MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

L. M. BARNARD · 2026 · Case ID: 26005006

DENIED

Summary

The veteran, who served in the U.S. Army from August 1981 to April 1994, including service in the Southwest Asia theater of operations during the Persian Gulf War, appealed the denial of service connection for colon cancer and brain cancer (benign brain tumor). The veteran alleged these conditions were caused by in-service exposure to burn pits and other toxins. While the Board acknowledged the veteran's service in Southwest Asia and the PACT Act's presumptive provisions, it found that the claims for colon cancer, on a basis other than the PACT Act, were not warranted. The Board noted the absence of any colon cancer diagnosis or related symptoms in the veteran's service treatment records or post-service records, apart from the already service-connected carcinoid tumor metastatic to the liver. The Board also denied service connection for brain cancer, finding that the veteran's diagnosed condition was a benign brain tumor (meningioma), not malignant brain cancer. The Board found the VA examiner's opinion, which stated the meningioma was less likely than not related to service or toxic exposures, to be highly probative, citing a lack of credible evidence linking Gulf War exposures to meningiomas. The Board concluded that the veteran's benign brain tumor was not shown to be causally or etiologically related to service or diagnosed within one year of discharge, and therefore, service connection was denied for both claimed conditions on a basis other than the PACT Act.

Rationale

No current diagnosis of colon cancer found in service treatment records or post-service records.; Veteran's lay assertions regarding colon cancer lack probative value due to lack of medical expertise.; Evidence of record is against the claim, precluding application of the benefit of the doubt doctrine.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

12-00 504

Full Decision Text

Citation Nr: 26005006
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 12-00 504
DATE: April 28, 2026

ORDER

Entitlement to service connection for colon cancer, other than carcinoma of the small intestine with metastasis to the liver, on a basis other than as pursuant to the PACT Act, to include as due to in-service toxin exposure, is denied.

Entitlement to service connection for brain cancer, to include a benign brain tumor, on a basis other than as pursuant to the PACT Act, to include as due to in-service toxin exposure, is denied.

FINDINGS OF FACT

1. At no time during, or prior to, the pendency of the claim does the Veteran have a diagnosis of colon cancer, other than carcinoma of the small intestine with metastasis to the liver.

2. Brain cancer, to include a benign brain tumor, was not incurred in service and is not otherwise causally or etiologically related to any disease, injury, or incident in service, to include exposure to environmental hazards in Southwest Asia, and did not manifest within one year of service discharge.

CONCLUSIONS OF LAW

1. The criteria for service connection for colon cancer, other than carcinoma of the small intestine with metastasis to the liver, to include on a basis other than as pursuant to the PACT Act, have not been met. 38 U.S.C. §§ 1110, 1112, 1116, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317.

2. The criteria for service connection for brain cancer, to include a benign brain tumor, on a basis other than as pursuant to the PACT Act, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1981 to April 1994, to include service in the Southwest Asia theater of operations during the Persian Gulf War.

In December 2013 and April 2015, the Board remanded the Veteran's claims for additional evidentiary development, and in March 2018 the Board denied the Veteran's claims for service connection.

The Veteran subsequently appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In January 2019, the Court granted a Joint Motion for Remand (JMR), vacating the Board's decision and remanding the case to the Board.

In July 2019, the Board remanded the matters for additional development. In October 2025, the Board granted the Veteran's claims for service connection pursuant to the PACT Act, however, as the Veteran's claims were pending prior to the enactment of the PACT Act, entitlement to service connection for such claims on a basis other than as pursuant to the PACT Act were remanded.

The claims have now returned to the Board for further adjudication, and the Board finds that there was substantial compliance with the prior remand directives. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268 (1998). Nonetheless, it is only substantial compliance, rather than strict compliance, with the terms of a remand that is required. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (finding substantial compliance where an opinion was provided by a neurologist as opposed to an internal medicine specialist requested by the Board); Dyment v. West, 13 Vet. App. 141 (1999).

The Board must discuss all theories of entitlement raised by the Veteran or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545 (2008).

