BENIGN NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The veteran, who served in the United States Marine Corps from February 1979 to September 1979, appeals the denial of service connection for residuals of cyst removal and a low back disability. The Board denied service connection for residuals of cyst removal, finding the evidence did not persuasively establish that the cyst developed or was removed during service. The veteran's testimony regarding the cyst's onset and removal was contradictory, and service treatment records were silent on the matter, leading the Board to find the claim not credible and the evidence against it. For the low back disability, the Board found competent evidence of a current condition, noting diagnoses of degenerative disease of the lumbar spine and arthritis in service treatment records and later examinations. However, the Board found that degenerative changes were first noted post-service, precluding presumptive service connection. While acknowledging the veteran's testimony of an in-service back injury from a zip line fall and finding the 1979 service treatment records documented muscle strain, the Board found the January 2024 VA nexus opinion persuasive. This opinion stated it was less likely than not that the current low back disorder was incurred in or caused by service, noting the lack of relevant findings on entrance/exit exams and the post-service onset of symptoms. The Board found this opinion adequate and supported by file review, leading to the denial of the back claim. The case was remanded for further development on acquired psychiatric disorder and sling palsy of the left arm.

Rationale

Contradictory testimony regarding cyst onset and removal; Service treatment records silent regarding cyst or surgery; Evidence persuasive weight against claim

Full Decision Text

Citation Nr: 26002108
Decision Date: 02/17/26	Archive Date: 02/17/26

DOCKET NO. 17-39 243
DATE: February 17, 2026

ORDER

Service connection for residuals of cyst removal is denied.

Service connection for a low back disability is denied.

REMANDED

Entitlement to service connection for an acquired psychiatric disorder is remanded.

Entitlement to service connection for sling palsy of the left arm is remanded.

FINDINGS OF FACT

1. Residuals of cyst removal were not incurred in,?or are otherwise etiologically related to, active service.

2. The current low back disability was not incurred in,?or is otherwise etiologically related to, active service; and did not onset to a compensable degree within one year of service separation.

CONCLUSIONS OF LAW

1. The criteria for service connection for residuals of cyst removal have not been met. 38?U.S.C. §§?1110, 1131, 1116, 5107;?38?C.F.R. §§?3.303, 3.307, 3.309, 3.310.

2. The criteria for service connection for a low back disability have not been met. 38?U.S.C. §§?1110, 1131, 1116, 5107;?38?C.F.R. §§?3.303, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from February 1979 to September 1979.

These matters are before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified during a December 2021 virtual hearing.  A transcript of this proceeding has been associated with the record.

In July 2022, the Board denied the appeals seeking service connection for a low back disability and residuals of cyst removal, and remanded two appeals seeking service connection for an acquired psychiatric disability and sling palsy of the left arm.  

Notably, the psychiatric and left arm appeals have not yet been returned to the Board.  As such, the Board asserts jurisdiction over those matters at this time to ensure they are not lost in development.

Upon receipt of a Joint Motion for Partial Remand (JMPR), the Court of Appeals for Veterans Claims (Court) vacated the Board's denials and remanded those matters for further review in April 2023. 

These appeals were then remanded by the Board in October 2023 additional development which has since been completed.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  Specifically, VA made repeat efforts to obtain specific agency treatment records, and VA nexus opinions were obtained in January 2024.

Service Connection

The Veteran is pursuing direct service connection for multiple disorders.  The Board will limit its analyses 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).  

Cyst Removal

First, the Veteran is pursuing service connection for residuals of a cyst removal.  Per a January 2024 VA examiner, he currently demonstrates residuals of a cyst removal which results in mild tenderness.  On this basis, a current disability is found.  

However, the record does not persuasively establish that the relevant cyst either developed or was removed during the Veteran's service.  During the December 2021 hearing, the Veteran testified that his cyst developed during active duty and was removed prior to separation.  However, he later informed his January 2024 VA examiner that the cyst onset post-separation, in 1980, and was removed thereafter.  

Indeed, the Veteran's testimony regarding onset and surgical history are contradictory throughout the record.  See, e.g., March 2011 claim (reporting 1979 surgery); June 2011 VA treatment record (reporting that the cyst developed post-service in 1980); June 2011 VA back examination (reporting that the cyst developed post-service in 1980); December 2012 VA treatment
 was removed during the Veteran's service.  During the December 2021 hearing, the Veteran testified that his cyst developed during active duty and was removed prior to separation.  However, he later informed his January 2024 VA examiner that the cyst onset post-separation, in 1980, and was removed thereafter.  

Indeed, the Veteran's testimony regarding onset and surgical history are contradictory throughout the record.  See, e.g., March 2011 claim (reporting 1979 surgery); June 2011 VA treatment record (reporting that the cyst developed post-service in 1980); June 2011 VA back examination (reporting that the cyst developed post-service in 1980); December 2012 VA treatment record (reporting removal surgery "several years earlier"); January 2013 VA treatment record (reporting removal surgery in 1988); see also Miller v. Wilkie, 32 Vet. App. 249 (2020).  

