BENIGN SKIN NEOPLASMS

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: 26004430

GRANTED

Summary

The veteran, who served from August 1969 to August 1971, including service in Vietnam from January 1970 to December 1970, appeals the denial of service connection for a fatty tumor (lipoma) and chronic seborrheic keratosis on the right side of his neck, claimed as secondary to service-connected chloracne. He also appeals the denial of service connection for a scar on the right side of his neck, claimed as secondary to the lipoma. The Board reviewed previous remands from January 2025 and June 2022, noting deficiencies in a prior VA examination. The March 2025 VA examination provided negative nexus opinions for both the lipoma and seborrheic keratosis, stating they were less likely than not related to service-connected chloracne or active service. However, the Board found these opinions to be of low probative value, as they were conclusory, did not adequately consider the veteran's service history or lay statements, and seemingly applied a higher standard than the benefit of the doubt. The examiner also acknowledged theoretical possibilities of inflammation affecting the lipoma and the unknown etiology of seborrheic keratosis. Giving the veteran the benefit of the doubt, the Board granted service connection for the lipoma and seborrheic keratosis secondary to chloracne. Service connection for the scar was also granted as secondary to the lipoma, based on established medical records.

Rationale

VA examiner's opinion found to be of low probative value; Did not adequately address veteran's service history or lay statements; Applied a higher standard than benefit of the doubt; Examiner conceded possibility of inflammation affecting lipoma

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-49 554

Full Decision Text

Citation Nr: 26004430
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 17-49 554
DATE: April 10, 2026

ORDER

Entitlement to service connection for a fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis, to include as secondary to service-connected chloracne, is granted.

Entitlement to service connection for a scar, right side of neck, to include as secondary to service-connected fatty tumor (lipoma), right side of neck, is granted.

FINDINGS OF FACT

1. The most probative and persuasive evidence shows that it is as likely as not that the Veteran's fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis, are a result of the Veteran's service or service-connected disability.

2. The most probative and persuasive evidence shows that it is as likely as not that the Veteran's scar, right side of neck, is a result of the Veteran's service or service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis, to include as secondary to service-connected chloracne, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.3.

2. The criteria for entitlement to service connection for a scar, right side of neck, to include as secondary to service-connected fatty tumor (lipoma), right side of neck, have been met.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from August 1969 to August 1971, including service in the Republic of Vietnam from January 1970 to December 1970.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), the agency of original jurisdiction (AOJ).

The Veteran then testified at a hearing before the undersigned Veterans Law Judge in February 2022. A transcript has been associated with the claims file.

This matter was previously before the Board in June 2022 and January 2025 at which time the Board remanded for further development of the record.

Particularly, in January 2025, the Board noted that the Veteran underwent an October 2022 skin diseases examination, in which the VA examiner had rendered a negative presumptive herbicide exposure nexus opinion and a negative direct service connection nexus opinion. However, the examiner's rationale in support of his opinion that the Veteran's lipoma was not related to herbicide agent exposure, acknowledged that such lesions were of unknown undetermined etiology. Further, his opinion that the Veteran's lipoma and chronic seborrheic keratosis were not related to active service on a direct basis was conclusory and seemingly applied a higher standard that did not reflect the benefit of the doubt standard and did not adequately address the circumstances of the Veteran's service or his lay statements. Further, the examiner did not note evidence that would counter the Veteran's assertions that his claimed disabilities were related to his active service in the context of the circumstances of the Veteran's Vietnam service. Finally, the Board found that the examiner had not addressed whether the Veteran's claimed disabilities were complications of his service-connected chloracne, or treatment therefor. As such, the Board noted that the VA examiner had not provided a medical opinion as to the claimed disabilities as secondary to the Veteran's service-connected chloracne.

Thus, the Board found that a remand was necessary to obtain addendum medical opinions addressing whether the Veteran's lipoma and chronic seborrheic keratosis were related to active service, to include as due to herbicide agent exposure, and addendum opinions addressing whether his lipoma and chronic seborrheic keratosis were proximately caused or aggravated by his service-connected chloracne. As the Veteran's scar was secondary the underlying disabilities that were being remanded, the claim for service connection for scar, right side of neck, was remanded as inextricably intertwined.