Accordingly, the Board has recharacterized the claims as indicated above to afford the Veteran the broadest possible scope of review. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131
Board); Dyment v. West, 13 Vet. App. 141 (1999).

The Board must discuss all theories of entitlement raised by the Veteran or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545 (2008).

Accordingly, the Board has recharacterized the claims as indicated above to afford the Veteran the broadest possible scope of review. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)].

Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309.

Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be granted for a disability due to a qualifying chronic disability of a Veteran who served in the Southwest Asia theater of operations during the Persian Gulf War provided that such disability became manifest during either active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. Part 4, not later than December 31, 2021, and by history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a)(1).

In the instant case, the record reflects that the Veteran had service in the Southwest Asia theater of operations and, therefore, such laws and regulations are applicable to his claims.

A chronic qualifying disability means a chronic disability resulting from an (A) undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) IBS; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117 (d) warrants a presumption of service connection. 38 C.F.R. § 3.317 (a)(2)(i).

For the purposes of this section the term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317 (a
or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117 (d) warrants a presumption of service connection. 38 C.F.R. § 3.317 (a)(2)(i).

"Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317 (a)(3).

Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317 (a)(4).

Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: (1) fatigue, (2) unexplained rashes or other dermatological signs or symptoms, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs and symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders. 38 C.F.R. § 3.317 (b).

Under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), effective from August 10, 2022, Section 303 implemented 38 U.S.C. § 1168, requiring a disability examination and medical opinion be requested for certain non-presumptive conditions involving toxic exposure risk activity (TERA). For such claims, VA is required to provide a disability examination and medical opinion when the Veteran submits a claim for compensation, has evidence of a disability, has evidence of participation in a TERA, and such evidence is not sufficient to establish service connection for the disability. A Veteran can claim participation in a TERA explicitly or implicitly through service in a location presumed associated with toxic exposure, or records showing participation in a TERA; or, if VA has conceded exposure in a prior claim, or the file has a claim attributable to toxic exposure. Other ways to claim or establish participation in a TERA include, when a Veteran's military occupational specialty (MOS) is associated with toxic exposure; when medical records suggest exposure to a toxic substance, chemical, or airborne hazard such as VHA exposure screening; or, with any other relevant evidence of record to include garrison exposures.

Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time, he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran's filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292 (1991).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in
on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292 (1991).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § § 5107 (b); 38 C.F.R. § § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

The Veteran contends that he suffers from colon cancer as a result of his active service. Specifically, the Veteran alleges that he was exposed to burn pits and other toxins while deployed in Iraq and that such caused his claimed colon cancer.

As previously noted, the Veteran's claims for service connection were granted pursuant to the PACT Act. However, as the PACT Act was not effective until August 10, 2022, grants premised on such cannot be effective prior to that date. Therefore, as the Veteran's claims were pending prior to August 2022, in order to fully consider the Veteran's claims, the Board must consider whether there is a basis for granting service connection for all or any portion of the period on appeal prior to the enactment of the PACT Act. This includes direct service connection, to include based on exposure to burn pits and other toxins. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed.Cir.1994) (finding that even if a presumption cannot be applied, service connection on a direct basis must be considered).

Turning to the evidence of record, the Veteran's service treatment records are silent for any complaints, treatment, or diagnosis of colon cancer. However, there are numerous reports of various complaints and symptoms throughout the Veteran's service, which he alleges were early signs of his cancers. Specifically, the Veteran's service treatment records reflect reports of paresthesias in his lower extremities, chest pain, leg pain, and joint pain/swelling (to include in his wrists, hands, back, neck, jaw, and knees). Furthermore, the Veteran alleges that he also experienced: rapid heart rate, headaches, diarrhea and nausea, dry cough, abdominal pain, blood in his urine, skin flushing, swelling in his feet and legs, wheezing and shortness of breath, sleep disturbance, muscle pains, high blood pressure, fatigue, rectal bleeding/pain, anxiety, and memory loss. Finally, he contends that while he sought treatment for his various complaints, as his symptoms did not manifest concurrently, they were given innocuous and non-cancerous explanations. However, the Veteran's military personnel records show that he served in the Southwest Asia theater of operations to include during the Persian Gulf War with service in Iraq. Therefore, the Veteran is presumed to have been exposed to burn pits and other toxins during his active service. In addition, the AOJ issued a TERA Memorandum in October 2025, which confirmed the Veteran's Southwest Asia service and in-service toxin exposures. Finally, while post-service treatment records reflect that the Veteran was diagnosed with a carcinoid tumor metastatic to the liver in June 2009, there are no other gastrointestinal cancer diagnoses, to include colon cancer.