In seeking clarity on this point, the Board notes that the Veteran's STRs are completely silent for symptoms or diagnoses of the identified cyst, or for the reported surgery.  Given that the reported cyst resulted in surgical removal, the Board reasonably expects that the procedure would have been documented in the Veteran's STRs had it occurred during active duty.  See Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (noting that the Board may use silence in STRs as contradictory evidence (only) if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the STRs).  Further, the Veteran's service treatment records for his short period of service show complaints of and treatment for other disabilities and injuries.  If the Veteran had undergone a surgical procedure (like having a cyst removed) during his active service, such a procedure should have been noted in his records which otherwise appear complete.

Accordingly, the Board does not find the Veteran's statement regarding his claimed in-service cyst removal to be credible, and there is no other evidence reflecting that he had a cyst in service or that such a cyst was removed.  The second element of the service connection framework is not met, and there is no competent or credible evidence otherwise relating his claimed cyst removal to his active service.  

The persuasive weight of the evidence is against the claim, the benefit-of-the-doubt rule is not applicable, and the appeal is hereby denied.

Back

Turning next to the back appeal, there is competent evidence of a current disability.  Historically, the Veteran was diagnosed with degenerative disease of the lumbar spine, degenerative arthritis, and spinal stenosis during June 2011 and January 2024 VA examinations.  Contemporaneous treatment records also document current symptoms and the treatment thereof.  See generally VA and private treatment records.  Accordingly, a current disability is found.

Given the Veteran's diagnosis of arthritis, the Board has considered whether a grant is possible on a presumptive basis.  38 C.F.R. §§ 3.307, 3.309.  However, degenerative changes are first noted in June 2011 VA treatment records, more than three decades after military separation.  Thus, the criteria for presumptive service connection are not met and the appeal does not succeed on this basis.  Id.

Rather, the Board moves to the second element of direct service connection.  Throughout the course of this appeal, the Veteran has offered conflicting testimony as to the onset of his back pain.  However, during the December 2021 hearing, he reported that he first injured his back after falling from a zip line during service, and has had persistent symptoms since that time.

Generally, a veteran is competent to report events capable of lay observation, including an in-service injury and the chronicity of symptoms.  Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Miller, 32 Vet. App. at 249.  At a minimum, this Veteran's service treatment records (STRs) document May 1979 complaints of back pain.  More broadly, the Veteran's testimony is consistent with the nature of his service.  Thus, although the Veteran has identified multiple onsets of back pain throughout the course of this appeal, the Board interprets this evidence in the light most favorable to the Veteran and finds that an in-service event is present, as supported by the 1979 STR.  As such, an in-service incurrence is also found.

The final question then is whether the Veteran's current back disability had its onset during or is otherwise related to his active service.

(Currently, the claims file contains a June 2011 VA nexus opinion which was found inadequate by the Board in October 2023, for the examiner's "failure to
9 complaints of back pain.  More broadly, the Veteran's testimony is consistent with the nature of his service.  Thus, although the Veteran has identified multiple onsets of back pain throughout the course of this appeal, the Board interprets this evidence in the light most favorable to the Veteran and finds that an in-service event is present, as supported by the 1979 STR.  As such, an in-service incurrence is also found.

The final question then is whether the Veteran's current back disability had its onset during or is otherwise related to his active service.

(Currently, the claims file contains a June 2011 VA nexus opinion which was found inadequate by the Board in October 2023, for the examiner's "failure to contemplate the Veteran's competent testimony of symptoms which onset during service and have persisted since that time."  Thus, this opinion does not merit further assessment herein.)  

A VA nexus opinion was obtained in January 2024, wherein the examiner opined that it was less likely than not that the Veteran's back disorder was incurred in or caused by military service.  By way of rationale, the examiner noted that the Veteran's entrance and exit examinations showed no findings relevant to the claimed condition.  Thus, there was no record to support a nexus between the current disorders and service.  Rather, the Veteran reports a fall off a zip line in approximately 1978, with an onset of back pain in 1983.  He reports that he was treated at the base hospital and his back pain resolved, with subsequent symptoms beginning in 1983.  Objectively, the Veteran's current examination showed lower back pain with limited motion.  A May 1979 STR documents treatment for recurrent pain to left shoulder and back-target disc land on left trapezius.  An impression of muscle strain was noted, and the Veteran was given a sling.  However, the noted back issue in service does not have any relation to the current diagnosed condition.  The noted target disc land on left trapezius comprises of the upper and middle back.  The claimed condition involves the lower back.  There are many records showing that the Veteran's lower back condition onset in 2002 or 2003, many years after his military separation.  Thus, a nexus was not established.

