Citation Nr: 22010335 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 17-03 012 DATE: February 23, 2022 ORDER Entitlement to service connection for lung cancer is denied. Entitlement to service connection for partial removal of colon is denied. Entitlement to service connection for acid reflux is denied. FINDINGS OF FACT 1. A clear preponderance of the evidence is against finding that the Veteran's lung cancer began during his active service; is otherwise related to an in-service injury, disease, or event; or is a manifestation of an undiagnosed illness or medically unexplained chronic multisymptom illness. 2. A clear preponderance of the evidence is against finding that the Veteran's partial removal of colon began during his active service; is otherwise related to an in-service injury, disease, or event; or is a manifestation of an undiagnosed illness or medically unexplained chronic multisymptom illness. 3. A clear preponderance of the evidence is against finding that the Veteran's acid reflux began during his active service; is otherwise related to an in-service injury, disease, or event; or is a manifestation of an undiagnosed illness or medically unexplained chronic multisymptom illness. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for lung cancer have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 2. The criteria for entitlement to service connection for partial removal of colon have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. 3. The criteria for entitlement to service connection for acid reflux have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service between March and June 1980, and from November 1990 to March 1992. He also had years of service in the Army National Guard. This matter came before the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Board remanded this matter for additional development. A review of the claims file shows that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). The case is again before the Board for review. Service Connection The Veteran claims that he incurred lung cancer, acid reflux, and a colon disorder during service. He contends that these disorders are part of an undiagnosed multisymptom illness that is related to service in the Southwest Asia theater of operations during the Persian Gulf War, or that they are due to environmental exposures, to include chemicals. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 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). Under 38 C.F.R. § 3.317, VA will pay compensation to a Persian Gulf veteran for disability due to an undiagnosed illness or medically unexplained chronic multisymptom illness, provided that certain requirements are met. A medically unexplained chronic multisymptom illness is defined by a cluster of signs or symptoms, and includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders. The evidence in this matter consists of service treatment records (STRs), service personnel records (SPRs), VA and private treatment records, and lay statements from the Veteran. This evidence shows that the Veteran has been diagnosed with lung cancer, gastroesophageal reflux disorder (GERD), and had a section of his colon removed. The record also indicates service during Operation Desert Storm in Southwest Asia. Service connection findings are unwarranted here, however. First, the disorders underlying the claims are clearly diagnosed in the VA and private medical evidence. They are not undiagnosed or medically unexplained. 38 C.F.R. § 3.317. Second, there is no medical evidence connecting service to the current disorders. The STRs do not indicate chronic lung, gastric, or digestive disorders during service. At his November 1991 separation examination, the Veteran had a normal clinical evaluation, except for his lower extremities. He stated on a November 1991 report of medical history that other than his right knee his present health was good and denied stomach, liver, or intestinal trouble. The disorders were not diagnosed until years after service. And the VA examinations that were scheduled to assess the issue of service nexus requested by the Board in its remand were canceled by the Veteran. VA has a duty to assist the Veteran in substantiating his claim. The duty is not a one-way street, and the Veteran must cooperate in VA's efforts to assist him. Woods v. Gober, 14 Vet. App. 214, 224 (2000); see also Hurd v. West, 13 Vet. App. 449, 452 (2000); 38 C.F.R. § 3.159 (c). VA satisfied its duty to assist by providing the Veteran an opportunity to attend VA examinations. The RO thereby substantially complied with the July 2021 remand directives. See 38 U.S.C. § 5103A (b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Neither the Veteran nor his representative has otherwise raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues decided herein. 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). In assessing the issue of medical nexus, the Board has considered the Veteran's lay assertions. He is competent to describe observable symptomatology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he is not a medical professional who is competent to determine matters such as diagnosis and etiology. The question of whether cancer, colon disease, or gastric distress relate to service is a complex medical issue. They concern complex internal diseases beyond the Veteran's capacity to observe or sense. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). For this reason, his assertions are of limited probative value on the issue of medical nexus here. When a claimant, without good cause, does not report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655 (b). In this case, the Veteran has not shown good cause for cancelling the VA examinations. Therefore, under 38 C.F.R. § 3.655, the Board is required to decide the appeal based on the evidence of record. As discussed above, the record as it currently stands does not show that it is at least as likely as not that the Veteran's claimed conditions are directly related to active service or manifestations of an undiagnosed illness or undiagnosed illness or medically unexplained chronic multisymptom illness, or are otherwise related to an in-service injury or event. Thus, based on the current record, the evidence clearly preponderates against the claims of entitlement to service connection. As a clear preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine does not apply, and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. C. J. McEntee Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. G. LeMoine, 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.