NEOPLASM HARD AND SOFT TISSUE MALIGNANT (ORAL CANCER)

Summary

The veteran, who served from April 1980 to November 1982, appeals the denial of service connection for basal cell carcinoma (BCC) and the remand of his claim for blood clots in the left leg. The Board found that the veteran has a current diagnosis of BCC and participated in toxic exposure risk activities (TERA) due to asbestos exposure as a machinist's mate aboard the USS Proteus. The Board also acknowledged the veteran's claims of exposure to cleaning chemicals and herbicide agents in Guam, noting that while the latter claim is not supported by the evidence due to the timing of his service, the former is likely. However, the Board found that the evidence persuasively weighed against service connection for BCC. The veteran's BCC first manifested in 2017, well after his service, and a VA examiner opined that skin cancer is not an asbestos-related illness and that the etiology of the Veteran's BCC is related to factors outside military service. The Board found this opinion adequate and highly probative. The Board also found no indication that BCC is associated with his service-connected disabilities. Therefore, service connection for BCC was denied. The claim for blood clots in the left leg was remanded because the RO failed to obtain a direct service connection opinion for this condition, despite favorable findings regarding varicose veins and TERA exposure. The Board noted the veteran's report of a left leg injury during service and the examiner's comment that blood clots can form after injury, necessitating a new opinion on direct service connection.

Rationale

Evidence persuasively weighs against onset during service or within one year of separation.; VA examiner provided negative opinion linking BCC to service exposures (asbestos, cleaning chemicals).; No indication BCC is associated with service-connected disabilities.

Full Decision Text

Citation Nr: A26035197
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 250210-519880
DATE: April 15, 2026

ORDER

Entitlement to service connection for basal cell carcinoma (BCC) (claimed as skin cancer) is denied.

REMANDED

Entitlement to service connection for blood clots in the left leg is remanded.

FINDING OF FACT

The evidence persuasively weighs against a finding that the Veteran's currently diagnosed BCC had its onset during service, became manifest to a degree of 10 percent or more within 1 year from the date of separation from service, or that it is otherwise etiologically related to his active service, including exposure to asbestos and/or cleaning chemicals, or was caused or aggravated by a service-connected disability.

CONCLUSION OF LAW

The criteria for service connection for BCC are not met.  38 U.S.C. §§ 1112, 1113, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran, who is the appellant in this case, served on active duty from April 1980 to November 1982.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).  By readjudicating the service connection claims on the merits in the January 2025 rating decision, the RO made an implicit favorable finding that new and relevant evidence had been received in support of the claims.  Having found no clear and unmistakable error, the Board is bound by this favorable finding.  38 C.F.R. § 3.104(c).  Accordingly, the Board will readjudicate the service connection claims on a de novo basis.

In February 2025, the Veteran filed a VA Form 10182 (Decision Review Request: Board Appeal) and requested direct review by the Board.  Therefore, the Board may only consider the evidence of record at the time of the January 2025 rating decision.  38 C.F.R. §?20.301.  Any evidence submitted after the January 2025 rating decision cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801.  

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.  However, because the Board is remanding the claim for service connection for blood clots in the left leg, any evidence the Board could not consider will be considered by the RO in the adjudication of that claim.  38 C.F.R. § 3.103(c)(2)(ii).

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the appellant and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015).

1. Entitlement to service connection for BCC 

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

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability.  Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 

Service connection may also be granted for any injury or disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).

Malignant tumors (in this case, BCC) are considered by VA to be a "chronic disease" as listed under 38 C
, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability.  Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 

Service connection may also be granted for any injury or disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).

Malignant tumors (in this case, BCC) are considered by VA to be a "chronic disease" as listed under 38 C.F.R. § 3.309(a).  Therefore, the presumptive service connection provisions based on "chronic" in-service symptoms and "continuous" post-service symptoms under 38 C.F.R. § 3.303(b) apply.  Where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service.  38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).  