As noted by the Board in its January 2025 decision, a November 2022 rating decision granted service connection for chloracne, upper back and shoulders on a presumptive basis to herbicide agent exposure, with an evaluation of 10 percent from December 7, 2015. 38 C.F.R. §3.307(a)(6)(iii). That issue is no longer on appeal.

The Veteran's
seborrheic keratosis were proximately caused or aggravated by his service-connected chloracne. As the Veteran's scar was secondary the underlying disabilities that were being remanded, the claim for service connection for scar, right side of neck, was remanded as inextricably intertwined.

The Veteran's appeal has been returned to the Board for further appellate consideration.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d).

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R.§ 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The governing regulation has been interpreted to permit a grant of service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of Ward v. Wilkie, the United States Court of Appeals for Veterans Claims held that, for secondary service connection, "aggravation" need not be permanent in nature. 31 Vet. App. 233, 241-42 (2019).

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the United States Court of Appeals for the Federal Circuit held that secondary service connection under 38 U.S.C. § 1110 is warranted for any increase in a nonservice-connected disability that is due to a service-connected disability, including where a service-connected disability precludes treatment for a nonservice-connected disability. Id. at 1363-1365. That decision also found unlawful the VA regulation that required evidence establishing a pre-aggravation baseline before secondary service connection based on aggravation could be granted. Id. at 1366 ("We decide this case based on our interpretation of § 1110 alone. To the extent that the VA also applied 38 C.F.R. § 3.310(b) to reject Mr. Spicer's theory of compensation, that regulation is unlawful as inconsistent with 38 U.S.C. § 1110.").

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data.
). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In adjudicating a claim of service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154(a).

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 the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to service connection for a fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis, to include as secondary to service-connected chloracne, is granted.

2. Entitlement to service connection for a scar, right side of neck, to include as secondary to service-connected fatty tumor (lipoma), right side of neck, is granted.

The Veteran claims entitlement to service connection for a fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis. The Veteran also claims entitlement to service connection for a scar, right side of neck.

A January 2001 VA medical treatment record shows surgical pathology: Specimen source included complex lipoma root of right neck area, also right cervical lymph node. Sizes included 10 x 8 x 5 cm, 3 x 2 x 1 cm, diagnosis of: mass of right neck lipoma with few scattered atypical cells and right cervical lymph node found to be reactive lymphadenitis.

In December 2015, the Veteran submitted a statement that in approximately 2000, he had a growth removed from the right side of his neck that was nearly the size of a grapefruit. There was no specific identifiable cause. He stated his belief that the growth was the result of his exposure to Agent Orange in Vietnam. In a March 2016 statement, the Veteran reiterated his belief that the growth was caused by exposure to Agent Orange.

At the February 2022 hearing, the Veteran testified that he experienced a growth the size of a softball on the right side of his neck 15-20 years earlier, and went to two or three civilian doctors. He went to the VA, and they removed it but when the Veteran requested it, he was informed that they did not keep a sample. He was told it wasn't cancerous and that it was a "fatty tumor." The Veteran stated that it took about a year for the tumor to reach full growth. It took about a year to develop to the softball size and kept getting worse, and he thought maybe it'd go down. The Veteran stated that he had to go to a funeral and couldn't put a tie on and had to leave the collar open. The surgeon told him they were going to make an incision about four or five inches long. He stated that, "And I said, ma'am, I hate to correct you, but in order to get something that's that big around, you're going to have to cut damn near around my neck to my backbone, and that's what they ended up doing." He indicated that the visible scar is seven or eight inches around and described that it "stuck out." He described that the scar starts at his chin and goes to the back of his neck. He indicated that the right side of his neck from the base of the back of his neck to the front is "all numb." The feeling has never come back. He stated that the surgeon explained it was like a living tumor that had blood vessels going to it, and when they did the operation, they had to be real careful because all those nerves get attached. The Veteran stated the scar is not painful or tender, but the right side of his neck is numb. He stated that he attended seminars put on by the VFW that discussed Agent Orange. He stated that a "lady come in from New York, and she was supposed to be the so-called authority on Agent Orange." He stated that he told her about his neck and she said, "it could have been Agent Orange."

Pursuant to the Board's latest January 2025 remand, a VA examiner issued a March 2025 VA opinion.