Although the Veteran has generally reported that his claimed colon cancer began in or was caused by his active-duty service, the evidence of record does not support the Veteran's claim. There is simply no indication of any colon cancer or symptoms related to such, other than his already service-connected carcinoid tumor metastatic to the liver. However, the Veteran has undergone several VA examinations in regard to his claimed cancers, to include in April and August 2010, August 2017, and November 2025.

As noted
Finally, while post-service treatment records reflect that the Veteran was diagnosed with a carcinoid tumor metastatic to the liver in June 2009, there are no other gastrointestinal cancer diagnoses, to include colon cancer.

As noted, in April 2010 the Veteran underwent a VA examination for his claimed cancers, and the examiner found that the Veteran was diagnosed with cancer of the liver and cancer of the small intestine, which had existed since approximately 1990 and 2009, respectfully. However, the examiner did not indicate any other diagnosed cancers, to include any additional or separate colon cancers. The examiner noted that the Veteran's intestinal cancer caused nausea and vomiting, diarrhea and cough, fatigue, dry peeling skin, hand and foot pain, and abdominal pain. In addition, he noted that the Veteran's liver cancer caused fatigability, arthralgia, gastrointestinal disturbances, nausea and vomiting, loss of appetite, joint pain, skin peeling, hand and foot pain, headaches, nosebleeds, trouble swallowing, abdominal pain, and cough. The examiner stated that the Veteran's symptoms occurred constantly except for his nausea and diarrhea which were occasional. The examiner reported that the Veteran had undergone treatments for his malignancies to include chemotherapy and that such treatments were not complete as his malignancies were still active, noting that the extent of the Veteran's small intestine cancer was "unknown" but that his liver was "covered with tumors."

In August 2010 the Veteran underwent a VA General Medical and Gulf War examination. The examiner conducted an extensive examination of the Veteran's various bodily systems and noted that physical examination of the Veteran was predominantly normal. The examiner indicated that examination of the Veteran's abdomen revealed no tenderness or organs palpated. While there were some reports of pain during range of motion testing, there were no findings of strength deficits, range of motion was normal in all joints, and there was no report of pain with palpation of the lower extremities. Furthermore, the examiner noted that the endocrine portion of the examination was entirely normal. Following the physical examination of the Veteran as well as laboratory and diagnostic testing, the examiner determined that the Veteran had diagnoses for, in pertinent part, carcinoid tumor of the small intestine with liver metastasis, fatigue attributable to carcinoid tumor of the small intestine with liver metastasis, and peripheral neuropathy of both feet, a side effect of chemotherapy for carcinoid tumor of the small intestine. However, the examiner did not indicate any colon cancer diagnoses.

In addition to the examination, the August 2010 VA examiner also provided an etiological opinion regarding the Veteran's cancer of the small intestine. The examiner found that the Veteran had a disease with a clear and specific etiology and diagnosis, specifically carcinoid tumor of the small intestine with liver metastasis. Furthermore, the examiner found that the Veteran's small intestine cancer at least as likely as not began during/immediately upon the Veteran's return from Desert Storm. However, the Board again notes that while the August 2010 examiner discussed the Veteran's carcinoid tumor, the examiner made no findings as to any additional or separate colon cancers.

In August 2017 an additional VA Medical Opinion was obtained. While the August 2017 examiner provided a contrary etiological opinion from that of the August 2010 VA examiner, finding that the Veteran's carcinoma of the small intestine with metastasis to the liver was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, the August 2017 examiner also made no findings as to any additional or separate colon cancers.

