Citation Nr: 25005309 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 17-41 052 DATE: April 18, 2025 ORDER Service connection for colon polyps is denied. FINDING OF FACT Colon polyps were not incurred in, nor are otherwise etiologically related to, the Veteran's active service, including in-service herbicide agent exposure. CONCLUSION OF LAW The criteria for service connection for colon polyps have not been met. 38?U.S.C. §§?1110, 1116, 5107; 38?C.F.R. §§?3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from January 1969 to January 1972 and the United States Army from June 1975 to June 1978, including service in the Republic of Vietnam. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal with one star and Vietnam Campaign Medal with 60 device. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at an October 2021 travel board hearing. A transcript of this proceeding has been associated with the record. This appeal was then remanded by the Board in October 2023 for additional development which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, VA nexus opinions were obtained in March 2024 and May 2024. Further, when this case first came before the Board in October 2023, the Board dismissed one issue at the request of the Veteran, denied service connection for two additional issues, and remanded service connection for three issues (including the issue before the Board now). In rating decisions of April 2024 and October 2024, the RO granted service connection for a psychiatric disorder and for a thyroid condition respectively. As those decisions represent complete grants of the issues on appeal, those matters are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Service Connection The Veteran remains in pursuit of direct service connection for colon polyps. The Board will limit its analysis accordingly. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). There is no controversy as to the first and second elements in this case. The Veteran was diagnosed with a history of colon polyps during May 2024 VA examination; VA and private treatment records also document his history of such. See generally VA and private treatment records. Additionally, the October 2023 Board decision conceded the Veteran's in-service exposure to herbicide agents. See also October 2022 VA memorandum. Accordingly, the first and second elements of direct service connection are met, and the appeal may be granted upon the finding of a nexus between the two. Two VA opinions were obtained following the Board's prior remand. In March 2024, the examiner concluded that the Veteran's colon polyps were less likely than not related to service. By way of rationale, the examiner noted that the Veteran was diagnosed with polyps in 2009, approximately 30 years following active duty. An additional opinion was obtained in May 2024, in which the examiner concluded that it was less likely than not that the Veteran's polyps were caused by his in-service herbicide agent exposure. To form that opinion, the examiner considered the total potential exposure through all applicable deployments of the Veteran and the synergistic, combined effect of all toxic risk activities. The examiner acknowledged the Veteran's history of colon polyps; however, no evidence of polyps was found during July 2009 colonoscopy. The examiner also noted the Veteran's history of in-service herbicide agent exposure. The examiner then explained that colon polyps/history of benign polyp of the large intestine is a condition which occurs in the general population and is not associated with herbicide agent exposure. Risk factors include advancing age, male gender, high-fat and low-fiber diets, tobacco use, excess alcohol intake, family history, colorectal cancer, and intestinal polyposis. The examiner used those risk factors, along with the findings of two cited academic studies, to conclude that the Veteran's colon polyps are less likely than not related to his active service, to include his in-service herbicide agent exposure. The above opinions are probative evidence against the claim. Collectively, the examiners have offered definitive nexus opinions with supporting rationales which address the nature of colon polyps, the specific onset in this case, and the Veteran's in-service exposure to herbicide agents. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the "factually accurate, fully articulated, sound reasoning for the conclusion"). There is no evidence that either examiner was not fully aware of the Veteran's medical history or misstated any relevant fact in providing their opinions, which are instead supported by academic literature; the Veteran's competent and credible testimony; and his medical records. Notably, there are no competent opinions or other competent evidence of record which contradict the examiners' findings. In so finding, the Board acknowledges the Veteran's contention that a nexus is present in this case. However, he lacks the training and expertise to offer a competent opinion as to complex medical matters, and his contentions are otherwise unsupported by objective medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Thus, greater probative value is afforded to the medical evidence of record, which supports the Board's findings herein. Thus, the probative evidence weighs against a nexus between the Veteran's colon polyps and in-service herbicide exposure, such that the third and final element of direct service connection is not met. Given the Veteran's exposure to herbicide agents, the Board has also considered whether this appeal may be granted on a presumptive basis under 38?C.F.R. § 3.309. However, colon polyps are not among the diseased enunciated in VA regulations, such that service connection cannot be awarded on a presumptive basis in this case. Further, as reflected by the preceding analysis, the Board has considered the Veteran's claim on a direct basis, but the evidence remains against the claim. In summary, the persuasive evidence of record is against the Veteran's claim; the evidence is not in approximate balance; and the benefit of the doubt rule is inapplicable. The appeal seeking service connection for colon polyps is hereby denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kovarovic, Kate 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.