Citation Nr: 21065397 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 15-18 951 DATE: October 26, 2021 ORDER Entitlement to service connection for a skin disability, which is currently diagnosed as seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, and nodular basal cell carcinoma, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his skin disability, which is currently diagnosed as seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, and nodular basal cell carcinoma, is etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for a skin disability, which is currently diagnosed as seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, and nodular basal cell carcinoma, 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 July 1968 to February 1970. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claim in July 2018, July 2020 and March 2021 for further development by the RO. The case has been returned to the Board for further appellate action. There was substantial compliance with the Board's remand directives of March 2021. See Stegall v. West, 11 Vet. App. 268 (1998). The March 2021 Board remand directed the agency of original jurisdiction (AOJ) to afford the Veteran an opportunity to identify any outstanding records and, thereafter, obtain a VA medical opinion that addressed the Veteran's lay statements, personal risk factors, and submissions of photographs and articles. The AOJ afforded the Veteran such an opportunity, see April 2021 subsequent development letter, and obtained a medical opinion in July 2021 that contains adequate information to assess the claim. Therefore, the Board will proceed to adjudicate the claim. Entitlement to service connection for a skin disability The Veteran has a skin disability, currently diagnosed as seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, and nodular basal cell carcinoma, that is related to in-service sun and herbicide agent exposure, thus warranting an award of service connection. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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). The record in this case is clear as to whether the Veteran has a skin disability. The July 2019 and December 2020 VA examinations show a diagnosis of seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, and nodular basal cell carcinoma. Post service medical treatment records also reflect such diagnoses. Thus, the first element of service connection, the existence of a current disability, is satisfied. Concerning the in-service event, illness, or injury, the Veteran's service treatment records (STRs) do not show complaints of or treatment for any skin condition. However, the Veteran has contended that his skin disability is due to sun exposure and herbicide exposure in service. He stated that he was exposed to the sun on a daily basis during basic training and had sunburn on his face and lips for nearly the entire two-month period. He submitted a photograph, which he stated was taken during that time period and would show sunburns and blisters on his lower lip. The Veteran also submitted articles indicating that individuals exposed to herbicide agents are at risk for the delayed onset of skin cancers. He also stated that there were incidents in service when he could smell herbicide agent, and that he was sunburned on assignment in Vietnam while traveling in an open-top vehicle. He further stated that was first diagnosed with skin cancer approximately in 1994 and again in 2014. See May 2014 correspondences. The Veteran has provided credible and competent statements regarding his skin-related symptoms both during and following service. The lay evidence is further corroborated by the record. Photographs submitted by the Veteran show him in uniform with a lip that appears blistered. See May 2014 correspondence. Medical treatment records confirm that the Veteran was treated for repair of a malignant neoplasm of the scalp and neck in 1994 and 2014. See VA treatment records received by VA in March 2015; private medical treatment records received by VA in August 2021. Furthermore, the Veteran's DD-214 shows service in the Republic of Vietnam from March 1969 to February 1970. Exposure to herbicide agents was conceded in the March 2015 statement of the case (SOC). While the Veteran's diagnosed conditions do not appear on the list of diseases associated with exposure to herbicide agents and presumptively service connected under 38 C.F.R. § 3.309, this is not dispositive of the Veteran's claim. When presumptive service connection is not warranted, direct service connection must be considered. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed Cir. 1994). Based on the first two elements of service connection being satisfied, the Board, three times throughout the pendency of this claim, sought a competent medical opinion regarding whether there is a causal relationship between the current skin disability and service. The Board initially remanded the claim in July 2018 to obtain a VA examination and medical opinion. The Board again remanded the claim in July 2020 and March 2021, having found that the medical opinions of record did not address multiple items of favorable evidence, specifically, the Veteran's lay statements, submissions of articles and photographs, and personal circumstances, to include risk factors. See also VA medical opinions dated July 2019 and December 2020. Following the most recent Board remand of March 2021, the RO obtained a medical opinion in July 2021. The July 2021 VA examiner opined that the Veteran's skin disabilities, to include seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basil cell carcinoma, and nodular basil cell carcinoma, are at least as likely as not due to the Veteran's sunburn and blisters in service as well as due to herbicide agent exposure in service. The examiner stated that he had reviewed the Veteran claims file, to include the lay statements and articles. Upon review, he concluded that the Veteran's skin conditions are linked to sun damage and herbicide agent exposure in service. He also stated that his prior opinion of December 2020 was in error. While the medical opinions of July 2019 and December 2020 VA did not find that there was a nexus to service, the Board finds that the contrary opinion of July 2021 deserves greater probative value. The July 2021 medical opinion offered an adequate statement of reasons and bases for its conclusions and considered all favorable evidence of record; specifically, the examiner stated that he reviewed the Veteran's lay statements and articles and considered the Veteran's risk factors. The Board affords the opinions of July 2019 and December 2020 less probative value because they did not address this favorable evidence. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In conclusion, the Board finds that the evidence is at least in equipoise as to whether the Veteran's skin disability had its onset during active service. Accordingly, the Board must resolve reasonable doubt in the Veteran's favor and finds that service connection for a skin disability, currently diagnosed as seborrheic dermatitis, squamous cell carcinoma, actinic keratosis, basal cell carcinoma, nodular basal cell carcinoma, is warranted. 38 U.S.C. § 5107(b); 39 C.F.R § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.