Citation Nr: 21027396 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 17-32 016 DATE: May 5, 2021 ORDER Service connection for recurring basal cell carcinoma and multiple melanomas with scarring (also claimed as squamous cell carcinoma) is granted. FINDING OF FACT The competent and credible evidence is at least in equipoise as to whether the Veteran has recurrent basal cell carcinoma and multiple melanomas with scarring that are related to service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for recurrent basal cell carcinoma and multiple melanomas with scarring have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from July 1966 to January 1970, to include service in Vietnam. His decorations include the Combat Action Ribbon and the Vietnam Campaign Medal. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In July 2020, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Service connection for recurring basal cell carcinoma and multiple melanomas with scarring is granted. The Veteran seeks to establish service connection for recurring basal cell carcinoma and multiple melanomas with scarring, also claimed as squamous cell carcinoma. He contends that he has these skin disorders as the result of sun exposure in Vietnam. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In the present case, there is no dispute that the Veteran has a current disability. The report of a January 2017 VA examination, for example, shows that he has scarring from past excision of basal cell carcinoma and melanomas. Nor is there any real dispute that the Veteran had extensive sun exposure during service. He has testified to that fact, and his testimony in that regard is consistent with the circumstances, conditions, and hardships of his combat service in Vietnam. 38 U.S.C. § 1154(b). As to the nexus, or link, between the Veteran's current disabilities and service, the Board notes there are medical opinions of record which both support and refute the Veteran's claim, including conflicting VA medical opinions. The evidence in favor the claim includes a May 2016 private opinion from Dr. S.H., a January 2017 VA examination report, and an August 2020 private statement from Dr. S.S. The evidence against the claim includes an unfavorable February 2017 VA medical opinion. The May 2016 private opinion from Dr. S.H. unequivocally concluded that the Veteran had had malignant lesions, including basal cell carcinoma and overt melanoma, that were "directly related to [his] exposure in Vietnam." The physician noted that he had first seen the Veteran in 1987 for a mole that had appeared 15 years earlier, in 1972; that biopsy revealed the mole to be a melanoma; that the Veteran had had 24 lesions excised over the years since that were either pre-malignant or frankly malignant; that the malignant lesions ran the gamut from basal cell carcinoma to overt melanoma; and that all of the lesions were located in areas that were subject to sun or chemical (herbicide) exposure. The physician explained that the number of lesions was far greater than would be expected in an individual normally, and that his opinion was based on many visits and discussions about the Veteran's individual service experiences in Vietnam. Inasmuch as the examiner's opinion was based on an accurate understanding of the facts, and articulates reasons for the conclusion reached, the Board finds the opinion probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The January 2017 examiner likewise found that it was at least as likely as not that the Veteran's recurring basal cell carcinoma and multiple melanomas with scarring were incurred in or causally related to sun and herbicide exposure during service in Vietnam. The opinion was based, in part, on the report from Dr. S.H., which the examiner found to be medically reasonable as it was from an expert in the surgical management of skin cancers. Inasmuch as the VA examiner's opinion was based on an accurate understanding of the facts, and articulated reasons for the conclusion reached, the Board also finds that opinion probative. See Nieves-Rodriguez, supra. The August 2020 statement from Dr. S.S. provides that the Veteran's skin cancer diagnosis had "been made due to long periods of sun exposure during his time of service." See August 2020 medical statement. While supportive of the Veteran's claim, the Board finds the statement from Dr. S.S. to be lacking in rationale. Therefore, the Board affords it little probative weight. As noted, the evidence against the Veteran's claim includes an unfavorable February 2017 VA medical opinion as to whether his basal cell carcinoma and malignant melanoma were at least as likely as not incurred in or caused by service. In arriving at that conclusion, the examiner posited that prolonged sun exposure causes basal and squamous cell carcinoma, but that melanoma is not caused by sun exposure. The examiner further observed that while the Veteran was exposed to sun for 13 months in Vietnam, he was also exposed to sun for many years while working both indoors and outdoors. During his July 2020 testimony before the Board, the Veteran denied that he had worked outside after service, believing there to have been a miscommunication with the February 2017 examiner, as his post-service career involved indoor office work. As the Board finds the Veteran's testimony credible, the Board affords the February 2017 medical opinion little probative weight as it appears to have been based, at least in part, on an inaccurate factual premise; namely, that the Veteran regularly worked outside as part of his post-service employment. In addition, the examiner provided no support for the proposition that sun exposure does not cause or otherwise lead to melanoma. In sum, the Board affords more probative weight to the May 2016 private medical opinion and the January 2017 VA opinion in support of the Veteran's claim than the unfavorable February 2017 VA opinion. Based on the relative weight of those opinions, and the other evidence of record, the Board is persuaded that the criteria for an award of service connection for recurring basal cell carcinoma and multiple melanomas with scarring have been met. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal is granted. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, 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.