MALIGNANT SKIN NEOPLASMS (OTHER THAN MALIGNANT MELANOMA)

JOHN R. DOOLITTLE, II · 2026 · Case ID: A26029896

MIXED

Summary

The Veteran, who served from November 1969 to September 1971, including service in the Republic of Vietnam, appeals the denial of service connection for squamous cell carcinoma, basal cell carcinoma, and scarring. The Board granted service connection for squamous cell carcinoma and basal cell carcinoma, finding the evidence in equipoise regarding their relation to in-service sun exposure and sunburns. The Veteran's service treatment records documented severe photosensitivity and dermatitis, including a medical evacuation due to sunburn. A private dermatologist provided a persuasive opinion stating it was more likely than not that these cancers were related to service, acknowledging the in-service sunburn and continuity of symptoms. While VA examiners opined less likely than not, the Board found their opinions inadequate for failing to fully address the link between the documented sunburn and the cancers. Service connection for scarring was also granted, as the scars resulted from procedures to treat the now service-connected skin cancers. The claim for actinic keratosis was remanded due to a pre-decisional duty to assist error; VA opinions failed to adequately address its link to in-service sun exposure and sunburn, despite acknowledging these as risk factors. A new opinion is required to determine the etiology of the actinic keratosis.

Rationale

Evidence in equipoise; Private opinion found more likely than not related to service; VA opinions found inadequate

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260225-631720

Full Decision Text

Citation Nr: A26029896
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 260225-631720
DATE: April 2, 2026

ORDER

Entitlement to service connection for squamous cell carcinoma is granted.

Entitlement to service connection for basal cell carcinoma is granted.

Entitlement to service connection for scarring, claimed as secondary to skin disorders, is granted.

REMANDED

Entitlement to service connection for actinic keratosis is remanded.

FINDINGS OF FACT

1. The competent and probative evidence is at least in equipoise as to whether the Veteran's squamous cell carcinoma is etiologically related to his in-service sun exposure and resultant sunburn while serving in the Republic of Vietnam during the Vietnam War.

2. The competent and probative evidence is at least in equipoise as to whether the Veteran's basal cell carcinoma is etiologically related to his in-service sun exposure and resultant sunburn while serving in the Republic of Vietnam during the Vietnam War.

3. Resolving all doubt in the Veteran's favor, his scars are related to his (now) service-connected squamous cell carcinoma and basal cell carcinoma.

CONCLUSIONS OF LAW

1. Service connection for squamous cell carcinoma is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. Service connection for basal cell carcinoma is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. Entitlement to service connection for scars is warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant is a Veteran who served on active duty from November 1969 to September 1971 and had service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2026 higher-level review rating decision. A February 2026 rating decision denied the claims on appeal, and in February 2026, the Veteran submitted a higher-level review request. In a February 2026 VA Form 10182, the Veteran appealed this case to the Board and selected direct review of the claim. Therefore, the Board's review is limited to the evidence reviewed in the February 2026 rating decision.

As a preliminary matter, the Board notes that this claim is "advanced on the docket (AOD)." Accordingly, the Board finds that it is in the Veteran's interest that this matter be adjudicated without further delay. The Board notes that Williams v. McDonough, 37 Vet. App. 305 (2024) provides guidance under which the Veteran may choose a docket review option during the latter of one year from the date that the Agency of Original Jurisdiction (AOJ) mails notice of the decision or sixty days from the date the Board receives the notice of disagreement, pursuant to 38 C.F.R. § 20.202(c)(2). However, in this case, the delay, until one year from the notice of the rating decision on appeal, or until February 2027 would not best serve the Veteran. He has AOD status due to age, three of the four issues on appeal are being granted, the evidence of record is not sufficient to grant the claim seeking service connection for actinic keratosis, and the Board must remand the actinic keratosis claim to correct a pre-decisional duty to assist error, which is discussed below in greater detail.

The Board also notes that although the Veteran did not specifically note on the VA Form 10182 that he was seeking to appeal the denial of the claim seeking service connection for scarring, he submitted a statement with the VA Form 10182 that discussed his scarring due to procedures that involved skin grafting due to problems with his squamous cell carcinoma and basal cell carcinoma. Therefore, the Board finds that the Veteran also intended to appeal his claim seeking service connection for scarring and has added it as noted above.

