Citation Nr: 21006949 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 15-04 372 DATE: February 8, 2021 ORDER Service connection for the residuals of basal cell carcinoma (skin cancer), to include as due to environmental exposures, is denied. VETERAN’S CONTENTIONS The Veteran contends that he developed basal cell carcinoma as a result of in-service environmental exposures, including herbicide agents and acid/chemicals. Alternately, the Veteran contends that he developed basal cell carcinoma as a result of in-service sun exposure. FINDING OF FACT Skin cancer was not shown in service or for many years thereafter; the current residuals of basal cell carcinoma are not otherwise related to service. CONCLUSION OF LAW The criteria for service connection for residuals of skin cancer are not met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1961 to August 1962 with subsequent service in the Air National Guard. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in February 2018. The transcript of the hearing has been associated with the claims file. This claim was previously before the Board at which times the Board remanded for additional development. Entitlement to service connection for residuals of basal cell carcinoma (skin cancer), to include as due to environmental exposures Generally, service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). In addition, a veteran who, during active service, served in Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, including Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). If a veteran is presumed to have been exposed to an herbicide during such active service, the veteran shall be service connected for the diseases listed under 38 C.F.R. § 3.309(e), if the disability manifested to a degree of 10 percent or more at any time after service. See 38 C.F.R. § 3.307(a)(6)(ii). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. VA must also consider all favorable lay evidence of record. See 38 U.S.C. § 5107 (b); see also Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a Veteran is competent to report on that of which he or she has actually observed and is within the realm of his or her personal knowledge). In addressing the criterion of a current diagnosis, the evidence of record includes a January 2020 VA report of examination in which the examiner diagnosed the Veteran with status post basal cell carcinoma. In addressing in-service incurrence, the Veteran’s military personnel records confirm a military occupational specialty (MOS) of Loadmaster. The Board made a finding of fact in its April 2018 decision that the Veteran had boots on the ground in Vietnam, and as a result is presumed to have been exposed to herbicide agents, including Agent Orange. The Veteran's service treatment records (STRs) are negative for complaints or treatment for skin cancer and/or related symptoms. A December 1988 separation examination documented normal skin. In addressing nexus, to the extent that the Veteran has stated that he has residuals of skin cancer attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the etiology of his disability because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the Board finds that the Veteran is not competent to relate his residuals of skin cancer to his service or to any incident therein. The evidence of record otherwise includes an opinion from the January 2020 VA examiner concluding that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that basal cell carcinoma is the most common form of cancer, occurring on sun-exposed skin in otherwise normal fair skinned individuals. The Veteran grew up in Texas where he had repeated exposure to ultra-violet light, and he is faired skinned. There was no evidence that the Veteran was exposed to unusual amounts of ultraviolet light while in service, suggesting that the majority of the Veteran’s sun exposure occurred in Texas, outside of the Veteran’s period of military service. The examiner further reasoned that the claims file was silent for a skin condition while in service or within one year of release from active duty service. The Veteran denied skin disease on a December 1988 separation examination. As such, it was less likely than not that he developed skin cancer as a result of in-service sun exposure. In an August 2020 addendum, an examiner opined that it was less likely than not that the Veteran’s basal cell skin cancer was related to any military experience or event and more likely than not that the Veteran’s basal cell cancer was due to the risk factors found commonly in the general population, such as genetic susceptibility, solar exposure as a child and adolescent, and his age; all risk factors associated with the occurrence of this type of skin cancer. The examiner explained that childhood and adolescence are critical periods for establishing risk from UV light/sunlight exposure. The examiner further explained that basal cell carcinoma is the most common cancer and afflicts about 30 percent of the general United States population. While there is some correlation with cumulative solar exposure, this is a minor effect, and multiple studies have shown that the most important exposure is that which is acquired early in life. Thus, the Veteran was at an increased risk for basal cell carcinoma development before he ever enlisted in the military. As there was no evidence that the Veteran developed skin cancer while in service (and, in fact, he developed the tumor years later, long after he left the service), it was less likely than not that the cancer developed as a result of in-service sun exposure. Regarding the relationship between in-service chemical exposures and the later development of basal cell carcinoma, the examiner explained that a review of the recent medical literature failed to document any incidence of increased tumor occurrence associated with either acid or chemical exposure, except for chronic arsenic exposure which was not mentioned or verified in any of the Veteran’s medical records. The examiner also noted in support that there are also no references to increased risk of developing basal cell carcinoma from Agent Orange/herbicide, as Agent Orange exposure is not listed as presumptive for any dermatological tumor. The Board finds the January 2020 and August 2020 VA examiner opinions to be highly probative. The opinions were based on review of the claims file, relevant facts, and peer reviewed medical literature, and the examiners provided a detailed rationale. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). There is no competent evidence to the contrary. In sum, without any competent evidence that the Veteran has residuals of skin cancer that are related to service, direct service connection is not warranted. Additionally, there is no indication that the condition manifested within one year of service; the first medical record of skin cancer does not appear in the record until February 2011, 23 years after discharge from service. The Board finds that the most probative and competent evidence of record places an onset of skin cancer years after the Veteran's service and fails to otherwise show that any residuals of skin cancer are related to service. Therefore, service connection is not warranted, and the claim must be denied. There is no doubt to be resolved in this case. 38 U.S.C. §5107. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith-Jennings, 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.