Citation Nr: 21072763 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 17-50 655 DATE: December 6, 2021 ORDER Entitlement to service connection for a gastrointestinal disorder, to include colon cancer and recurrent polyps, as due to Camp Lejeune Contaminated Water (CLCW) exposure, is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of colon cancer. 2. The Veteran's gastrointestinal disorder did not have its onset during active service or within one year of discharge and is not otherwise etiologically related to active service or to exposure to CLCW. CONCLUSION OF LAW The criteria for entitlement to service connection for a gastrointestinal disorder has not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had honorable active service with the United States Marine Corps from September 1974 to March 1977. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claim for entitlement to service connection for colon cancer was originally denied in a February 2015 rating decision. The Veteran did not file an appeal and the decision became final. In November 2019, the Board reopened the previously denied claim for service connection for colon cancer, to now include other gastrointestinal disorder. The Board also remanded the claim for development. After a Supplemental Statement of the Case (SSOC), the claim is back before the Board for adjudication. Entitlement to service connection for a gastrointestinal disorder is denied. The Veteran primarily contends that his colon cancer was due to exposure to contaminated water at Camp Lejeune. See NOD received August 2016. Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). A grant for service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the present disability and the in-service event, injury, or disease. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, the law provides a presumption of service connection for certain diseases associated with exposure to contaminants in the water supply at Camp Lejeune, subject to rebuttable presumption provisions. See 38 C.F.R. §§ 3.307, 3.309(f). In this case, the Board has reviewed all the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim on appeal. Except as otherwise provided by law, a Veteran or other claimant has the responsibility to support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information, including lay and medical evidence, of record in a case before the Secretary, with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. First, the Board considered whether service connection was warranted on a presumptive basis. While the Veteran has conceded exposure to the contaminated water at Camp Lejeune, he does not have a diagnosis of any of the diseases associated with contaminated water supply in Camp Lejeune. Consequently, presumptive service connection for a gastrointestinal condition is not warranted. Moreover, service connection is not warranted for a gastrointestinal condition on a direct basis either. Importantly, the Veteran's medical records do not show that he has a diagnosis of cancer of the colon. He has had polyps removed during colonoscopies. He has also been designated by his doctor as having a higher risk to have colon cancer. But having a higher risk to have cancer is not the same thing as having the condition. For example, in the year 2002, the Veteran reported having a family history of colon cancer to his VA doctor. See CAPRI received August 2019. Since then, he has had several colonoscopies at the VA with polyps removed from the colon. Records noted that he was at a high risk for colon cancer based on his history of colonic polyps. See CAPRI received March 2020. However, it does not appear that during the relevant period he has been treated for cancer. The February 2020 VA examiner noted that the Veteran had a colonoscopy in 2016 and a follow-up biopsy in 2019, which both showed no cancer. See C&P Exam received February 2020. The examiner further noted that the Veteran had never had treatment with chemotherapy or radiation for colon cancer. Id. Next, the records do not show that the Veteran's other gastrointestinal conditions have any link to service. The Veteran has been noted with recurrent polyps and hemorrhoids. The records do not show that these conditions began in service. Rather, the records suggested that these conditions occurred decades after service. Additionally, the records do not show continuous symptoms since service. As to the direct service connection test, the Veteran has the current disability of recurrent polyps and hemorrhoids. See C&P Exam received February 2020. He also has conceded exposure to contaminated water at Camp LeJeune. Therefore, he meets the first and second prong of the direct service connection test. However, the evidence does not support that the Veteran's current disabilities have any link to his service. In February 2020, the Veteran had a VA examination. See C&P Exam received February 2020. The examiner stated (with emphasis) that the "Veteran does not hold or sustain a diagnosis of colon cancer!" It was noted that the Veteran had had several polyps located on colonoscopy that the Veteran had mistaken for cancer. The examiner further opined that the Veteran's polyps and hemorrhoids were less likely than not related to or incurred in service. The examiner noted that the Veteran had years of bright red blood per rectum with intense itching that were very consistent with internal hemorrhoids. The Veteran's service records did not discuss any gastrointestinal cancers, polyps or hemorrhoids during service. Additionally, the Veteran has not been diagnosed with any abnormal polyps. He has had symptoms of hemorrhoids including itching and bleeding, which is essentially a prevalent condition for people ages 45 to 65. Id. In summary, the examiner opined that it was less likely than not that the Veteran's moderate to severe internal hemorrhoids were related to or incurred in service. The Board recognizes that the Veteran might sincerely believe that he has colon cancer, or he may believe that his current symptoms are related to exposure to contaminated water at Camp Lejeune. While the Veteran believes that his current symptoms are related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of the Veteran's disabilities are matters not capable of lay observation and require medical expertise to determine. Accordingly, his opinion as to the diagnosis of cancer or etiology of his current symptoms is not competent medical evidence. Thus, the Board finds the opinions of the February 2020 VA examiner to be significantly more probative than the Veteran's lay assertions. As to the November 2019 Board remand, the RO sent the Veteran a letter in January 2020 to further develop the claim. See Subsequent Development Letter dated in January 2020. Then in February 2020, the Veteran had a VA examination. No other duty to notify or duty to assist issues have been raised. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Additionally, the Veteran has a duty to assist and cooperate with VA in developing evidence the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190 (1991). As to the remand, the Board finds that the foregoing reflects substantial compliance with the November 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Board will adjudicate the claim currently on appeal. The Board finds that the preponderance of the evidence of record weighs against the establishment of a nexus between the Veteran's polyps and hemorrhoids and active duty service. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, C. Parnell 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.