Citation Nr: 21066680 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 14-43 880 DATE: November 1, 2021 ORDER Entitlement to service connection for a skin condition to include actinic keratosis (AK) and malignant melanoma is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, it is at least as likely as not that his actinic keratosis and malignant melanoma are etiologically linked to his active-duty service. CONCLUSION OF LAW The criteria for service connection for a skin condition to include actinic keratosis and malignant melanoma have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from August 1976 to August 1979 and in the United States Army from March 1984 to October 1989. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision issued by the Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in August 2018. The transcript is of record. The appeal was remanded for additional development in May 2019 and May 2021. Most recently, the appeal was remanded to obtain an adequate medical opinion as to the nature and etiology of the Veteran's malignant melanoma. The Veteran was afforded a VA examination, and new medical opinions were associated with the file in July 2021. The Board find the examiner's opinions inadequate. However, in light of the full grant of benefits awarded herein, further remand is not required. Entitlement to service connection for a skin condition Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish entitlement to service-connected compensation benefits, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran contends that his malignant melanoma was caused by exposure to toxins through contaminated water at Camp Lejeune. In the alternative, the Veteran argues that his skin cancer was caused by sun exposure during his active-duty service. There is no dispute that the Veteran has been diagnosed with actinic keratosis and malignant melanoma. Therefore, the first element of service connection is satisfied. A July 2021 VA examiner clarified that the Veteran had both skin conditions and that they were separate conditions arising from the same pathogenesis rather than a progression of AK to melanoma. The Board acknowledges that the U.S. Court of Appeals for Veterans Claims has held that when a veteran claims service connection, he or she is not claiming service connection for a specific diagnosis but for his or her symptoms regardless of the diagnosis, and the claim encompasses the underlying condition regardless of diagnosis. Clemons v. Shinseki, 23 Vet. App. 1, 4-6 (2009). As such, the Board has considered whether service connection may be granted for actinic keratosis and malignant melanoma. As to an in-service incurrence, the Veteran's service treatment records (STRs) confirm he was stationed at Camp Lejeune during his service with the United States Marine Corps from 1976 to 1979. Additionally, the Veteran competently and credibly reported excessive sun exposure during service. Therefore, the second element of service connection is established. The sole remaining issue is a nexus. In its May 2021 remand decision, the Board deemed the March 2021 VA opinion inadequate because the examiner failed to address the Veteran's specific contentions, particularly with respect to in-service sun exposure. Pursuant to the remand, the Veteran underwent a new VA examination in July 2021. The July 2021 VA examiner opined that sun exposure, perhaps in service, is the most likely cause of the Veteran's actinic keratosis and malignant melanoma. The Board finds that this opinion is equivocal and thus inadequate. However, the rationale provides sufficient medical evidence to establish a nexus between sun exposure during service and the Veteran's current disabilities. In finding that the Veteran's skin conditions were not caused by his exposure to toxins and Camp Lejeune, the July 2021 examiner explained that it is now widely accepted that the major environmental risk factor for the development of primary cutaneous melanoma is ultraviolet radiation including UVA, UVB and UVC. The examiner included medical literature that supports a direct relationship between UVB and melanoma as the result of certain DNA changes. The literature also noted that recent evidence shows UVA causing similar DNA changes. The record does not contain any competent evidence to contradict the July 2021 opinion. In fact, the March 2021 examiner concluded that sun exposure was a risk factor for the development of malignant melanoma. Of issue has been the Veteran's level of exposure during service. Importantly, the Veteran has consistently reported and testified that he has taken extreme protective measures regarding his exposure to the sun since service. The Board finds no reason to doubt the credibility of the Veteran's statements. Therefore, resolving all reasonable doubt in the Veteran's favor, it is at least as likely as not that sun exposure during the Veteran's service caused his current skin disabilities. As a result, all elements have been established, and entitlement to service connection for a skin condition to include actinic keratosis and malignant melanoma is warranted. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Sherman 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.