MALIGNANT SKIN NEOPLASMS (OTHER THAN MALIGNANT MELANOMA)

Summary

The Veteran, an Army service member who served from June 1966 to October 1967, including service in the Republic of Vietnam, appeals the denial of service connection for skin cancer. The primary issue on appeal was melanoma, for which service connection was granted. The Veteran also claimed other types of skin cancer, which were remanded for further development. For the melanoma claim, the Veteran asserted a link to Agent Orange exposure. The Board considered the Veteran's service in Vietnam, which triggers a presumption of Agent Orange exposure under 38 C.F.R. § 3.307(a)(6), although melanoma itself is not a presumptive condition under § 3.309(e). The Board relied on a January 2026 private medical opinion that linked the Veteran's melanoma to Agent Orange exposure, citing scientific literature and explaining the biological plausibility. This opinion was found adequate because it addressed the Veteran's exposure, cited relevant studies, and explained the carcinogenic mechanisms. The Board found the melanoma at least as likely as not related to service, granting service connection. For other skin cancers (squamous and basal cell), the Board remanded the claim for a new VA examination. The Veteran had multiple biopsies for these conditions, and the existing evidence did not fully address their service connection or residuals. The remand directive requires the VA examiner to consider the Veteran's history, Agent Orange exposure, and provide an opinion on the relationship between these other skin cancers and service.

Rationale

Private medical opinion found melanoma at least as likely as not related to Agent Orange exposure.; Opinion cited scientific literature and explained biological mechanisms.; Veteran has current diagnosis of melanoma and presumed Agent Orange exposure.

Full Decision Text

Citation Nr: A26038815
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250903-582950
DATE: April 27, 2026

ORDER

Service connection for melanoma is granted.

REMANDED

Service connection for skin cancer other than melanoma is remanded.

FINDING OF FACT

The Veteran's melanoma skin cancer is at least as likely as not related to service.

CONCLUSION OF LAW

The criteria for service connection for melanoma have been met.  38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1966 to October 1967.

In a February 2025 rating decision, the agency of original jurisdiction confirmed and continued the denial of service connection for skin cancer.  In May 2025, the Veteran filed a Higher-Level Review Request, which was denied in an August 2025 rating decision.  In September 2025, the Veteran filed a VA Form 10182 to initiate an appeal on the Board's Hearing Docket.  In January 2026, the Veteran testified at a Board hearing.  Thus, the Board will review the evidence of record at the time of the February 2025 rating decision and any evidence received at or within 90 days after the Board hearing.  38 C.F.R. §§ 20.300, 20.302; see also 38 C.F.R. § 3.2600(f) (limiting the evidence reviewed during a Higher-Level Review to that which was before VA at the time the decision on review was issued).

Service connection for melanoma

The Veteran is claiming that his skin cancer is related to Agent Orange exposure during service.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. § 1110; 38 C.F.R. § 3.303.  A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service."  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

In this case, the Veteran served in the Republic of Vietnam and is presumed to have been exposed to Agent Orange.  38 C.F.R. § 3.307(a)(6).  Even though skin cancer is not presumed to be related to Agent Orange exposure, 38 C.F.R. § 3.309(e), service connection is still available on a direct basis.  See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).  

In September 2015, the Veteran had a biopsy of his left cheek and was diagnosed with melanoma.  The February 2025 and August 2025 rating decisions include a favorable finding that there is a current diagnosis of melanoma.

In January 2026, after the Board hearing, the Veteran submitted a medical opinion in which a physician opined that his melanoma cell skin cancer was at least as likely as not related to service.  The physician explained that the current scientific literature demonstrates a connection between an increased risk of melanoma and Agent Orange exposure and cited to several studies specifically noting melanoma cell skin cancer as being associated with Agent Orange exposure.  The physician then explained that Agent Orange exerts its carcinogenic effects primarily through the activation of the aryl hydrocarbon receptor pathway, leading to dysregulation of gene expression, oxidative stress, and cellular proliferation-mechanisms well-documented in carcinogenesis.  Melanocytes, the cells affected by melanoma, are susceptible to these molecular pathways, making the development of melanoma a biologically plausible outcome of Agent Orange exposure.

The Board finds that the Veteran's melanoma is at least as likely as not related to service.  The January 2026 medical opinion is adequate to decide the claim.  Specifically, the physicians considered the Veteran's Agent Orange exposure, cited to relevant medical literature, and explained the pathophysiological mechanisms by which Agent Orange exposure would cause melanoma.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  Given that the Veteran has also been found to have a current diagnosis of melanoma and presumed to have been exposed to Agent Orange during
 by melanoma, are susceptible to these molecular pathways, making the development of melanoma a biologically plausible outcome of Agent Orange exposure.