In November 2025 the Veteran underwent a VA Intestinal Conditions examination with an accompanying disability benefits questionnaire (DBQ). The examiner noted that the Veteran was diagnosed with a malignant intestinal neoplasm, specifically a metastatic neuroendocrine tumor (carcinoid tumor metastatic to the liver) in June 2009. In addition, the examiner noted that the Veteran had undergone surgery in September 2021 and was status post ex-lap with right hepatectomy, cholecystectomy, partial small bowel resection and small diaphragmatic resection. While the Veteran reported that he was diagnosed with liver and colon cancer for which he underwent surgery, the VA examiner did not indicate that the Veteran had any diagnosed cancers other than the carcinoid tumor or metastatic neuroendocrine tumor, to include colon
an accompanying disability benefits questionnaire (DBQ). The examiner noted that the Veteran was diagnosed with a malignant intestinal neoplasm, specifically a metastatic neuroendocrine tumor (carcinoid tumor metastatic to the liver) in June 2009. In addition, the examiner noted that the Veteran had undergone surgery in September 2021 and was status post ex-lap with right hepatectomy, cholecystectomy, partial small bowel resection and small diaphragmatic resection. While the Veteran reported that he was diagnosed with liver and colon cancer for which he underwent surgery, the VA examiner did not indicate that the Veteran had any diagnosed cancers other than the carcinoid tumor or metastatic neuroendocrine tumor, to include colon cancer. On examination, the examiner found no evidence of irritable bowel syndrome, Crohn's disease, ulcerative colitis, undifferentiated form of irritable bowel disease, chronic enteritis, diverticular disease, resection of the large intestine, external intestinal fistulous disease, celiac disease, gastrointestinal dysmotility syndrome, or visceroptosis. The examiner noted in June 2009 the Veteran underwent diagnostic testing which revealed a carcinoid tumor metastatic to the liver; thus, the Veteran was diagnosed with a primary malignant neoplasm. However, the Veteran underwent surgery in September 2021, to include resection of the small intestine, and was in remission. The examiner found that the Veteran's small intestine was asymptomatic, and he did not suffer any chronic complications as a result of the surgery. However, the examiner noted that the Veteran reported fatigue.

In addition to the examination, the November 2025 VA examiner also provided medical opinions in regard to the Veteran's claimed colon cancer. As an initial matter, the examiner stated that the Veteran's claimed condition was "not considered a 'small colon cancer' rather, it is a metastatic neuroendocrine tumor (NET), specifically a carcinoid." The examiner stated that such was biologically and clinically distinct from adenocarcinoma of the colon. The examiner stated that carcinoid tumors were well-differentiated neuroendocrine neoplasms that arose from enterochromaffin cells and could occur throughout the gastrointestinal tract, including the colon. Furthermore, they were classified separately from conventional colon adenocarcinomas due to their origin, histology, and clinical behavior. The examiner noted that patients with metastatic carcinoid tumors to the liver often presented with symptoms related to tumor bulk (pain, obstruction) and hormone excess (flushing, diarrhea, carcinoid heart disease). In addition, the examiner noted that surgical management, including right hepatectomy, cholecystectomy, partial small bowel resection, and diaphragmatic resection, was aimed at cytoreduction to relieve symptoms, prevent complications, and improve survival, especially in those with indolent disease and limited extrahepatic spread. The examiner noted that such was the case for the Veteran, who was status post ex-lap with right hepatectomy, cholecystectomy, partial small bowel resection, and small diaphragmatic resection. The examiner also provided etiological opinions as to the Veteran's carcinoid tumor, finding that his condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, and that it was less likely than not caused by the Veteran's indicated toxic exposure risk activities, after considering the total potential exposures through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner provided the rationale that there was a lack of substantiating evidence to support a direct nexus and noted that the Veteran's tumor was diagnosed 15 years after his service and 18 years after his deployment to Southwest Asia. Furthermore, the examiner noted that metastatic neuroendocrine tumors were a condition with a clear etiology and that while they were typically sporadic, they could also be associated with hereditary syndromes such as multiple endocrine neoplasia type 1 (MEN1), genetic mutations, and aberrant gene expression drive tumorigenesis and progression. The examiner noted that current epidemiologic studies of Gulf War veterans have not shown an increased risk of overall cancer or site-specific cancers (including neuroendocrine tumors like carcinoid tumors) linked to deployment or specific exposures such as oil well fire smoke, pesticides, or depleted uranium. The examiner further noted studies comparing Gulf War veterans to non-deployed controls which found no excess risk of cancer overall or gastrointestinal cancers, and no link between self-reported hazardous exposures and subsequent cancer development. Therefore, the examiner found no credible evidence in the medical literature connecting exposures, such as those of the Veteran, to the development of metastatic neuroendocrine neoplasms.

