ft Worth, Texas, a year in Vietnam and several summers in California. Dr. S opined in June 2018 stated that the Veteran has had squamous cell carcinoma and basal cell carcinoma which are the logical progression from actinic keratoses. She noted that the Veteran faced a lifetime of treatment for these conditions and he is at high risk for additional development of melanoma which current thinking relates to sunburn itself rather than cumulative exposure. Despite their apparent treatability, she stated that these problems are a devastating lifetime burden to the patient and she believed his service for his country has directly contributed and is due to this exposure. In February 2019, however, the VA examiner opined that the condition claimed was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. The VA examiner reasoned that the Veteran has developed a basal cell epithelioma which is different and separate than his service-connected actinic keratoses. Therefore, he found that the conditions of actinic keratosis and basal cell epithelioma are less likely (less than 50 percent probability) to be secondarily related. In weighing the positive and negative evidence of record, and in resolving reasonable doubt, the Board finds in favor of the claim for service connection. To that end, the Veteran is service-connected for actinic keratosis due to excessive sun exposure in service and positive evidence has been presented linking the Veteran’s basal cell epithelioma to his in-service sun exposure. The Board is mindful that the February 2019 VA examiner opined that basal cell epithelioma and actinic keratosis are not secondarily related. The Board notes, however, the opinion does not discuss and/or consider the Veteran’s accepted history of prolonged sun exposure. The credible lay statements of record in conjunction with the medical opinions of Dr. S place the evidence at least in equipoise. In resolving reasonable doubt in his favor, the Board finds that a grant of service connection for basal cell epithelioma is warranted. Accordingly, the claims are granted. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’..., the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits.”) T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S. Willie 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.