Effective August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) added Guam (and the territorial waters thereof) to the list of locations with presumed exposure to herbicide agents for service during the period beginning on January 9, 1962, and ending on July 31, 1980.  See 38 U.S.C. § 1116(d)(2).  

A presumption of service connection has been established for certain diseases found to be associated with herbicide agent exposure.  See 38 U.S.C. § 1116(a); 38 C.F.R. § 3.309(e).  Absent affirmative evidence to the contrary, such diseases will be service connected even if there is no evidence of the disease during service, provided that herbicide agent exposure is established.  See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(d), 3.309(e).  As relevant here, even if a disease is not listed under 38 U.S.C. § 1116(a)(2) or 38 C.F.R. § 3.309(e), service connection may still be established with proof of direct causation.  See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994).  

VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a claimant prevailing in either event.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination.  See Lynch v. McDonough, 999 F.3d 1391 (2021); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001).  If the evidence persuasively weighs against the claim, the claim is denied.

In this case, the Veteran asserts that service connection is warranted for BCC, to include as due to claimed exposure to herbicide agents during his active service in Guam in the 1980s.  See May 2023 VA Form 21-526EZ.

The RO has made the following relevant favorable findings in this matter: (1) the Veteran has a current diagnosis of BCC; (2) he participated in a toxic exposure risk activity (TERA) during service, since he was exposed to asbestos in his duties as a machinist's mate aboard the USS Proteus; (3) BCC is a chronic disease which may be presumptively linked to military service if manifested to a degree of 10 percent disabling within one year of release from service; and (4) the Veteran has sufficient service to meet the minimum requirements for presumptive service connection based on a chronic disease.  See rating decisions dated October 2023 to February 2026; see also DD-214, January 2025 VA "Skin Diseases" Disability Benefits Questionnaire (DBQ).  Having found no clear and unmistakable error, the Board is bound by these favorable findings.  38 C.F.R
 during service, since he was exposed to asbestos in his duties as a machinist's mate aboard the USS Proteus; (3) BCC is a chronic disease which may be presumptively linked to military service if manifested to a degree of 10 percent disabling within one year of release from service; and (4) the Veteran has sufficient service to meet the minimum requirements for presumptive service connection based on a chronic disease.  See rating decisions dated October 2023 to February 2026; see also DD-214, January 2025 VA "Skin Diseases" Disability Benefits Questionnaire (DBQ).  Having found no clear and unmistakable error, the Board is bound by these favorable findings.  38 C.F.R. § 3.104(c).  Accordingly, a current disability and an in-service event are established.

Additionally, the Veteran reported exposure to fumes from cleaning chemicals during active service, which the Board finds as likely as not given the observable nature of such exposure and his duties as a machinist's mate.  See, e.g., DD-214; January 2025 VA "Skin Diseases" DBQ.  The Veteran also asserts that he was exposed to herbicide agents during his active service in Guam in the 1980s.  See May 2023 VA Form 21-526EZ.  As noted previously, the PACT Act added Guam (and the territorial waters thereof) to the list of locations with presumed exposure to herbicide agents for service during the period beginning on January 9, 1962, and ending on July 31, 1980.  See 38 U.S.C. § 1116(d)(2).  Here, the Veteran's military personnel records reflect that he was not received for duty (RECDUT) in Guam until October 11, 1980, which is after the period of presumed exposure to herbicide agents.  See "History of Assignments."  The Board acknowledges that in a July 2023 memorandum, VA indicated that the Veteran qualifies for a presumption of exposure to herbicide agents given his active service in Guam, and that in a September 2023 VA medical opinion, the VA examiner noted "[A]gent [O]range exposure."  However, VA later issued two additional memoranda: (1) a September 2023 memorandum finding that the Veteran did not participate in any TERAs during active service; and (2) a December 2023 memorandum finding that while the Veteran does not qualify for a presumption of exposure to herbicide agents, there is evidence of a non-deployment related exposure to asbestos.  Notably, the RO never made a favorable finding in any rating decision that the Veteran was exposed to herbicide agents during active service, and the Board affords little to no probative value to the Veteran's conclusory lay assertions that he was exposed to herbicide agents during active service.  Even if herbicide agent exposure were found to exist for this Veteran, the Board emphasizes that, based on cumulative scientific data reported by the National Academy of Science (NAS) since 1993, VA has determined that a positive association does not exist between herbicide exposure and BCC.  See VBA Letter 20-24-06, Updated Guidance on Processing Claims Involving the PACT Act, 89 Fed. Reg. 51,224 (Jun. 17, 2024).

