MALIGNANT SKIN NEOPLASMS (OTHER THAN MALIGNANT MELANOMA)

Summary

The Veteran, a veteran who served from November 1974 to December 1993, appeals the denial of service connection for malignant melanoma, including squamous cell carcinoma (SCC) of the right hand. The Veteran claimed his condition was caused by exposure to Cesium 127 and plutonium radiation during service, citing his MOS as a precision measurement equipment laboratory craftsman. The Board reviewed the Veteran's service treatment records, which showed no complaints or treatment for hand conditions or cancer during service. However, post-service VA examinations and a private medical opinion from Dr. W.F. provided favorable findings. The VA examiner in May 2024 opined the SCC was at least as likely as not caused by toxic exposure risk activities (TERA), noting a presumption for SCC related to TERA exposure between 1990-1991 and finding a causal link. A subsequent VA examination in June 2025 also diagnosed SCC and melanoma, finding it at least as likely as not caused by TERA, though a later VA memorandum in June 2025 concluded the exposure was below annual limits, deeming the SCC non-service related. The Veteran's treating physician, Dr. W.F., provided a highly probative opinion in July 2024, stating the SCC was highly likely related to over 27 years of military service, citing exposure to radiation and uranium as contributing factors. The Board assigned high probative weight to Dr. W.F.'s opinion, finding it consistent with the Veteran's history and supported by a clear rationale, while discounting the negative VA opinion. The Board found the competent, credible, and probative evidence established the Veteran's melanoma/SCC was caused by service activities. Service connection for melanoma, including SCC of the right hand, is granted.

Rationale

Competent, credible, and probative evidence establishes the Veteran's melanoma/SCC was caused by service activities.; Dr. W.F.'s private opinion was given high probative weight due to thorough review, analysis, and clear rationale.; Negative VA opinion from July 2025 was discounted due to apparent bias in seeking a negative outcome after prior positive opinions.

Full Decision Text

Citation Nr: A26039757
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 251007-582388
DATE: April 28, 2026

ORDER

Entitlement to service connection for melanoma, to include squamous cell carcinoma (SCC) of the right hand, is granted.

FINDING OF FACT

The evidence is at least in approximate balance that the Veteran's SCC of the right hand was incurred in service.

CONCLUSION OF LAW

The criteria for service connection for melanoma, to include SCC of the right hand, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1974 to December 1993.

In October 2025, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal electing hearing docket to review a July 2025 rating decision issued by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

A Board hearing was scheduled for January 2026; however, in a December 2025 correspondence, the Veteran requested the hearing be canceled.  Therefore, the Board may only consider the evidence of record at the time of the July 2025 rating decision as well as any evidence submitted by the appellant or his representative within 90 days following receipt of the withdrawal.  38 C.F.R. § 20.302(b).

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.

Entitlement to service connection for melanoma, to include SCC of the right hand

The Veteran contends his SCC of his right hand was caused by his exposure to Cesium 127 and plutonium radiation sources when he was exposed to them during service.  See January 2024 VA Form 21-526EZ, Fully Developed Claim.

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, 1131; 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."  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

In the July 2025 rating decision, the AOJ made the favorable findings the Veteran was diagnosed with malignant melanoma and that malignant melanoma was a condition that may be linked to radiation exposure.  The Board notes that the Veteran's military occupational specialty (MOS) was precision measurement equipment laboratory craftsman.  See August 2019 DD 214 Certificate of Release or Discharge from Active Duty.

There were no complaints, diagnosis, or treatment pertaining to his hands or cancer in the Veteran's service treatment records (STRs.)  

The Veteran's post-service treatment records reflect, in May 2024, the Veteran was afforded a VA examination for skin conditions.  The examiner confirmed the Veteran's diagnosis of SCC on the right hand and actinic keratosis.  The Veteran reported that while in service he was exposed to radiation from equipment that he used.  His MOS during service was to calibrate radiation machines.  The Veteran stated that it was not until 1991 that he was told he had to start wearing personal protection equipment.  

The examiner opined that the Veteran's SCC of the right hand was at least as likely as not caused by the indicated toxic exposure risk activity(ies) (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  The examiner found it was presumed that the Veteran was exposed to an agent that may have caused SCC and the condition was most likely due
  The Veteran reported that while in service he was exposed to radiation from equipment that he used.  His MOS during service was to calibrate radiation machines.  The Veteran stated that it was not until 1991 that he was told he had to start wearing personal protection equipment.  

The examiner opined that the Veteran's SCC of the right hand was at least as likely as not caused by the indicated toxic exposure risk activity(ies) (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  The examiner found it was presumed that the Veteran was exposed to an agent that may have caused SCC and the condition was most likely due to TERA Exposure.  The examiner noted that SCC was listed as a "Presumptive Illness" for claimed TERA exposure between 1990-1991.  Further, the Veteran submitted medical progress notes following separation or thereafter that established a longitudinal trend of subjective complaints and objective findings; therefore, the examiner found a causal relationship could be established.

