Citation Nr: 21064081 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 20-02 870 DATE: October 19, 2021 ORDER Entitlement to service connection for right lobe metastasis as secondary to service-connected colorectal cancer is granted. FINDING OF FACT The competent medical evidence supports that the diagnosed right lobe metastasis was caused by the service-connected colorectal cancer. CONCLUSION OF LAW The criteria to establish service connection for right lobe metastasis as secondary to service-connected colorectal cancer are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1966 to October 1969. Service Connection for Right Lobe Metastasis Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). 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). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). In the context of claims for secondary service connection, the evidence must demonstrate an etiological relationship between the service-connected disability or disabilities and the condition said to be proximately due to the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998). The record must also contain competent evidence that the secondary disability was caused by the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). The Veteran asserts that the diagnosed right lobe metastasis and its residuals were caused by his now service-connected colorectal cancer. In this regard, the Board notes that service connection for colorectal cancer was granted by the Board in a November 2020 decision. In support of his claim, the Veteran provided a June 2019 opinion authored by Dr. M.K., an oncologist, who after a review of the record, opined that the diagnosed right lobe metastasis was caused by the colorectal cancer. The oncologist explained that colorectal cancer pathogenesis was notable for sequential accumulation of disease predisposing mutations as normal mucosa transformed to an adenoma and ultimately to an invasive carcinoma. Tumor cells migrate or metastasize away from the primary disease site by either lymphatic vessels or through the circulatory system. The Veteran's right lobe metastatic tumor in his lung arose from hematogenous (by route of the blood) spread of his rectal lesion to his right lung. This was the most common route for metastasis to the lung. The oncologist noted that the lung tumor would not technically be considered lung cancer since it did not arise in the lung. This was confirmed by immunohistochemistry studies (associated with the opinion). In addition, microscopically it appeared similar to the original rectal tumor. In support of the opinion, the oncologist cited to specific medical evidence in the record as well as to relevant medical literature. On review, the Board finds that the private opinion is adequate, competent and of probative value. In forming his opinion, the oncologist relied on the accurate facts in this case and provided fully articulated and supported by the evidence of record, to include related medical research and evidence from this Veteran's medical record. In sum, the Board concludes that the probative medical evidence is this case supports the claim. Resolving all doubt in the Veteran's favor, service connection on a secondary basis is granted. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Yaffe, 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.