Citation Nr: 22012848 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 17-14 987 DATE: March 7, 2022 ORDER Entitlement to service connection for residuals of colon cancer, claimed as secondary to psycho-physiological musculoskeletal reaction, is granted. FINDINGS OF FACT 1. Colon cancer was diagnosed in 2003; he was successfully treated surgically and with chemotherapy for eight months, and there has been no recurrence of active colon cancer. 2. Residuals of the treatment for colon cancer, to include bloating, cramping, and urgent diarrhea, are aggravated by service-connected psycho-physiological musculoskeletal reaction. CONCLUSION OF LAW The criteria for entitlement to service connection for residuals of colon cancer, claimed as secondary to psycho-physiological musculoskeletal reaction, have been met. 38 U.S.C. 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.306, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty with the United States Army from March 1951 to May 1952. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). This matter was first remanded by the Board in February 2019 for additional development and was then denied in an October 2019 Board decision. The Veteran appealed the denial to the Court of Appeals for Veterans Claim (Court). In October 2020, based on a Joint Motion for Remand (JMR), the Court remanded the issue, finding that the Board had erred by failing to provide an adequate statement of reasons or bases to support a finding that the Veteran's service-connected psycho-physiological musculoskeletal reaction did not aggravate his colon cancer. Following this determination by the Court, the Board remanded the matter in March 2021 and again in July 2021 for additional development. A VA intestinal conditions examination was completed in November 2021 and the matter is once again before the Board. At this time, in light of the allegations of the Veteran and the evidence of record, the Board has recharacterized the issue to focus the claim on the current disability, which are the residuals of the colon cancer, and not the cancer itself. The cancer was excised and successfully treated prior to the period on appeal. The appeal previously included the issue of entitlement to service connection for coronary artery disease (CAD). A November 2021 rating decision granted service connection for CAD with myocardial infarction. The Board finds that this issue has been granted in full and is no longer before the Board. The Veteran was awarded service connection for psycho-physiological musculoskeletal reaction effective from November 1972. It has been evaluated as 50 percent disabling since 1998. He contends that his coronary artery disease and colon cancer are causally related to his service-connected psychiatric disorder. The Veteran's service treatment records (STRs) do not reflect any complaints, findings, or treatment for colon cancer, or any relevant problems. His post-service VA treatment records show that the Veteran was diagnosed with colon cancer in March 2003. He underwent a right colectomy followed by chemotherapy. The Veteran underwent a VA examination in December 2016 to determine whether his service-connected psychiatric disorder caused or aggravated his colon cancer. The VA examiner opined it was less likely than not that the Veteran's claimed disability was related to his service-connected psychiatric disorder. The examiner explained that his psychiatric disorder was not a risk factor for colon cancer, and that psychiatric disorders are not commonly related to such condition. However, in a January 2017 addendum opinion, the examiner opined that it was as likely as not the colon cancer was aggravated by the psychiatric disorder. The somatic disorder did not result in symptoms that were feigned or showed malingering. His colon cancer related symptoms "are more severe than generally expected." The psychiatric disorder "is going to aggravate every physical manifestation of the disease." In February 2017, she stated she could not describe the baseline manifestations. A July 2019 addendum opinion from the same examiner indicated that the somatization disorder was less likely than not to have influenced the natural progression of the colon cancer. In April 2021, a new examiner opined that there was no casual or aggravating link between the psychiatric disorder and colon cancer, based on the "weight of the medical literature." Colon cancer was associated with genetics, diet, and family history. In May 2021, the examiner stated that the positive 2017 opinions included no rationale and did not mention "any causal association" between the psychiatric condition and colon cancer. He reiterated that factors such as a Western lifestyle, age, and heredity were important. Most recently, a November 2021 examiner opined that it was less likely than not that the Veteran's colon cancer was aggravated or caused by an in-service event or due to the service-connected psycho physiological musculoskeletal reaction. She said that she was unable to speculate as to the etiology of the colon cancer, but noted several casual factors including diabetes, genetics, diet, age, and family history. She discussed a couple of these factors that were applicable to the Veteran. She further noted that she was unable to find any information regarding a strong link from studies suggesting mental health conditions being the "sole cause" of colon cancer and noted that the Veteran did not have any presumed exposure to Agent Orange. Regarding consideration of the 2017 medical opinions, she found that "the medical opinion from 2017 failed to use any objective evidence to give a positive opinion." The Board finds that the negative opinions of record fail to truly address the Veteran's contentions, that his current disability is caused or aggravated by his service-connected psychiatric disorder. They instead addressed whether colon cancer, which was resolved prior to the appellate period, was associated with the psycho physiological musculoskeletal reaction. The Veteran's complaints, however, deal with the presence and functional impact of the residuals of the colon cancer. On that point, the sole probative opinion is the January 2017 finding that the psycho physiological musculoskeletal reaction has a very real impact on the symptoms experienced by the Veteran. The examiner, who had physically examined the Veteran and reviewed the claims file several times, stated very clearly that the psychiatric condition "is going to aggravate every physical manifestation or disease." In this case, such are identified as bloating, cramping, and urgent diarrhea. Service connection for residuals of colon cancer is warranted on the basis of aggravation. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.P. Faris 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.