Citation Nr: A25035377 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240624-450116 DATE: April 16, 2025 ORDER Service connection for stage 3 melanoma of the right 5th digit and right axilla, to include any residuals, is granted. FINDING OF FACT The Veteran's melanoma of the right 5th digit, which metastasized to his right axilla, is linked to his exposure to an herbicide agent during active service in the Republic of Vietnam (Vietnam). CONCLUSION OF LAW The criteria for service connection for state 3 melanoma and its residuals of the right 5th digit and right axilla 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 Army from May 1970 to May 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2024 decision of a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). The Veteran filed a timely VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in June 2024 and elected the Direct Review option. See 38 U.S.C. §§ 7105, 7113(a); 38 C.F.R. §§ 20.202, 20.203. Under the Direct Review option, the Board's decision will be based on the evidence of record at the time of the AOJ decision on the issue or issues on appeal. 38 U.S.C. § 7113(a); 38 C.F.R. §§ 20.301, 20.801(a). Accordingly, the Board may only consider the evidence of record at the time of the June 2024 AOJ decision. See id. If evidence was submitted by the Veteran or otherwise added to the claims file since the AOJ decision on appeal, the Board has not considered it at this time. See id. Although the Veteran's Notice of Disagreement (NOD) only mentions melanoma of the right 5th digit, the Board finds that the Veteran did not intend to limit the appeal to just the melanoma of the right 5th digit, and that the appeal encompasses melanoma of the axilla as well. Service Connection Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § § 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link ("nexus") between the current disability and the disease or injury incurred or aggravated in service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply. Id. at 781-82. Entitlement to service connection for stage 3 melanoma of the right 5th digit and right axilla. For the following reasons, the Board finds that service connection for the Veteran's stage 3 melanoma of the right 5th digit and right axilla is established. The Veteran served on active duty in Vietnam and was exposed to an herbicide agent such as Agent Orange while serving there, as found by the AOJ. See March 2024 Toxic Exposure Risk Activity (TERA) Memorandum; June 2024 AOJ Decision; see also 38 U.S.C. § 1116 (providing for a presumption of exposure to an herbicide agent for veterans who performed "covered service," which includes service in Vietnam). In June 2023 the Veteran developed a lesion under the nail of the 5th digit of his right hand which was assessed as melanoma. See May 2024 VA Hand Examination. The melanoma progressed to stage 3 and metastasized to his right axilla, with the melanoma of the right 5th digit being the primary site. See October 2023 VA Treatment Record. He underwent chemotherapy in October 2023 and surgery of his right axilla melanoma in January 2024. See May 2024 VA Hand Examination. The May 2024 VA examination notes that he was continuing chemotherapy for another eleven treatments. His current symptoms included fatigue, adrenal insufficiency, and worsening hypothyroidism due to the chemotherapy. The Veteran attended VA-contracted medical examinations in May 2024. The examiner concluded that the Veteran's melanoma is at least as likely as not caused by his in-service herbicide agent exposure. In that regard, the examiner explained that peer reviewed medical literature supports a nexus between melanoma and TCDD (an ingredient in herbicide agents used in Vietnam) exposure. The examiner added that research shows that genetic susceptibility and environmental factors contribute to the initiation and progression of melanoma, and that exposure to environmental chemicals, especially TCDD, activates the aryl-hydrocarbon-receptor pathway and contributes to melanoma progression, specifically through stimulation of the expression and activity of the matrix metalloproteinases. The May 2024 VA medical opinion constitutes competent and probative evidence sufficient to establish a medical nexus between the Veteran's melanoma and his in-service exposure to an herbicide agent while in Vietnam. In that regard, it is based on examination of the Veteran and review of his medical opinion, and is supported by a well-reasoned explanation. There are no medical opinions to the contrary. Accordingly, the criteria for service connection have been met; therefore, service connection for stage 3 melanoma of the right 5th digit and right axilla, to include any residuals, is granted. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Rutkin 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.