In July 2024, the Veteran submitted a private opinion from his treating physician Dr. W.F.  Dr. W.F. noted that he had been treating the Veteran since April 2023 due to a history of skin cancer, SCC, and extensive actinic keratosis.  Dr. W.F. opined the Veteran's SCC was highly likely related to his more than 27 years of active military service.  Dr. W.F. stated he reviewed the Veteran's entire military file history and all his medical records, and they demonstrated that the Veteran worked with high-risk materials as a calibration technician, with known exposure to radiation and uranium.  Dr. W.F. found that both radiation and uranium could contribute to the development of cutaneous malignancies.  

In a July 2024 VA memorandum, the VA conceded that the Veteran had exposure to ionizing radiation.  

In August 2024, the Veteran completed a Radiation Risk Activity Information Sheet.  The Veteran noted dates and locations of different times he was exposed to radiation and plutonium.  

In August 2024, the Veteran reported that he was exposed to toxic metals, including plutonium cesium, and he believed that had caused his SCC of the right hand.  See August 2024 Perry Outreach Clinic note. 

In January 2025, the Department of Air Force confirmed that the Veteran was exposed to radiation, albeit under the annual total effective dose equivalent for exposed individuals annually.  Attached to the correspondence was the cumulative occupational exposure history to ionizing radiation for the Veteran during active service.  

In June 2025, the Veteran was afforded another VA examination for skin diseases.  The examiner diagnosed the Veteran with tumors and neoplasms of the skin, including malignant melanoma.  

The examiner opined the Veteran's SCC of the right hand was at least as likely as not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  The examiner found that the records demonstrated a history of working with high-risk materials as a calibration technician, with known exposure to radiation and uranium.  The examiner noted that exposure to both radiation and uranium could contribute to the development of malignant melanoma.

The examiner found that in addition to well-established risk factors, job-related factors were considered modifiable risk factors for skin cancer.  The concentration of carcinogens in workplaces was typically higher than that in non-work settings.  The examiner noted that occupational cancer can develop when workers are exposed to specific risk factors or a combination of these factors.  The examiner found that people exposed to ionizing radiation may be at increased risk of developing melanoma, although alternative explanations are possible.  

In June 2025, the VA submitted a memorandum which found the Veteran's radiation exposure was below the Federal annual occupational radiation exposure limit.  Thus, the Director concluded the Veteran's SCC of the right hand had to be non-service related.  See June 2025 VA Advisory Opinion by Director of Compensation Services.

In July 2025, the VA conceded the Veteran had engaged in TERA due to his MOS.  Specifically, the VA conceded the Veteran had been exposed to gases, high voltage, lethal current levels, mercury, ethanol, methanol, isopropanol, trichloroethylene, trichloro-trifluoroethane, magnesium nitrate, ammonium sulfate, potassium acetate, magnesium chloride, hydraulic fluid, methylene chloride, paints and paint thinners.

In July 2025, the Veteran underwent yet another VA examination for skin diseases.  The examiner diagnosed the Veteran with melanoma of the right hand.  

The examiner opined the Veteran's melanoma of the right hand was less likely than not caused by the indicated
2025, the VA conceded the Veteran had engaged in TERA due to his MOS.  Specifically, the VA conceded the Veteran had been exposed to gases, high voltage, lethal current levels, mercury, ethanol, methanol, isopropanol, trichloroethylene, trichloro-trifluoroethane, magnesium nitrate, ammonium sulfate, potassium acetate, magnesium chloride, hydraulic fluid, methylene chloride, paints and paint thinners.

In July 2025, the Veteran underwent yet another VA examination for skin diseases.  The examiner diagnosed the Veteran with melanoma of the right hand.  

The examiner opined the Veteran's melanoma of the right hand was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  Unlike the previous examiners, this examiner found that it was not presumed that the Veteran was exposed to an agent that may have caused skin cancer and the examiner opined the condition was most likely due to prolonged sun exposure and age.  

The Board assigns Dr. F.W.'s private medical opinion high probative weight based on the physician's knowledge and skill in analyzing the data, the thorough review and examination of the Veteran and the Veteran's history, including any lay statements, and the medical conclusion that the physician reached.  Dr. F.W.'s opinion is consistent with all the statements and the Veteran's medical history of his melanoma of the right hand.  Further, Dr. F.W. provided a rationale that considered both medical and lay evidence and that is clear and consistent with the evidence of record.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  The Board therefore finds Dr. F.W.'s opinion to be highly probative medical evidence in favor of the Veteran's claim.  

Alternatively, the Board finds little to no probative value in the July 2025 VA opinion as it appears that despite having issued two positive opinions, the AOJ continued to request examination after examination until such time as a negative opinion was issued which contradicted the two previous opinions.  

Considering the totality of the evidence of record, the Board finds that the competent, credible, and probative evidence in the record establishes that the Veteran's melanoma, to include SCC of the right hand, was caused by activities in service, and the Veteran's claim is granted.

 

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Simons

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.