Thus, the remaining question before the Board is whether there is competent evidence of a nexus between the Veteran's current BCC and his active service, or to a service-connected disability.

On review, the Board finds that the evidence persuasively weighs against the Veteran's claim.  

First, the evidence persuasively weighs against a finding that the Veteran's currently diagnosed BCC had its onset during service or became manifest to a degree of 10 percent or more within 1 year from his separation from active service in November 1982.  Instead, the record reflects that the Veteran's BCC first onset in 2017.  See August 2017 VA dermatology outpatient note (Veteran noted to be "here for lesion on left nose as noted in telederm.  Has been present for a few months" and was assessed with "Neoplasm of unknown origin- r/o BCC," and his lesion was biopsied); September 2017 VA treatment records (BCC with nodular component confirmed on biopsy); January 2025 VA "Skin Diseases" DBQ (Veteran stated that his BCC onset in 2017).

Second, the evidence persuasively weighs against a finding that the Veteran's current BCC is caused by his in-service exposures to asbestos and cleaning chemicals.  In a January 2025 VA medical opinion, the VA examiner provided a negative TERA opinion, reasoning, in pertinent part, "The Veteran is claiming skin
 left nose as noted in telederm.  Has been present for a few months" and was assessed with "Neoplasm of unknown origin- r/o BCC," and his lesion was biopsied); September 2017 VA treatment records (BCC with nodular component confirmed on biopsy); January 2025 VA "Skin Diseases" DBQ (Veteran stated that his BCC onset in 2017).

Second, the evidence persuasively weighs against a finding that the Veteran's current BCC is caused by his in-service exposures to asbestos and cleaning chemicals.  In a January 2025 VA medical opinion, the VA examiner provided a negative TERA opinion, reasoning, in pertinent part, "The Veteran is claiming skin cancer based upon exposure to asbestos and cleaning chemicals while performing his MOS.  The Veteran was stationed on the USS Proteus, his MOS was Machinist Mate and exposure is conceded in the TERA memo dated 12/20/2023...The reported onset was in 2017 when the Veteran notice[d] a growth on the left side of his nose.  He had a biopsy that was positive for [BCC] and then has a resection with a MOHs procedure.  According the VA public health webpage, skin cancer is not an asbestos related illness.  According the VA webpage titled [']Exposure to burn pits and other specific environmental hazards,['] skin cancer is not a presumptive condition.  There is no medical or scientific evidence available that provides any indication of relationship between the development of the condition at issue and the TERA.  The etiology of the Veteran's skin can[cer] is related to other factors outside military service."  On review, the Board finds the January 2025 VA TERA opinion to be adequate and highly probative given the VA examiner's consideration of the Veteran's medical history and reliance on relevant medical literature.

Third, there is no indication that the Veteran's BCC may be associated with any of his service-connected disabilities (lumbosacral strain, left lower extremity radiculopathy, and inguinal hernia), to include on a causation or aggravation basis.

For these reasons, the Board finds that the evidence persuasively weighs against the Veteran's claim for service connection for BCC.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable, and service connection must be denied.