1. Service connection for squamous cell carcinoma is granted.

2. Service connection for basal cell carcinoma is granted.

The Veteran asserts that his squamous cell carcinoma and basal cell carcinoma are due to an in-service event, injury, or disease. Specifically, he asserts that it each disorder is due to his in-service excessive sun exposure and resultant sunburns from serving in the
for scarring, he submitted a statement with the VA Form 10182 that discussed his scarring due to procedures that involved skin grafting due to problems with his squamous cell carcinoma and basal cell carcinoma. Therefore, the Board finds that the Veteran also intended to appeal his claim seeking service connection for scarring and has added it as noted above.

1. Service connection for squamous cell carcinoma is granted.

2. Service connection for basal cell carcinoma is granted.

Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

The Board concludes that the evidence is at least in equipoise regarding whether the Veteran's squamous cell carcinoma and basal cell carcinoma are related to excessive sun exposure and resultant sunburns while serving in the Republic of Vietnam during the Vietnam War.

An August 19, 1970, service treatment record (STR) notes that the Veteran sought treatment for sunburn and sore throat. The provider indicated that he had photosensitivity dermatitis, had been in Vietnam 3 weeks, and had been wearing his shirt sleeves down. It was noted that the Veteran had blistering on his knuckles.

An August 21, 1970, STR notes that the Veteran was evaluated for blistering of his skin and hands. The impression was severe photosensitivity and dermatitis. The provider recommended that the Veteran be transferred to the rear and that he remain out of sunlight as much as possible.

A September 4, 1970, STR, noted that the Veteran's lesions were healing and that he was to remain out of the sunlight.

An August 1971 separation report of medical examination notes that the Veteran had severe photosensitivity and dermatitis on August 19, 1970. The provider indicated that although the conditions persisted, it was to a lesser degree.

In a May 2025 private medical statement, the Veteran's provider indicated that she was board-certified in dermatology, had been practicing for 29 years, and had experience diagnosing and treating skin cancers, such as basal cell carcinoma, squamous cell carcinoma, cutaneous T-cell lymphoma, Merkel cell carcinoma, and precancerous lesions. She also noted that she was experienced in diagnosing and treating psoriasis, eczema, and various other skin rashes. The provider indicated that she had reviewed the Veteran's STRs and deployment history, VA medical records, private provider medical records, diagnostic imaging reports, medical research and literature relevant to the claimed conditions. She noted that the Veteran had been formally diagnosed with squamous cell carcinoma and basal cell carcinoma, and she opined that it was more than likely that his diagnosed conditions were related to or were aggravated by his military service. The provider indicated that a review of the STRs showed that he had to be medically evacuated out of Vietnam due to severe burns in August 1970 and that his post service medical records demonstrate continuity of symptoms and treatment following discharge. She explained that, based on her detailed review of the Veteran's evidence and records, a review of current medical research, and her clinical experience, she concluded that it was more than likely that the Veteran's basal cell carcinoma and squamous cell carcinoma were due to his military service. The provider noted that the evidence supported this conclusion through documentation of symptoms during service, post service continuity, and scientific studies that validated such associations.

In an October 2025 statement, the Veteran reported that while he was serving in Vietnam he was medically evacuated out of Da Nang due to severe sun burns he endured in country. He related that he was then
1970 and that his post service medical records demonstrate continuity of symptoms and treatment following discharge. She explained that, based on her detailed review of the Veteran's evidence and records, a review of current medical research, and her clinical experience, she concluded that it was more than likely that the Veteran's basal cell carcinoma and squamous cell carcinoma were due to his military service. The provider noted that the evidence supported this conclusion through documentation of symptoms during service, post service continuity, and scientific studies that validated such associations.

In an October 2025 statement, the Veteran reported that while he was serving in Vietnam he was medically evacuated out of Da Nang due to severe sun burns he endured in country. He related that he was then sent to Camp Lejeune. The Veteran reported that since service he has struggled with his skin and has developed basal cell carcinoma, squamous cell carcinoma, and actinic keratosis. He related that he recently had skin grafts on his face and now has scarring and facial asymmetry on his face where the skin was grafted.

On December 2025 VA skin diseases examination, basal cell carcinoma, squamous cell carcinoma, and actinic keratosis were diagnosed.

In a December 2025 VA skin opinion, the provider opined that it was less likely than not that the Veteran had squamous cell carcinoma and basal cell carcinoma that due to sunburns during service. She explained that there were no STRs to support that there was a sunburn in service that directly caused the squamous cell carcinoma or basal cell carcinoma.

