Citation Nr: A25041297 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 240513-440675 DATE: May 6, 2025 ORDER Entitlement to service connection for basal cell carcinoma (BCC) of the nose is granted. Entitlement to service connection for residuals of skin cancer of the left forearm is granted. FINDINGS OF FACT 1. The Veteran is a covered veteran with BCC of the nose. 2. The Veteran's skin cancer of the left forearm manifested during active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for BCC of the nose have been met. 38 U.S.C. §§ 1110, 1119, 1120, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for residuals of skin cancer of the left forearm have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1979 to August 1982, December 1990 to June 1991, and November 2006 to April 2008. He served honorably in the U.S. Army, including service in Southwest Asia during the Persian Gulf War. The Board thanks the Veteran for his service to our country. The rating decision on appeal was issued in April 2024 and constitutes a supplemental claim decision to a December 2023 initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the May 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. Service Connection Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also 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. To substantiate a claim of service connection, there must be evidence of: (1) a current disability; (2) a disease, injury, or event in service; and (3) a nexus or causal relationship between the claimed disability and the disease, injury, or event in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to service connection for BCC of the nose Entitlement to service connection for BCC of the nose is granted. Under the Honoring Our PACT Act, service connection may also be established for a covered veteran with a disease associated with exposure to burn pits and other toxins. Under this Act, any enumerated disease, including head cancer of any type, becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active military, naval, air, or space service even though there is no record of such disease during the period of such service. Honoring our PACT Act of 2022, sec. 406, § 1120. A covered veteran means any veteran who performed active military, naval, air, or space service while assigned to a duty station in enumerated countries, including Saudi Arabia, on or after August 2, 1990. Honoring our PACT Act of 2022, sec. 302, § 1119. The sub-regulatory guidance identifies several diagnostic codes (DC) for Gulf War Presumptions. Under "Head cancers," it identifies DC 7818 for malignant skin neoplasms. VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022). In this case, the Veteran had service in Saudi Arabia in 1991; accordingly, he is a covered Veteran. In a December 2023 VA examination report, the examiner identified diagnoses of basal cell carcinoma of the nose under tumors and neoplasms of the skin. The examiner also noted that the Veteran had malignant neoplasm in remission due to surgery, noting an October 2019 left nasal ala shave biopsy followed by a December 2019 MOHS procedure. Read in the light most favorable to the Veteran, the evidence is at least in relative equipoise that the Veteran is a covered veteran with a head cancer. Accordingly, service connection for the disability is warranted. 38 U.S.C. § 1120, 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for residuals of skin cancer of the left forearm Entitlement to service connection for residuals of skin cancer of the left forearm is granted. As noted above, the Veteran served on active duty from November 2006 to April 2008. During this period of active service, a February 2008 private treatment record notes that a biopsy of a lesion on the Veteran's arm was a skin cancer. In a July 2023 dermatology note, the Veteran reported two ongoing itchy spots on his left forearm at the site where he thought he had skin cancer before. The provider noted a presumed history of nonmelanoma skin cancer treated with electrodesiccation and curettage as the Veteran had stated 3 lesions were "burned off" the left forearm; biopsy results later showed recurrent BCCs on the left forearm. Read in the light most favorable to the Veteran, the evidence is at least in relative equipoise that the Veteran's left forearm skin cancer had its onset during active service. Accordingly, service connection for its residuals is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.K. Vashaw, 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.