The March 2025 VA examiner opined that the Veteran's claimed lipoma was less likely than not proximately due to or the result of the Veteran's service-connected chloracne. The VA examiner also opined that the Veteran's claimed lipoma was not at least as likely as not aggravated beyond its natural progression by his service-connected chloracne. As support for the opinions, the VA examiner explained that there was no established evidence that chloracne directly contributed to the development or progression of lipomas. The pathophysiological mechanisms underlying the two conditions were distinct, with chloracne affecting the pilosebaceous units of the skin and lipomas arising from deeper fat tissue. However, the VA examiner noted that it was theoretically possible for significant local inflammation associated with severe chloracne or irritation from topical treatments (such as retinoids) to cause transient swelling or tenderness in a lipoma located in the same region, although such effects would not be expected to influence the actual growth or biological behavior of the lipoma. As such, in rare cases, trauma, infection, or inflammation involving overlying or adjacent skin could draw attention to an existing lipoma or cause it to become temporarily symptomatic.

Also, the March 2025 VA examiner opined that the Veteran's claimed seborrheic keratosis was less likely than not proximately due to or the result of the Veteran's service-connected chloracne. The VA examiner also opined that the Veteran's claimed seborrheic keratosis was not at least as likely as not aggravated beyond its natural progression by his service-connected chloracne. As support for the opinion, the VA examiner explained that chloracne or the treatment of chloracne could not directly cause seborrheic keratosis. Chloracne was a skin condition caused by exposure to halogenated aromatic hydrocarbons, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The pathogenesis of chloracne involved the alteration of sebaceous gland differentiation and keratinocyte biology, leading
-connected chloracne. The VA examiner also opined that the Veteran's claimed seborrheic keratosis was not at least as likely as not aggravated beyond its natural progression by his service-connected chloracne. As support for the opinion, the VA examiner explained that chloracne or the treatment of chloracne could not directly cause seborrheic keratosis. Chloracne was a skin condition caused by exposure to halogenated aromatic hydrocarbons, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The pathogenesis of chloracne involved the alteration of sebaceous gland differentiation and keratinocyte biology, leading to the formation of comedones and cysts. Seborrheic keratosis, on the other hand, was a benign epidermal tumor characterized by the proliferation of immature keratinocytes. There was no evidence in the medical literature to suggest a direct causal relationship between chloracne or its treatment and the development of seborrheic keratosis. However, the VA examiner also explained that, although genetic factors and aging were considered related factors, rather than environmental factors or the treatment of other skin conditions, the etiology of seborrheic keratosis was not fully understood.

After careful consideration, the Board finds the March 2025 VA opinions of low probative values as to the nature and etiology of the claimed disabilities. Particularly, the VA examiner did not address and consider the Veteran's military and medical history or his statements and testimony. Also, to render the opinions, the VA examiner used a more stringent standard, that is, one seemingly based on causality, rather than the applicable "approximate balance" standard, where the veteran would be entitled to the benefit of the doubt when the evidence was approximately balanced, that is, nearly equal, if not higher. Further, the VA examiner did observe that it was theoretically possible for significant local inflammation associated with severe chloracne or irritation from topical treatments to cause transient swelling or tenderness in a lipoma located in the same region. As such, even if rare, it was possible that trauma, infection, or inflammation involving overlying or adjacent skin could draw attention to an existing lipoma or cause it to become temporarily symptomatic. Finally, the VA examiner did observe that, although genetic factors and aging were considered related factors, rather than environmental factors or the treatment of other skin conditions, the etiology of seborrheic keratosis was not fully understood. As such, the Board finds that the VA examiner essentially conceded the possibility that the Veteran's claimed disabilities could be related to his service-connected chloracne. Moreover, had the examiner more fully understand the appropriate evidentiary standard in this case, the Board finds it reasonable to conclude that his ultimate opinions would have been favorable to the Veteran's claims.

Accordingly, giving the Veteran the benefit of the doubt, entitlement to service connection for a fatty tumor (lipoma), right side of neck, and chronic seborrheic keratosis, to include as secondary to service-connected chloracne, is warranted.

Finally, the Board notes that it already has been established that the Veteran's right side neck scar resulted from his January 2001 excision surgery to remove his lipoma. See VA treatment records, January 2001; October 2022 VA scars examination; March 2025 VA scars examination. Accordingly, entitlement to service connection for a scar, right side of neck, to include as secondary to service-connected fatty tumor (lipoma), right side of neck, is also warranted.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Aquino Ramos, Carlos M.

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.

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