In January 2026 VA skin diseases opinions, the VA provider furnished additional Toxic Exposure Risk Activity (TERA) opinions and opinions related to Camp Lejeune for the Veteran's squamous cell carcinoma and basal cell carcinoma claims. The provider noted that she reviewed the exposure information and noted that the Veteran was stationed at Camp Lejeune and was exposed to herbicide agents in Vietnam. She indicated that the records reviewed did not show that the Veteran had any risk factors outside of military service. The provider opined that his basal cell carcinoma was less likely than not due to a TERA. She noted that the Veteran was diagnosed with basal cell carcinoma which is a type of skin cancer that begins in the basal cells. The provider indicated that the STRs were silent for the disorder and that medical research did not show that exposure to herbicide agents or Camp Lejeune water contamination was a risk factor for this disorder. She noted that basal cell carcinoma occurs most often on areas of the skin that are exposed to the sun, such as the head and neck and that most basal cell carcinomas were thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. The provider indicated that some risk factors for the development of basal cell carcinoma included, in part, chronic sun exposure, severe sunburns, radiation therapy, skin that sunburns easily, having light skin, and having a family history of the cancer carcinomas.

The provider then opined that the Veteran's squamous cell carcinoma was less likely than not due to an in-service TERA. She noted that squamous cell carcinoma of the skin occurs when the squamous cells in the skin get changes in their DNA. The provider explained that the STRs were silent for any treatment for this disorder and noted that the medical research has not shown that exposure the herbicide agents or the Camp Lejeune water contamination are risk factors for the disease. She indicated that squamous cell carcinoma was a type of cancer that started as a growth of cells on the skin and that risk factors for its development included, in part, having skin that sunburns easily, having light skin, being in the sun too often, having a history of sunburns, having had one or more sunburns that raised blisters as a child or teenager, and having sunburns as an adult.

The Board notes that on December 2025 VA skin diseases examination, basal cell carcinoma and squamous cell carcinoma were diagnosed. As such, the first element of service connection, a current disability, has been met, for each disorder.

As noted above, a review of the Veteran's STRs shows that although he was not specifically treated for basal cell or squamous cell carcinoma, he was treated for significant sunburn during service. Also, in an October 2025 statement, the Veteran related that he had to be medically evacuated from Da Nang due to his severe sunburn. The Board finds the Veteran's report regarding his in-service sun exposure and resultant sunburn is competent and credible evidence and entitled to high probative weight. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) (Competent lay evidence is that which the witness has actually observed and is
, has been met, for each disorder.

Thus, the question becomes whether the Veteran's current squamous cell carcinoma and basal cell carcinoma are related to the in-service sun exposure and resultant sunburns. On this question there are VA opinions against the claim and a private opinion in favor of the claim.

The Board finds that the VA opinions against the Veteran's claims, specifically the ones that address whether the carcinomas were related to sun exposure during service, are inadequate and less probative evidence against the claim. Although the provider seemed to acknowledge that the Veteran sustained a sunburn during service, the provider did not explain why such a sunburn might have eventually led to one or both carcinomas. Also, in separate opinions by another VA provider, risk factors for the development of the carcinomas included exposure to sunlight and having had sunburns as an adult or child.

The Board finds that the May 2025 private medical statement is probative and persuasive evidence in support of the Veteran's claim. The provider indicated that she had extensive experience diagnosing and treating skin cancers and had reviewed the Veteran's file, to include treatment records, and pertinent medical research. She opined that it was more likely than not that his carcinomas were related to service and acknowledged the report in the STRs of the Veteran's sunburn and acknowledged his reports of treatment for the sunburn during and after service. The provider explained that, based on her detailed review of the Veteran's evidence and records, a review of current medical research, and her clinical experience, that it was more than likely that the Veteran's basal cell carcinoma and squamous cell carcinoma were due to his military service. The Board notes that although the provider did not specifically note the medical literature reviewed in the process of developing the opinion, the Board has no reason to believe that such literature was not reviewed, especially in light of the provider's extensive experience with evaluating skin cancers. Therefore, as noted above, the Board finds the opinion to be probative and persuasive evidence in support of the Veteran's claims.

The Board also notes that although the VA opinions were against the Veteran's claims, the January 2026 VA provider noted that risk factors for basal cell carcinoma and squamous cell carcinoma included, in part, exposure to UV radiation and having experienced sunburns, which supports his contentions that both cancers were due to exposure to sunlight and/or having experienced a sunburn during service.

In sum, the competent and credible medical and lay evidence is at least in equipoise regarding whether the Veteran's sunburn during service was related to his development of basal cell carcinoma and squamous cell carcinoma. His STRs showed treatment for a severe sunburn, and the private medical opinion indicated a positive etiological relationship between his basal cell carcinoma and squamous cell carcinoma and in-service sun exposure and sunburn. Accordingly, service connection for squamous cell carcinoma and basal cell carcinoma is granted.