Throughout the appeal, the Veteran has submitted statements indicating his belief that
enesis and progression. The examiner noted that current epidemiologic studies of Gulf War veterans have not shown an increased risk of overall cancer or site-specific cancers (including neuroendocrine tumors like carcinoid tumors) linked to deployment or specific exposures such as oil well fire smoke, pesticides, or depleted uranium. The examiner further noted studies comparing Gulf War veterans to non-deployed controls which found no excess risk of cancer overall or gastrointestinal cancers, and no link between self-reported hazardous exposures and subsequent cancer development. Therefore, the examiner found no credible evidence in the medical literature connecting exposures, such as those of the Veteran, to the development of metastatic neuroendocrine neoplasms.

Throughout the appeal, the Veteran has submitted statements indicating his belief that he suffers from colon cancer, other than carcinoma of the small intestine with metastasis to the liver, which was caused by and began during his active service. Specifically, he has alleged that he was not only exposed to burn pits and other toxins during his Gulf War service, but that he developed signs and symptoms of his cancers during his service.

Following a thorough review of the evidence of record, the Board finds that service connection for colon cancer, other than carcinoma of the small intestine with metastasis to the liver, is not warranted to include on a basis other than as pursuant to the PACT Act, as the probative evidence of record fails to demonstrate a current disability related to the Veteran's military service.

In the instant case, the probative evidence of record fails to demonstrate a current diagnosis of colon cancer, other than carcinoma of the small intestine with metastasis to the liver. Although the Board has also considered the Court's holding in Romanowsky, supra, there is also no probative evidence of a recent diagnosis of this disability prior to the Veteran's claim. While the Veteran's service treatment records reflect the Veteran's reports of symptoms which he alleges were early signs of his cancers, they are silent for any findings, complaints, or diagnoses of colon cancer. Furthermore, the Veteran's post-service treatment records are silent for any complaints, treatment, or diagnosis of colon cancer, other than the Veteran's already service-connected carcinoma of the small intestine with metastasis to the liver.

The Board notes that the Veteran is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2007). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).

However, the matter of a medical diagnosis for a disability not capable of lay observation, such as that of issue here, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Specifically, the diagnosis of colon cancer involves medical subjects concerning internal physical processes encompassing various internal systems, extending beyond an immediately observable cause-and-effect relationship and requires the administration and interpretation of specialized testing. In the instant case, there is no suggestion that the Veteran has had any medical training. Therefore, as the Veteran does not have the appropriate medical training and expertise to competently self-diagnose colon cancer, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 ("[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

Moreover, the Veteran has offered only conclusory statements regarding his alleged colon cancer and its relationship to his service. In contrast, the VA examiners took into consideration all the relevant facts in providing their findings and opinions. Therefore, the Board accords great probative weight to the VA examinations and medical opinions of record.

The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.30, 3.310. Thus, where, as here, the probative evidence indicates that the Veteran does not have a current diagnosis for colon cancer, other than carcinoma of the small intestine with metastasis to the liver, for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir
Board accords great probative weight to the VA examinations and medical opinions of record.

In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence of record is against the Veteran's claim of entitlement to service connection for colon cancer, other than carcinoma of the small intestine with metastasis to the liver, on a basis other than as pursuant to the PACT Act, to include as due to in-service toxin exposure, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Entitlement to service connection for brain cancer, to include a benign brain tumor, on a basis other than as pursuant to the PACT Act, to include as due to in-service toxin exposure, is denied.