This opinion is probative evidence against the claim, and the Board finds it adequate.  Notably, the examiner offered a definitive opinion with a supporting rationale which directly contemplates the Veteran's in-service injury, the onset of his back pain, and the distinct nature of the in- and post-service conditions.  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 the examiner was not fully aware of the Veteran's past medical history or misstated any relevant fact in providing their nexus opinion, which is instead supported by comprehensive file review and interview of the Veteran.  And, there are no competent opinions which tend to contradict the examiner's opinion.

Thus, the examiner has established that no nexus exists between the Veteran's service and current disorder.  Rather, the in-service treatment was for a distinct condition, and the Veteran's current disorder-as based upon his own testimony and statements-had its onset several years after separation.  

Thus, the third and final element of direct service connection is not met. Accordingly, the persuasive weight of the evidence is against the claim such that the benefit-of-the-doubt rule is not applicable, and the appeal is hereby denied.

With respect to both of the above appeals, the Board has considered the Veteran's good faith belief that his current disabilities are related to service.  However, he lacks the expertise to offer a competent opinion as to complex medical matters, including the etiology of a diagnosed condition.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  Rather, greater probative value is afforded to the medical opinions of record, which support the findings enunciated above.

The Board also acknowledges its reference to multiple VA examinations and opinions in arriving at the above findings.  These examinations are found to be adequate for rating purposes, as the examiners reviewed the Veteran's claims file; conducted contemporaneous interview and evaluation; and offered clear and unequivocal opinions contemplative of all theories of entitlement.  

Finally, as previously noted, this case was the subject of a Joint Motion for Remand in 2023.  That JMR noted that the Veteran had contended that he had treatment for his back disability at
d 1372, 1377 (Fed. Cir. 2007).  Rather, greater probative value is afforded to the medical opinions of record, which support the findings enunciated above.

The Board also acknowledges its reference to multiple VA examinations and opinions in arriving at the above findings.  These examinations are found to be adequate for rating purposes, as the examiners reviewed the Veteran's claims file; conducted contemporaneous interview and evaluation; and offered clear and unequivocal opinions contemplative of all theories of entitlement.  

Finally, as previously noted, this case was the subject of a Joint Motion for Remand in 2023.  That JMR noted that the Veteran had contended that he had treatment for his back disability at a VA facility in Washington, DC, shortly after his separation from service.  

Following the Board's most recent remand, VA sought additional records both from VA and via the NPRC.  No additional records were found, and VA notified the Veteran of this fact in a May 2024 letter.  VA did obtain additional private medical records following the Veteran's submission of a release to obtain those records, though others were not available.  Accordingly, the Board finds substantial compliance with the directives of the JMR, and that VA has satisfied its duty to assist.

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).

REASONS FOR REMAND

Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to adjudication of the remaining appeals.

Regarding the psychiatric appeal, this matter was remanded in July 2022 to obtain a new VA nexus opinion.  The requested opinion was obtained in September 2022, which implies that the Veteran entered service with a preexisting psychiatric condition.  However, the opinion provided does not address the criteria relevant to aggravation of a preexisting condition.  An addendum is required for an adequate opinion to be obtained.

As for the left arm appeal, this matter was similarly remanded in July 2022 to obtain a VA examination and opinion.  Opinions were obtained in September 2022and October 2022; however, the examiner failed to account for the Veteran's contention that his current disability is related to an in-service fall from a zip line.  Remand is required for a complete opinion to be obtained.  

The matters are REMANDED for the following actions:

Obtain addendum opinions responsive to the questions below.  If the examiner(s) determines that the requested opinions cannot be answered without first evaluating the Veteran, an examination should be scheduled. 

The claims file and a copy of this remand must be made available for review.

In particular, the psychiatric examiner is asked to offer medical opinions as to:

(1)	Offer an opinion as to whether it is clear and unmistakable (obvious and manifest) that the Veteran's psychiatric condition preexisted his entry into service.

a.	If so, opine whether it is clear and unmistakable (obvious and manifest) that the preexisting disability was not aggravated by service.  In other words, is it clear and unmistakable that any worsening of the disability was due to the natural progression of the disability?

b.	If not, offer an opinion as to whether it is at least as likely as not (50 percent probability or more) that the condition began in service, was caused by service, or is otherwise related to service.

The sling palsy examiner is asked to offer medical opinions as to:

(1)	Is it at least as likely as not (50 percent probability or more) that any current condition began in service, was caused by service, or is otherwise related to service?

Here, the examiner must address the Veteran's in-service treatment for perceived sling palsy; AND his contention that any current disability is related to an in-service fall from a zip line.

In formulating the opinion, the examiner is advised that the term "at least as likely as not" does not mean "within the realm of possibility."  Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it.

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A complete rationale should be provided for all opinions or conclusions expressed.  It should be noted that the Veteran is competent to attest to observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.