3. Service connection for scarring, claimed as secondary to skin disorders, is granted.

The Veteran asserts that he has scarring, primarily on his face, due to procedures related to his squamous cell carcinoma and basal cell carcinoma.

A December 2025 VA scars examination indicated that the Veteran had one or more scars and had disfigurement of the head, face, or neck. He related that he underwent several skin removals for his skin cancer. The examiner indicated that the Veteran had four facial scars that measured from 1x1 cm to 2x2 cm.

In a February 2026 VA scar addendum opinion, a VA provider indicated that the Veteran's scars were directly due to his skin cancer because he has had several biopsies and surgical procedures completed which caused the scars.

In an additional February 2026 addendum opinion, a VA provider indicated that the scar was not linked to the skin symptoms during military service.

As the Board herein grants service connection for squamous cell carcinoma and basal cell carcinoma, and the evidence shows
figurement of the head, face, or neck. He related that he underwent several skin removals for his skin cancer. The examiner indicated that the Veteran had four facial scars that measured from 1x1 cm to 2x2 cm.

In an additional February 2026 addendum opinion, a VA provider indicated that the scar was not linked to the skin symptoms during military service.

As the Board herein grants service connection for squamous cell carcinoma and basal cell carcinoma, and the evidence shows scars resulting from treatment for the carcinomas, the evidence now weighs in favor of a finding that the scars due to procedures for squamous cell carcinoma and basal cell carcinoma are related to a service-connected disability, and service connection is therefore granted. The Board notes that the February 2026 VA opinions are seemingly for and against the Veteran's claim, but the Board finds that notwithstanding those opinions service connections for the scars is warranted.

REASONS FOR REMAND

One of the effects of the Appeals Modernization Act (AMA) is to narrow the set of circumstances in which the Board must remand appeals to the Agency of Original Jurisdiction (AOJ) for further development instead of immediately deciding them directly. Nevertheless, even under the AMA, the Board still has the duty to remand issues when necessary to correct a pre-decisional duty to assist error. See Pub L. No. 115-55 section (2)(d); 38 C.F.R. § 20.802(a).

4. Entitlement to service connection for actinic keratosis.

The Veteran asserts that his actinic keratosis is due to exposure to sunlight and/or experiencing a sunburn during service.

The Board finds that although the December 2025 and January 2026 VA opinions found that the Veteran's actinic keratosis was not due to exposure to herbicide agents, contaminated Camp Lejeune, or other TERA exposures due to the medical literature not supporting such a connection, the opinions are inadequate because they did not address whether the actinic keratosis was due to the Veteran's exposure to sunlight and/or his acknowledge sunburn during service. The Board notes that the January 2026 VA opinion acknowledged that exposure to UV rays and/or having a sunburn are risk factors for the development of the actinic keratosis. However, the VA provider did not discuss whether the Veteran's in-service sunburn could possibly have led to the development of his actinic keratosis.

The Board notes that the May 2025 private provider furnished a positive opinion for the Veteran's basal cell and squamous cell carcinomas. However, the provider did not opine that the actinic keratosis was related to the Veteran's service. Therefore, the Board finds that the opinion is not probative evidence in support of the Veteran's actinic keratosis claim.

Therefore, the Board finds that the Regional Office (RO) committed a pre-decisional duty to assist error by not obtaining an adequate medical opinion, and the Board finds that remand is necessary to obtain an adequate medical advisory opinion regarding the etiology of the Veteran's actinic keratosis. 38 C.F.R. § 4.2 (2019).

The matter is REMANDED for the following:

Forward the Veteran's claims file to an appropriate VA provider (other than the December 2025 and January 2026 providers), for further review and an addendum medical opinion regarding the etiology of the Veteran's actinic keratosis, specifically whether it is directly related to (was incurred during) his service. [If further examination of the Veteran is deemed necessary, such should be arranged.] On review of the record (including this remand), and examination of the Veteran if deemed necessary, the consulting provider should:

(a) Identify the likely etiology for the Veteran's actinic keratosis. Specifically, is it at least as likely as not that it is etiologically related to the Veteran's service/was incurred therein, to include his exposure to sunlight and/or his documented sunburn in the August 1970 STRs?

(b) If the provider determines that the actinic keratosis is not related to the Veteran's service, provide a likely etiology and explain why it is so.

All opinions must include rationale.

John R. Doolittle, II

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bayles, James J.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not

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