Citation Nr: 22015509 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 15-04 277 DATE: March 17, 2022 ORDER Service connection for a carcinoid tumor condition of the gastrointestinal tract is granted. FINDING OF FACT The Veteran's carcinoid tumor condition of the gastrointestinal tract had its onset during service. CONCLUSION OF LAW The criteria for service connection for g carcinoid tumor condition of the gastrointestinal tract have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1999 to October 2003. The case is on appeal from a January 2016 rating decision. In July 2018, the Board granted service connection for a psychiatric disorder and remanded a claim for service connection for gastroparesis for additional development. The Board also remanded the claim for additional development in December 2019, October 2020, June 2021, and December 2021. Service connection for a carcinoid tumor condition of the gastrointestinal tract. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(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." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Analysis The Veteran is seeking service connection for a gastrointestinal condition. He asserts that he has a gastrointestinal condition that is related to his exposure to jet fuel during service. He specifically asserts that he swallowed and inhaled jet fuel while on active duty while in Saudi Arabia when a fuselage hose came loose and immersed him in jet fuel. See July 2012 Social Security Administration (SSA) consultative examination report. Alternatively, the Board finds the question of whether the Veteran's gastrointestinal condition had its onset during service is raised by the record. Initially, the Board finds the evidence of record establishes that the Veteran has a current disability. A March 2021 VA examination reflects a diagnosis of carcinoid tumor, and that all other components of the Veteran's gastrointestinal complaints are subsumed by this condition, including gastroparesis. In addition, the evidence of record establishes the occurrence of an in-service illness and the occurrence of an in-service event, particularly when reasonable doubt is resolved in the Veteran's favor. Concerning the occurrence of an in-service illness, the Veteran's service treatment records (STRs) reflect that he complained of recurrent abdominal pain and rectal bleeding in 1999. In addition, concerning the occurrence of an in-service event, although the Veteran's service records do not specifically document the incident described by the Veteran in which he swallowed and inhaled jet fuel while on active duty while in Saudi Arabia when a fuselage hose came loose, the Board finds the occurrence of this incident consistent with the circumstances of his service. In this regard, the Veteran's service personnel records (SPRs) reflect the Veteran's a primary specialty of fuels journeyman. A "Master Workplace Exposure Data Summary" states that the Veteran had the potential to come into contact with fuel containing benzene when draining aircraft refueling trucks and that he deployed to Saudi Arabia in September 2011. The next question for the Board is whether there is a nexus between the Veteran's current carcinoid tumor condition and his in-service gastrointestinal complaints or his in-service exposure to jet fuel. Concerning the question of whether the Veteran's carcinoid tumor condition had its onset during service, the evidence of record weighs in favor and against the claim. Weighing in favor of the claim is VA opinion provided in December 2021. The examiner determined it is at least as likely as not that the Veteran's carcinoid tumor had its onset during service. The examiner described the Veteran's medical history including the Veteran's in-service gastrointestinal complaints, additional complaints in 2010, which led to a likely misdiagnosis of gastroparesis, and subsequent diagnosis of carcinoid tumor in 2018, that was determined to be Stage IV at diagnosis. The examiner explained that given the related complaints during service and subsequent complaints noted following service, as well as the advanced stage of the carcinoid tumor at diagnosis, the current condition is likely to represent the same disease process as the related complaints that occurred during service. Weighing against the claim is a VA opinion provided in January 2022. The examiner determined that it is less likely than not that the Veteran's carcinoid tumor had its onset during service. He noted that the Veteran's STRs reflect recurrent abdominal pain and a weak stomach in September 1999 and loose stools and abdominal pain in August 2002. The examiner also noted that the Veteran's medical records reflect stomach complaints in 2010, and that the Veteran was diagnosed with carcinoid tumor that was found to be Stage IV in 2018. However, the examiner stated that while the in-service symptoms could potentially represent symptoms associated with a carcinoid tumor, the symptoms were nonspecific, and there was no objective evidence of a carcinoid tumor in service. The Board notes that a June 2020 VA opinion addressing this theory of entitlement is of record but the Board determined that it was not adequate to decide the claim in an October 2020 decision. In regard to the December January 2022 opinion, the Board can identify no compelling reason to find this opinion more probative than the December 2021 opinion regarding the nexus element. Both opinions considered the same critical facts, which led them to different conclusions. Thus, the Board determines the evidence is in equipoise. Accordingly, given the both the positive and negative medical opinions, the Board determines the evidence is in equipoise as to whether the Veteran's carcinoid tumor condition of the gastrointestinal tract had its onset during service. Accordingly, resolving reasonable doubt in the Veteran's favor, the Board finds service connection for a carcinoid tumor condition of the gastrointestinal tract is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As a final matter, the Board acknowledges the Veteran's contention that his carcinoid tumors are related to his exposure to jet fuel during service and that there are opinions of record addressing this theory of entitlement. However, as the Veteran's claim of service connection for carcinoid tumors has been granted in full, the Board finds it unnecessary to address this theory of entitlement. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.