Citation Nr: A25035646 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 241002-476651 DATE: April 17, 2025 ORDER Service connection for residual status-post cancer of the tongue is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran's tongue cancer began during active service, is otherwise related to an in-service injury or disease, including due to the Veteran's toxic exposure risk activities (TERAs), or is secondary to a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for residual status post cancer of the tongue have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected to appeal the issue listed above and requested a period of 90 days to submit additional evidence. This restricts the Board's review to the evidence of record at the time of the March 2024 rating decision on appeal and evidence submitted with, or within 90 days of filing of, the Notice of Disagreement initiating appellate review. 38?C.F.R. § 20.303. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. 1. Entitlement to service connection for residual status post cancer of the tongue The Veteran is seeking service connection for tongue cancer and asserts that his disability is related to the use of the medication Ranitidine that was prescribed by VA to treat his gastroesophageal reflux disease (GERD) for more than 20 years. See October 2023 VA Form 21-526EZ. 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). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Regarding the first element of service connection on a direct and secondary basis, there is evidence of a current disability, as the evidence shows the Veteran was diagnosed with squamous cell cancer of the right tongue and underwent a partial glossectomy in March 2020. Indeed, during the March 2024 VA oral examination, the Veteran was diagnosed with residual status-post tongue cancer. Thus, the evidence persuasively shows he has a current disability, and the first element of service connection is met. At this juncture, the Board will discuss the Veteran's assertions regarding this claim; i.e., that his cancer is caused by the use of medication taken to treat his GERD disability. While the Veteran has asserted a secondary relationship between his tongue cancer and GERD disability, service connection has not been established for GERD and there is no medical evidence or opinion of record that attributes the Veteran's tongue cancer to a service-connected disability. In this regard, the Board notes that the Veteran has a separate claim pending for entitlement to service connection for GERD but, as also noted, the Board's review of this appeal is limited to the evidence of record at the time of the March 2024 rating decision on appeal and evidence submitted with, or within, 90 days of filing the October 2024 Notice of Disagreement which does not provide a basis on which to grant service connection for tongue cancer on a secondary basis. Therefore, service connection for tongue cancer on a secondary basis is not warranted. While not specifically alleged by the Veteran, VA has considered whether service connection may be granted for tongue cancer as directly due to service. The evidence does not show, nor does the Veteran allege, that his tongue cancer began or had its clinical onset during service. Indeed, the service treatment records do not contain any complaints, treatment, or findings involving tongue lesions, pain, or abnormality. Instead, during the March 2024 VA examination, the Veteran reported that his tongue disability began in 2018 (more than 40 years after service) as an abnormal area in the back of his tongue that was subsequently diagnosed as tongue cancer. While the evidence does not show the Veteran's tongue cancer began during his period of service, there is evidence of an in-service incurrence or aggravation of an injury, as his service records indicate he was exposed to toxic substances during service. Specifically, his military occupational specialty (MOS) as a truckmaster included exposure to exhaust, petroleum products, and solvents. See February 2024TERA memorandum. Thus, the evidence persuasively shows an in-service incurrence or aggravation of a disease or injury, and the second element is met. Regarding the third element of service connection, the Board finds that the evidence does not establish a causal relationship between the Veteran's current disability and his in-service toxic substance exposure. In a March 2024 VA opinion, the examiner opined that the Veteran's tongue cancer was less likely than not caused by his TERAs. In rendering this opinion, the examiner discussed the nature of tongue cancer and also noted the Veteran's exposure information, including type, duration, route, and frequency of the exposure; however, the examiner noted there is no medical or scientific evidence available that provides any indication of a relationship between the development of tongue cancer and the Veteran's TERAs. Therefore, the examiner opined that the Veteran's tongue cancer was less likely than not caused by the TERAs, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. In evaluating this claim, the Board notes that neither the Veteran nor his representative have submitted or identified any medical literature or evidence that establishes a nexus or link between tongue cancer and exposure to toxic substances similar to those to which the Veteran was exposed during service. While the Veteran may believe that his tongue cancer is related to his TERA during service, the etiologic relationship between tongue cancer and exposure to exhaust, petroleum, and solvents requires more than direct observation to resolve and is a complex, medical matter that requires medical training to resolve. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). The evidence does not reflect, nor has the Veteran alleged, that he has any medical education, experience, or training; nor has he offered any basis in common lay knowledge to support a conclusion that there is a nexus between tongue cancer and his in-service TERA. Therefore, the Board concludes that there is no competent evidence that establishes a link between the Veteran's tongue cancer and his period of active service, to include his TERAs. Based on the foregoing, the Board finds that the evidence persuasively weighs against finding that the Veteran's tongue cancer was incurred during or as a result of his, to include his in-service TERA. As such, the benefit of the doubt rule does not apply and the Veteran's claim of service connection must be denied. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.