The Veteran contends that he suffers from brain cancer as a result of his active service. Specifically, the Veteran alleges that he was exposed to burn pits and other toxins while deployed in Iraq and that such caused his claimed brain cancer.

Turning to the evidence of record, the Veteran's service treatment records are silent for any complaints, treatment, or diagnoses of brain cancer, to include benign tumors. However, there are numerous reports of various complaints and symptoms throughout the Veteran's service, which he alleges were early signs of his cancers. Specifically, the Veteran's service treatment records reflect reports of paresthesias in his lower extremities, chest pain, leg pain, and joint pain/swelling (to include in his wrists, hands, back, neck, jaw, and knees). Furthermore, the Veteran alleges that he also experienced: rapid heart rate, headaches, diarrhea and nausea, dry cough, abdominal pain, blood in his urine, skin flushing, swelling in his feet and legs, wheezing and shortness of breath, sleep disturbance, muscle pains, high blood pressure, fatigue, rectal bleeding/pain, anxiety, and memory loss. He contends that while he sought treatment for his various complaints, as his symptoms did not manifest concurrently, they were each given innocuous and noncancerous explanations. However, the Veteran's military personnel records reflect that he served in the Southwest Asia theater of operations to include during the Persian Gulf War with service in Iraq. Therefore, the Veteran is presumed to have been exposed to burn pits and other toxins during his active service. In addition, in the October 2025 TERA Memorandum, the AOJ confirmed the Veteran's Southwest Asia service and in-service toxin exposures. Furthermore, post-service treatment records reflect that the Veteran was diagnosed with a benign brain tumor (meningioma) in March 2010.

In November 2025 the Veteran underwent a VA Central Nervous System (CNS) and Neuromuscular Diseases (Except Traumatic Brain Injury, Amyotrophic Lateral Sclerosis, Parkinson's Disease, Multiple Sclerosis, Headaches, TMJ Conditions, Epilepsy, Narcolepsy, Peripheral Neuropathy, Sleep Apnea, Cranial Nerve Disorders, Fibromyalgia, Chronic Fatigue Syndrome) examination with an accompanying DBQ. The examiner noted that the Veteran had been diagnosed with a CNS condition, specifically a brain tumor (meningioma) in March 2010. The Veteran reported that he was told that he had "something on his brain that was benign." However, he also reported that he had not received any treatment for such. The examiner noted that the Veteran's meningioma did not require continuous medication nor was it an infectious condition. On examination, the examiner found no evidence of muscle weakness in the upper or lower extremities, pharynx, larynx or swallowing conditions, respiratory conditions, sleep disturbance, impairment of the sphincter or bowel incontinence, gastrointestinal symptoms, voiding dysfunction causing urine leakage, frequency, or obstructed voiding, required appliances, recurrent urinary infections, erectile dysfunction, or any mental health manifestations attributable to the Veteran's CNS condition. During the neurological examination of the Veteran, his speech, gait, strength, and deep tendon reflexes were normal, and the examiner found no evidence of muscle atrophy or weakness. The examiner noted that the Veteran was diagnosed with a benign neoplasm in March 2010, and that while he had not undergone treatment for such, the Veteran was watchfully waiting. Furthermore, the examiner found no residuals or complications due to the Veteran's neoplasm. The examiner noted that in April 2020, the Veteran underwent an MRI which revealed "stable left cavernous sinus enhancing mass lesion that likely represents a meningioma and a stable CSF attenuation fluid collection along the right cavernous sinus that likely represents an arachnoid cyst." Finally, the examiner found no other pertinent physical findings, complications, conditions, signs, or symptoms.

