Citation Nr: 21076476 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 16-33 686 DATE: December 23, 2021 ORDER Entitlement to service connection for malignant skin neoplasms is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, malignant skin neoplasms are at least as likely as not related to the Veteran's military service. CONCLUSION OF LAW The criteria for entitlement to service connection for malignant skin neoplasm have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309, REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps November 1966 to August 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Entitlement to service connection for malignant skin neoplasms. The Veteran contends that he developed malignant skin neoplasms (skin cancer) as a result of his military service. In an October 2016 Statement, the Veteran referenced an Aspen Institute study which showed the highest use of Agent Orange in the area the Veteran was stationed in, Danang, Vietnam. He referenced several more articles that found that Agent Orange doubled the risk of invasive skin cancer. He also stated that he did not have skin cancer in his family. See also May 2018 Statement. See also October 2015 Notice of Disagreement (Treated by Dr. H.; Worked the night shift for 20 years). During the June 2021 Board hearing, the Veteran testified that he was exposed to Agent Orange while serving in Vietnam. He developed lesions and started having them removed a year and half after discharge to the present. He tried to retrieve the medical records from that time, but the physician that treated him passed away. He was only able to obtain records back to the 1994. He also stated that he submitted a June 201 statement from Dr. O. in support of his claim. Service connection may be granted for a 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). A veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during such service to certain herbicide agents (e.g., Agent Orange). In the case of such a veteran, service incurrence for the following diseases will be presumed if they are manifest to a compensable degree within specified periods, even if there is no record of such disease during service: chloracne or other acneform diseases consistent with chloracne, type 2 diabetes, Hodgkin's disease, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin's lymphoma, acute and sub-acute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, and trachea), and soft-tissue sarcomas. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). In determining whether service connection is warranted for a disability, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). An October 1968 STR indicated the Veteran had a rash on his left side. Post-service treatment records show the Veteran has a current diagnosis of skin cancer. See e.g., December 1994 Dr. H. Record (growth right side top of scalp); October 2000 Dr. A. Record (mass on right arm; noticed it because the sunlight was shining across his arm); March 2003 Pathology Associates (basal cell carcinoma on the chest and scalp); July 2016 Medical Associates Record (basal cell carcinoma (BCC) of the paraspinal midback). A VA medical opinion was obtained in September 2016. The examiner opined that the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that skin malignancies are not a presumptive condition associated with herbicide exposure. Sun exposure is the most important environmental cause of BCC, and most risk factors relate directly to a person's sun exposure habits or susceptibility to solar radiation. These risk factors include having fair skin, light-colored eyes, red hair, northern European ancestry, older age, childhood freckling, and an increased number of past sunburns. The type, quantity, and timing of sun exposure associated with an increased risk of BCC are not clearly defined. Childhood sun exposure appears to be more important than exposure during adult life. Evidence supporting this hypothesis comes from case control studies and clinical trials. The Veteran submitted a July 2020 private medical opinion from Dr. F. The physician wrote that the Veteran had a history of skin cancer that she treated skin 2015. Records show that the Veteran was treated for skin cancer by Dr. H., Dr. K., Dr. S., and Dr. O. at the Medical Associates clinic. She recited the Veteran's dates of diagnosis from 2016 to 2020. The physician stated that due to the frequency of the Veteran's skin cancers and precancerous lesions, the Veteran is seen every three to four months. She opined that the amount of skin cancers and treatment required caused her to believe it was possible that there was a link between the Veteran's skin cancer and his Vietnam service. The Board notes there was no statement from Dr. O dated June 2021 as mentioned during the Board hearing. Giving reasonable doubt to the evidence found in the record, the Board finds that entitlement to service connection for malignant skin neoplasms is warranted. STR indicate the Veteran suffered issues with his skin during services. Post-service treatment records indicate a current diagnosis and ongoing treatment of skin cancer. The September 2016 VA medical opinion did not support a link between Agent Orange exposure and the Veteran's skin cancer because the type of skin cancer the Veteran has was not subject to presumptive service connection. However, the examiner acknowledged that sun exposure was an important environmental factor in the development of skin cancer. This was corroborated by the article submitted by the Veteran in October 2016. The private medical opinion supported a link between the Veteran's skin cancer and military service due to the amount and frequency of his required treatment. Accordingly, resolving all reasonable doubt in the Veteran's favor, service connection for malignant skin neoplasms is warranted. 38 U.S.C. § 5107. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris, Attorney Advisor 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.