The Board finds that the Veteran's melanoma is at least as likely as not related to service.  The January 2026 medical opinion is adequate to decide the claim.  Specifically, the physicians considered the Veteran's Agent Orange exposure, cited to relevant medical literature, and explained the pathophysiological mechanisms by which Agent Orange exposure would cause melanoma.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  Given that the Veteran has also been found to have a current diagnosis of melanoma and presumed to have been exposed to Agent Orange during service, service connection for melanoma skin cancer is granted.  38 C.F.R. § 3.102.  Other types of skin cancer for which the Veteran has received treatment are addressed below.

REASONS FOR REMAND

Service connection for skin cancer other than melanoma

The Board finds that, based on the pre-decisional evidence of record, a remand is necessary to afford the Veteran a VA examination of his skin cancer other than melanoma.  38 C.F.R. § 20.802(a).  Generally, VA will afford a veteran an examination when there is an indication that a current disability might be related to service.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).  Under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), where a veteran participates in a toxic risk exposure activity (TERA), VA is to obtain a medical opinion which considers the total potential exposure through all applicable military deployments and the synergistic, combined effect of all TERAs.  38 U.S.C. § 1168(a); see also Combee, supra.

The Veteran has a long history of suspected skin cancer dating back to approximately February2002 .  Although the Veteran was diagnosed with melanoma in 2015, he also has a history of squamous and basal cell skin cancer.  The Veteran had biopsies confirm basal cell skin cancer on the left arm in September 2018, squamous cell skin cancer on the right arm in June 2020, squamous cell skin cancer on the left neck in July 2021, and squamous cell skin cancer on the left arm in February 2024 and May 2024.  A November 2024 VA treatment record also notes multiple recent excisions on the arms.

Thus, there is an indication that the Veteran might have squamous cell skin cancer on the left arm just prior to filing the supplemental claim in October 2024.  See 38 C.F.R. § 3.2500.  Further, there is no detailed record of what, if any, further treatment or residuals the Veteran had after the biopsies of his squamous and basal cell skin cancer lesions.  The Veteran also participated in a TERA-i.e., Agent Orange exposure in the Republic of Vietnam.  Therefore, a remand to afford the Veteran an examination of his skin cancer (other than melanoma) is warranted.  McLendon, supra; see also 38 U.S.C. § 1168(a).

In January 2026, after the Board hearing, the Veteran submitted a medical opinion in which a physician opined that his melanoma from 2015 was at least as likely as not related to service.  However, the opinion did not address the Veteran's squamous and basal cell skin cancer.  Further, it is still unclear from the record whether the Veteran currently has residuals of squamous or basal cell skin cancer during or just prior to the pendency of the claim.  See Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007).  Therefore, a remand to afford the Veteran a VA examination of his squamous and basal cell skin cancer is still warranted.

On remand, the Veteran may highlight for the examiner's benefit his Board hearing testimony and the January 2026 medical opinion.  However, since the Board may only remand to correct a pre-decisional duty to assist error, 38 C.F.R. § 20.802(a), this evidence will not be noted in the remand directive below.  

The matter is REMANDED for the following action:

Afford the Veteran a VA examination of his skin cancer other than melanoma.  The examiner should note any prior treatment for skin cancer and current residuals for skin cancer.  Thereafter, the examiner should address the following:

Is it at least as likely as not that the Veteran's skin cancer other than melan
 warranted.

On remand, the Veteran may highlight for the examiner's benefit his Board hearing testimony and the January 2026 medical opinion.  However, since the Board may only remand to correct a pre-decisional duty to assist error, 38 C.F.R. § 20.802(a), this evidence will not be noted in the remand directive below.  

The matter is REMANDED for the following action:

Afford the Veteran a VA examination of his skin cancer other than melanoma.  The examiner should note any prior treatment for skin cancer and current residuals for skin cancer.  Thereafter, the examiner should address the following:

Is it at least as likely as not that the Veteran's skin cancer other than melanoma is related to service, including Agent Orange exposure, after considering the synergistic, combined effect and total potential exposure through all applicable military deployments?

Please consider the Veteran's prior biopsies confirming basal cell skin cancer on the left arm in September 2018, squamous cell skin cancer on the right arm in June 2020, squamous cell skin cancer on the left neck in July 2021, and squamous cell skin cancer on the left arm in February 2024 and May 2024.

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A complete rationale should be provided for any opinion rendered.  

 

 

C. CRAWFORD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. George

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.