In addition to the examination, the November 2025 VA examiner also provided medical opinions in regard to the Veteran's claimed brain cancer. As an initial matter, the examiner found that the Veteran did not have a diagnosis for brain cancer. Rather the examiner noted that while the Veteran had a brain tumor, such was a meningioma and "is not typically considered a type of 'brain cancer,' but is classified as a primary central nervous system (CNS) tumor." Furthermore, the examiner noted that the vast majority of meningiomas (approximately 90 percent) were benign, meaning they did not exhibit the invasive or metastatic behavior characteristic of malignant cancers. The examiner opined that the Veteran's meningioma was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, and that it was less likely than not caused by the Veteran's indicated toxic exposure risk activities, after considering the total potential exposures through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner provided the rationale that meningiomas arose from the meninges, the membranous coverings of the brain and spinal cord, and not from the brain parenchyma itself. In addition, the examiner stated that based on the current evidence, it was less likely than not that the Veteran's meningioma was caused by exposure to Gulf War environmental factors such as airborne hazards and burn pit exposures. The examiner noted that "studies of Gulf War veterans have not demonstrated an increased risk of cancer-including brain tumors-related to deployment or specific exposures such as oil well fire smoke, pesticides, or depleted uranium." Furthermore, the examiner noted that studies specifically examining hospitalization and morbidity among Gulf War veterans exposed to oil well fire smoke, airborne hazards, and burn pits found no evidence of an increased risk for postwar morbidity or cancer. In addition, the examiner noted that follow-up studies found no excess risk of site-specific cancers, to include brain tumors, in Gulf War veterans compared to non-deployed controls. The examiner noted that the most relevant study on occupational exposures and meningioma risk was the INTEROCC case-control study, which found no excess meningioma risk associated with most combustion products, dusts, and chemical agents. Furthermore, the examiner noted that meningiomas were the most common benign primary brain tumors, and the most prevalent risk factors for such were a genetic predisposition (particularly neurofibromatosis type 2) and exposure to ionizing radiation. The examiner noted that other potential associations included obesity, cigarette smoking, and possible hormonal influences, but such were not well established. The examiner stated that there was "no
of site-specific cancers, to include brain tumors, in Gulf War veterans compared to non-deployed controls. The examiner noted that the most relevant study on occupational exposures and meningioma risk was the INTEROCC case-control study, which found no excess meningioma risk associated with most combustion products, dusts, and chemical agents. Furthermore, the examiner noted that meningiomas were the most common benign primary brain tumors, and the most prevalent risk factors for such were a genetic predisposition (particularly neurofibromatosis type 2) and exposure to ionizing radiation. The examiner noted that other potential associations included obesity, cigarette smoking, and possible hormonal influences, but such were not well established. The examiner stated that there was "no established causal relationship" between Gulf War exposures, to include airborne hazards and burn pits, and the development of meningiomas and therefore a causal relationship could not be established. Finally, the examiner noted that the Veteran's brain tumor was diagnosed 19 years after his deployment to Southwest Asia. Thus, the examiner found that the Veteran's meningioma, which he claimed was brain cancer, was less likely than not caused by his in-service environmental hazard exposures. As the November 2025 VA examiner provided clear conclusions supported by detailed medically based rationales, the Board finds his opinions highly probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). In addition, the Board notes that there are no contrary medical opinions of record.

Throughout the appeal, the Veteran has submitted statements indicating his belief that he not only suffers from brain cancer but that such was caused by and began during his active service. Specifically, he has alleged that he was not only exposed to burn pits and other toxins during his Gulf War service, but that he developed signs and symptoms of his cancers during his service.

Following a thorough review of the evidence of record, the Board finds that service connection for brain cancer, to include a benign brain tumor, on a basis other than as pursuant to the PACT Act, to include on either a presumptive or direct basis, is not warranted.

The Board notes that the medical evidence is not in dispute as to whether the Veteran has a current diagnosis, specifically a benign brain tumor (meningioma). There is ample evidence in the Veteran's post-service treatment records to support such diagnosis. Furthermore, the November 2025 VA examiner confirmed the Veteran's diagnosis; therefore, the first element of service connection, whether for direct or presumptive service connection, is met.

