Citation Nr: 21061616 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 16-45 488 DATE: October 4, 2021 ORDER Entitlement to service connection for malignant skin neoplasms is granted. FINDING OF FACT There is a balance of evidence on whether the Veteran's malignant skin neoplasms are related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for malignant skin neoplasms 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 in the United States Marine Corps from January 1971 to September 1998. This matter comes before the Board of Veterans' Appeals (Board) from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in February 2021. A transcript of the hearing is of record. This matter was previously before the Board in April 2021, at which time it was remanded for additional development. That development having been completed; this claim is once again before the Board. Entitlement to service connection for malignant skin neoplasms The Veteran contends that his malignant neoplasms are the result of his significant sun exposure in service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). March 2020 private treatment records show the Veteran has a current diagnosis of melanoma and has been treated for various skin cancers. The Veteran was examined for VA purposes in April 2014 and June 2021, and there are private medical opinions dated in 2014 and 2020. The April 2014 VA examiner opined that the Veteran's skin cancer was less likely than not related to service because the Veteran was not treated in service; however, the examiner's opinion did not include a full accounting of the Veteran's in-service skin treatments, it included incorrect dates of his various diagnoses, and it did not consider the Veteran's in-service sun exposure. As such, the Board affords the April 2014 examination little probative weight. The June 2021 VA examiner also opined that the Veteran's malignant skin neoplasms were not related to service. Notably, the logic of the opinion was based in part on the amount of sun exposure the examiner understood the Veteran experienced during service. Specifically, the examiner considered it was limited exposure, as he understood the Veteran would have worn a thick long sleeved uniform and that the Veteran's duties were primarily indoors. The Veteran's private physician assistant stated in a March 2020 letter that the Veteran's exposure to various chemicals and environmental conditions during service may have increased his risk for the development of skin cancers. She added that sun exposure in everyday life also is a cause for many skin cancers. The Veteran's private dermatologist wrote in an October 2014 letter, that Gulf Coast residents, (where the Veteran was living at the time, and where records show was his place of birth, and the area from which he first enlisted in 1971), are more prone to develop non-melanoma skin cancers because of more cumulative sun absorption, due to sand and salt water, which reflect more sun. Further, he noted that high humidity encourages lighter weight clothing for more months during the year. Nevertheless, he stated that there was no way to put a time frame on when sun damage occurs. The Veteran's service treatment records confirm his service in locations including San Diego, California and Yuma, Arizona. The Veteran also credibly reported that he wore a short-sleeved uniform throughout his nearly 28 years of service, and only rarely wore a long-sleeved uniform. Likewise, he provided credible testimony that he was often outdoors during service, especially during his time as a drill instructor. On this record, it is seen the medical opinions focus on sun damage as the basis for the Veteran's skin disability. The 2014 private opinion acknowledges the difficulty in determining when sun damage occurs, but does not rule out that it could have occurred during the Veteran's decades of military service. Similarly, the 2020 private opinion allowed that routine sun exposure causes skin cancer. This likewise does not rule out the in-service sun exposure as the basis for the Veteran's skin disability. For its part, the 2021 VA medical opinion, expresses a conclusion against the claim. Its logic, however, permits the interpretation that had the examiner thought the Veteran was sun exposed in the circumstances the examiner thought had not been present, the examiner would have found in favor of the claim. Here, the evidence, which includes the Veteran's credible statements, and his duty assignments, reasonably supports the finding the Veteran's responsibilities and duty uniform would have resulted in the sun exposure the 2021 examiner indicated to be sufficient to produce the claimed disability. Therefore, after considering all the evidence of record, the Board finds the evidence to be at least in equipoise as to whether the Veteran's malignant skin neoplasms were incurred in service. Accordingly, after resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for malignant skin neoplasms is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Geer, 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.