REASONS FOR REMAND

1. Entitlement to service connection for blood clots in the left leg is remanded.

Remand by the Board in the system governed by the Appeals Modernization Act (AMA) is proper for correction of (1) duty to assist errors occurring prior to the date of the RO decision on appeal (i.e., pre-decisional duty to assist errors) and (2) RO errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the Veteran's claim.  38?C.F.R. §?20.802(a). 

The RO has made the following relevant favorable findings in this matter: (1) the Veteran has a current diagnosis of varicose veins in the left leg; and (2) he participated in a TERA during service, since he was exposed to asbestos in his duties as a machinist's mate aboard the USS Proteus.  See rating decisions dated October 2023 to February 2026; see also DD-214, January 2025 VA "Artery and Vein Conditions (Vascular Diseases Including Varicose Veins)" DBQ.  Having found no clear and unmistakable error, the Board is bound by these favorable findings.  38 C.F.R. § 3.104(c).  

On review, the Board finds that remand is necessary to cure a pre-decisional duty to assist error.  

In January 1983, the Veteran was provided a VA examination for his claimed residuals of injury to his left leg, and he reported that he had previously injured his left leg during service in October 1982 when he was struck by a car while on foot.  The Veteran was diagnosed with varicose veins in the left leg, per the September 2023 and January 2025 VA "Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) DBQs.  The RO only requested VA TERA opinions for this claim and did not request an opinion as to direct service connection for blood clots in the left leg.  See "Exam Requests" dated July 2023 and August 2024.  Notably, as part of the rationale in a September 2023 VA TERA opinion, the VA examiner noted that "[b]lood clots are more likely to form after an injury.    

Based on
 was struck by a car while on foot.  The Veteran was diagnosed with varicose veins in the left leg, per the September 2023 and January 2025 VA "Artery and Vein Conditions (Vascular Diseases Including Varicose Veins) DBQs.  The RO only requested VA TERA opinions for this claim and did not request an opinion as to direct service connection for blood clots in the left leg.  See "Exam Requests" dated July 2023 and August 2024.  Notably, as part of the rationale in a September 2023 VA TERA opinion, the VA examiner noted that "[b]lood clots are more likely to form after an injury.    

Based on the foregoing evidence, the Board finds that, prior to adjudicating the claim, the RO should have obtained an opinion as to direct service connection for the Veteran's claimed blood clots in the left leg, as due to his asserted left leg injury during service.  This must be accomplished on remand.

As an aside, the Board acknowledges that a VA examiner provided a positive VA TERA opinion in September 2023, reasoning, in pertinent part, "This Veteran was diagnosed with laryngeal cancer after agent orange exposure and cancer has been known to be an etiology of blood clots."  However, the Veteran is not service connected for laryngeal cancer and as discussed above, there is little to no probative evidence of exposure to herbicide agents (such as Agent Orange) during his active service.  Therefore, the Board finds the September 2023 VA TERA opinion to be inadequate.  An adequate VA TERA opinion was later obtained in January 2025.

Accordingly, the matter is REMANDED for the following action:

Obtain an addendum VA medical opinion regarding the nature and etiology of the Veteran's claimed blood clots in the left leg.  The claims file, including a copy of this Remand, must be made available to, and be reviewed by, the examiner.  If another examination is indicated, one should be provided to the Veteran.

After a review of the entire claims file, the examiner is asked to provide an opinion as to whether the Veteran's claimed blood clots in the left leg at least as likely as not (at least an approximate balance of positive and negative evidence) had their onset during or are otherwise related to his active service, to include as due to his asserted left leg injury during active service in October 1982.

In providing this opinion, please consider the following:

(a)	In January 1983, the Veteran was provided a VA examination for his claimed residuals of injury to his left leg, and he reported that he had previously injured his left leg during service in October 1982 when he was struck by a car while on foot.  

(b)	As part of the rationale in a September 2023 VA TERA opinion, the VA examiner noted that "[b]lood clots are more likely to form after an injury."

 

 

S. B. MAYS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. M. Gill, 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.