Citation Nr: A21019706 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 211005-189296 DATE: December 10, 2021 ORDER Entitlement to service connection for colorectal cancer is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, the evidence of record is at least in equipoise as to whether a nexus exists between an in-service event and the Veteran's colorectal cancer. CONCLUSION OF LAW The criteria for entitlement to service connection for colorectal cancer 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 had active duty service from August 1953 to August 1956. In July 2021, the AOJ issued the rating decision on appeal, which denied the claim based on the evidence of record at the time. In October 2021, VA received a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), in which the Veteran elected the Direct Review option. The Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). Service Connection Establishing service connection generally requires competent evidence showing: (1) the existence of a current 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). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Entitlement to service connection for colorectal cancer The Veteran claims entitlement to service connection for colorectal cancer. He contends that his colorectal cancer is due to his service at Camp Lejeune. Following a thorough review of the Veteran's medical records, the Board finds that he is entitled to an award of service connection. The rating decision on appeal made the binding favorable findings that the Veteran had a current disability during the appeal period of colorectal cancer, and that exposure to contaminated water is conceded based on his service at Camp Lejeune. The only question remaining is a nexus between the in-service event and current disability. Resolving reasonable doubt in the Veteran's favor, the Board concludes that the Veteran has a current disability that is related to service. In an April 2021 letter, received at VA in June 2021, the Veteran's treating VA physician provided a positive nexus opinion for the Veteran's colorectal cancer. She wrote, [The Veteran] is under my care and he was exposed to contaminated water at Camp Lejeune. He was diagnosed to have colorectal cancer in August 2019. ATSDR (Agency for Toxic Substances and Disease Registry) issued a report on January 13, 2017, concluding that the epidemiological evidence for association between exposure to contaminated water and rectal cancer is weak. However, there is an ongoing controversy of association of various other cancers with contaminated water which is subject to continued data gathering...I strongly feel that [his] colorectal cancer is at least as likely as not related to the contaminated water and I urge that he be given the benefit of doubt in his favor. VA examiners provided medical opinions in May 2021 and July 2021, both of which contain negative nexus opinions, in which the examiners concluded that the Veteran's colorectal adenocarcinoma was less likely as not caused by or a result of the Veteran's exposure to contaminated water at Camp Lejeune. The examiners discussed the Veteran's medical history and referenced relevant medical literature. The July 2021 examiner explained, in relevant part, "The evidence...is strong that [his] Crohn's disease with tubular adenomas and colon cancer are related as a strong risk. His other risk factors include obesity, diabetes, age and sedentary lifestyle...These risk factors accumulated for over 30 years...His exposure to contamination at Camp Lejeune was for 2 years which is much less than his life exposure to known risk factors." The Board finds the opinions of the May 2021 and July 2021 VA examiners and the April 2021 private examiner to be probative, as they all provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Upon review of the record, in this particular case, based on these facts and evidence, the Board finds the competent, credible, probative evidence both for and against the claim are in equipoise as to whether the Veteran's colorectal cancer was related to his military service. When the evidence for and against a claim is in equipoise, the benefit of the doubt is resolved in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Therefore, the Board resolves doubt in the Veteran's favor and finds that service connection for the Veteran's colorectal cancer is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Minock 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.