As the Veteran had service in the Southwest Asia theater of operations during the Persian Gulf War, the Board has considered presumptive service connection pursuant to 38 C.F.R. § 3.317. However, such presumption is only applicable where the evidence demonstrates an undiagnosed illness, i.e., one that is not attributed to any known clinical diagnoses. As previously noted, here the probative evidence of record indicates that the Veteran's claimed condition has been diagnosed as a benign brain tumor. Therefore, such has been attributed to a known clinical diagnosis, precluding entitlement to service connection for a separate disorder on a presumptive basis under 38 C.F.R. § 3.317.

The Board has also considered presumptive service connection and service connection based on continuity of symptomatology pursuant to 38 C.F.R. §§ 3.303, 3.307, 3.309. However, the probative evidence of record is against service connection on such bases for the Veteran's claimed disability. Most notably, benign tumors such as the Veteran's meningioma, are not listed as chronic diseases under 38 C.F.R. § 3.309 (a). Furthermore, there is no evidence of the Veteran's brain tumor within one year after his discharge from service. As previously noted, there is no diagnosis, complaints, or treatment for his benign brain tumor during the Veteran's service or for several years after his discharge. The earliest evidence of an assessment of such was in March 2010.

It is acknowledged that the Veteran is competent to give evidence about observable symptomatology. Layno v. Brown, 6 Vet. App. 465, 469-470 (1994). It is further acknowledged that lay evidence concerning continuity of symptoms after service may be credible regardless of the lack of contemporaneous medical evidence. Buchanan, 451 F.3d at 1331. Here, however, any statements as to the Veteran's benign brain tumor continuing immediately after service are not found to be persuasive in light of the persuasive medical evidence of record to the
for his benign brain tumor during the Veteran's service or for several years after his discharge. The earliest evidence of an assessment of such was in March 2010.

For these reasons, continuity of symptomatology has not been established, either through the medical evidence or through the Veteran's statements. Stated differently, a benign brain tumor was not demonstrated during service, at separation, or within one year of separation. The findings of record are consistent with a diagnosis of a benign brain tumor but inconsistent with any possible allegation of continuity of symptomatology. Furthermore, there is no competent evidence linking the remote onset of the Veteran's benign brain tumor to service. Therefore, presumptive service connection or service connection based on continuity of symptomatology is not warranted.

The Board has also considered direct service connection but finds that the probative evidence of record is against direct service connection, to include as due to in-service toxin exposure, for the Veteran's benign brain tumor. First, as previously noted there are no complaints, treatment, or diagnoses of any brain cancer, brain tumors, or any associated symptoms in service, and while the Veteran is presumed to have been exposed to toxins as a result of his Southwest Asia service, the November 2025 VA examiner found no link between the Veteran's diagnosed benign brain tumor and any in-service exposure or any incident in service. Second, the earliest indications of a benign brain tumor are post-service in March 2010. Such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson v. Gober, 230 F.3rd 1330, 1333 (Fed. Cir. 2000). Finally, there is no competent, probative medical evidence in the record that links the Veteran's benign brain tumor to an incident of the Veteran's active military service, to include his presumed in-service toxin exposure. As previously noted, the Board has found the November 2025 VA opinions probative. In this regard, the November 2025 VA examiner found that the Veteran's benign brain tumor was not related to his service, to include his in-service toxin exposures and that the medical literature did not include any credible evidence connecting exposures, such as those of the Veteran, to the development of benign brain tumors. Finally, as there are no contrary opinions of record, there is no reasonable possibility of substantiating the Veteran's claim on a direct basis. Therefore, direct service connection is not warranted.

Consequently, the Board finds that the Veteran's benign brain tumor is not shown to be causally or etiologically related to a disease, injury, or incident in service to include any in-service toxic exposure and did not manifest within one year of service discharge. Therefore, service connection for such is not warranted.

Accordingly, for the reasons stated above, the Board finds that the evidence of record is against the claim for service connection for brain cancer, to include a benign brain tumor, on a basis other than as pursuant to the PACT Act, to include as directly related to in-service toxin exposure. As the evidence is not in relative

equipoise, the benefit of the doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

L. M. BARNARD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Unger, 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.

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