Citation Nr: 21027569 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-08 370 DATE: May 6, 2021 ORDER Entitlement to service connection for stomach cancer, including as due to an undiagnosed illness or in-service exposure to an environmental hazard is denied. FINDING OF FACT The preponderance of the evidence is against finding that stomach cancer began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for stomach cancer are not 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 honorably served in the United States Marine Corps from September 1983 to September 1987 and November 1990 to May 1991, including in combat in the southwest Asia theater of operations during the Persian Gulf War. He also had unverified service in the U.S. Marine Corps Reserve and U.S. Army National Guard. This matter appears before the Board of Veterans' Appeals (Board) on appeal of an October 2015 rating decision of the Regional Office (RO) in Janesville, Wisconsin. In February 2020, the Veteran testified before the undersigned Veterans Law Judge via videoconference from the RO in Salt Lake City, Utah; a transcript is of record. In July 2020, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction (AOJ) to obtain an addendum opinion. In August 2020, VA requested the addendum opinion, and an addendum opinion was associated with the claim that same month. The Board finds substantial compliance with its July 2020 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Entitlement to service connection for stomach cancer, including as due to an undiagnosed illness or in-service exposure to an environmental hazard The Board finds that the preponderance of the evidence is against granting the Veteran's claim of entitlement to service connection for stomach cancer, including as due to an undiagnosed illness and exposure to an environmental hazard. The Veteran contends that he is entitled to service connection for stomach cancer. Specifically, he contends that his stomach cancer was related to an undiagnosed illness in service as a result of his service in Southwest Asia or exposure to an environmental hazard. The evidence instead shows that the Veteran's diagnosed stomach cancer has a clear and specific etiology. Furthermore, the Veteran's medical records show that the cancer developed between 2001 and 2003, approximately a decade after separating from active service. Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability that manifested either during active service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2021. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i). Here, the Veteran had active service in Southwest Asia from December 1990 to April 1991. Therefore, he is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). A VA examination shows the Veteran has a diagnosis of gastric carcinoma of the stromal tumor (GIST). As the Veteran's GIST is a diagnosed condition, it cannot be considered an undiagnosed illness. Furthermore, during an October 2015 Gulf War general medical examination, the examiner found that the Veteran's GIST is not a MUCMI because it has a clear and specific etiology. The August 2020 addendum VA opinion also provides a partial etiology for the Veteran's GIST. Specifically, the examiner says this type of cancer is sporadic and approximately five percent of cases are familial hereditary condition. Further, the August 2020 examiner explains that while the cause is unknown it would be highly speculative to attribute development of a GIST tumor to any Gulf War exposures. Accordingly, the Gulf War presumption does not apply to the Veteran's claim. While, the above presumption does not apply, the Board will address the Veteran's claim on a direct theory of entitlement. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of stomach cancer, in remission, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of stomach cancer began during service or is otherwise related to an in-service injury, event, or disease. VA treatment records show the Veteran was not diagnosed with GIST until 2003, years after his separation from service. Further, the August 2020 VA examiner opined that the Veteran's GIST is not at least as likely as not related to an in-service injury, event, or disease, including an undiagnosed illness or exposure environmental hazards. The rationale was that the Veteran's tumor likely developed after service between 2001 and 2003 because he had a esophagogastroduodenoscopy (EGD) in October 2001 where biopsied were taken and found to be nonmalignant. Further, the examiner found nothing in the Veteran's service treatment records indicated an undiagnosed illness that caused or aggravated his stomach cancer. Finally, the examiner noted there is no epidemiologic evidence to support the notion that an environmental hazard caused or aggravated his stomach cancer. The examiner pointed to an IOM report which showed no known association between Gulf War exposures and the development of GIST. (Continued on the next page) 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 Veteran believes his stomach cancer is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he 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 August 2020 VA opinion. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. N. Fournier, Associate 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.