Citation Nr: 21020714 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 17-39 682 DATE: April 8, 2021 ORDER Service connection for a colon disorder, to include colon cancer and rectal polyps, including as secondary to Camp Lejeune Contaminated Water (CLCW) exposure is denied. Service connection for bilateral foot fungus is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a colon disorder began during active service or is otherwise related to an in-service injury or disease, to include CLCW exposure. 2. The preponderance of the evidence is against finding that a bilateral foot fungus began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria to establish service connection for a colon disorder, to include colon cancer and rectal polyps have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria to establish service connection for bilateral foot fungus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1974 to August 1976. In July 2016, VA was notified of the Veteran’s death. The Appellant in this case is the Veteran’s surviving spouse who is properly substituted. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Board remanded the claims for additional development. There was substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). “To establish a right to compensation for a present disability, a veteran must show: ‘(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’ - the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In deciding an appeal, the Board must determine the probative value of evidence, discuss the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency means whether evidence may be considered as coming from a source who is qualified to provide it, while credibility asks whether the evidence may be believed. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). For example, medical professionals are generally competent through training and experience to express opinions about whether a disability was caused during active service. Generally, the opinions of medical professionals such as doctors, psychiatrists, nurses, and others who work in the health care field are evaluated by their apparent training, as well as the detail of their reports and knowledge of the facts in individual cases. Medical professionals may also report various findings of laboratory studies and testing that could be evidence in a claim, such as the level of hearing impairment, blood tests, range of motion testing in joint pain, etc. When deciding whether a non-medically trained individual (“layperson”) may provide competent evidence, the Board must determine in each case whether a veteran’s disability is the type for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptoms, which a non-medically trained person may generally do. Barr, 21 Vet. App. 303. In deciding claims, it is the Board’s responsibility to evaluate the entire record. See 38 U.S.C. § 7104(a). After all the evidence is assembled, the Board determines whether the evidence supports the claim or is in relative balance between the evidence favoring and against the claim. If this occurs, the benefit must be granted. However, if the weight of the evidence is against the claim, the benefit is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. The issue of service connection for a colon disorder, to include colon cancer and rectal polyps, including as secondary to CLCW exposure. The Appellant contends that the Veteran’s colon disorder was directly related to exposure to CLCW during service. While the Veteran had a current diagnosis of colon cancer and rectal polyps, and evidence shows that he was exposed to contaminated water during his service at Camp Lejeune, the preponderance of the evidence is against the claim and the appeal will be denied. Private treatment records show the Veteran was diagnosed with colon cancer and rectal polyps in March 2013, decades after his separation from service. The Veteran nor the Appellant alleged any symptoms associated with the Veteran’s colon disorder during service. A September 2020 VA examiner opined that the Veteran’s colon cancer and rectal polyps were not at least as likely as not related to an in-service injury, event, or disease, to include exposure to CLCW. The rationale was based on research on exposure to Tetrachloroethylene (TCE) and Perchloroethylene (PCE) found in the water at Camp Lejeune and extensive review of the medical evidence. The examiner explained that research suggested that colon cancer and rectal polyps were not among the diseases associated with these chemicals. The examiner explained that the Veteran’s limited exposure to CLCW was unlikely the cause of the Veteran’s colon cancer and rectal polyps. It was noted that service treatment records did not reflect any symptoms that would be associated with colon cancer or rectal polyps and the Veteran’s only report of a rectal condition was caused by a heat rash which the examiner noted was not related to a diagnosis of colon cancer. Additionally, the Veteran had been diagnosed with colon cancer in March 2013 which was over 37 years after separation from service making it less likely than not that the disability was related to service. The examiner listed several risk factors for the development of colon cancer and rectal polyps and indicated that colorectal cancer is most commonly diagnosed in males globally. The examiner extensively documented all materials used when analyzing whether the Veteran’s disability was related to CLCW exposure and examined all pertinent records associated with the claim. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Consequently, the Board gives more probative weight to the September 2020 VA examiner’s opinion. The Appellant believes the Veteran’s colon disorder was related to an in-service injury, event, or disease. The Appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Appellant in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical evidence of record and the September 2020 VA medical opinion and the claim is denied. 2. The issue of service connection for bilateral foot fungus. The Appellant contends the Veteran had a bilateral foot fungus related to service. While the Veteran had diagnosis of tinea unguium, and evidence shows that the Veteran complained of having an ingrown toenail and deep plantar corns bilaterally, the preponderance of the evidence is against the claim and the appeal will be denied. VA treatment records show the Veteran was diagnosed with tinea unguium in June 2007, decades after his separation from service. While the Veteran was competent to report having experienced symptoms of problems with his feet since service, he was not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a foot fungus. In an August 2020 opinion and a September 2020 addendum, the examiner opined that the Veteran’s bilateral foot fungus was not at least as likely as not related to an in-service injury, event, or disease, including complaints of deep plantar corns bilaterally and an ingrown toenail. The examiner noted that neither of these conditions are the same as a fungal infection and there are no other service treatment records or records immediately following service separation that document a complaint of a foot fungus until 2007. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Appellant believes the Veteran’s bilateral tinea unguium was related to an in-service injury, event, or disease. However, the Appellant is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized knowledge, and the Appellant does have the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical evidence of record and the August and September 2020 VA medical opinions and the claim is denied. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McDuffie, 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.