STOMACH NEOPLASM OF

K.A. KENNERLY · 2026 · Case ID: A26001969

MIXED

Summary

The veteran, who served in the United States Marine Corps from August 1979 to August 1983, appeals the denial of service connection for a stomach tumor, involuntary facial movements, and a neurological disability, all claimed to be due to exposure to Camp Lejeune contaminated water (CLCW). The Board found that the November 2020 rating decision favorably established the veteran's diagnosis of a stomach tumor, involuntary facial movements, and neurological impairments, as well as his exposure to CLCW. The Board relied on three private medical opinions, particularly one from September 2025, which found the stomach tumor likely caused by carcinogenic agents in the water and deemed the opinions adequate with supporting rationale. Consequently, service connection for the stomach tumor was granted. For involuntary facial movements and the neurological disability, the Board again relied on the favorable findings from the prior decision and the September 2025 opinion, which linked these conditions to in-service solvent and jet fuel exposures. These opinions were deemed adequate and afforded significant probative weight, leading to the granting of service connection for these conditions as well. The appeal concerning an eye disability, including astigmatism, was remanded for a new VA examination to determine the nature and etiology of the condition, considering the veteran's claimed exposures and the possibility of a neurological overlay to the astigmatism.

Rationale

Favorable findings from prior decision regarding diagnosis and CLCW exposure; Private medical opinions support nexus to CLCW; September 2025 opinion found tumor likely caused by Benzene, TCE, vinyl chloride

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

211108-197292

Full Decision Text

Citation Nr: A26001969
Decision Date: 01/08/26 Archive Date: 01/08/26

DOCKET NO. 211108-197292
DATE: January 8, 2026

ORDER

Entitlement to service connection for a stomach tumor, due to exposure to Camp Lejeune contaminated water (CLCW), is granted.

Entitlement to service connection for involuntary facial movements, due to exposure to CLCW, is granted.

Entitlement to service connection for a neurological disability, due to exposure to CLCW, is granted.

REMANDED

Entitlement to service connection for an eye disability, to include an astigmatism, and to include as a result of a toxic exposure risk activity (TERA), and as secondary to a service-connected headache disability, is remanded.

FINDINGS OF FACT

1. The appellant's stomach tumor is due to his exposure to CLCW.

2. The appellant's involuntary facial movements are due to his exposure to CLCW.

3. The appellant's neurological disability, other than involuntary facial movements, is due to his exposure to CLCW.

CONCLUSIONS OF LAW

1. The criteria for service connection for a stomach tumor are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307(a)(7), 3.309(f).

2. The criteria for service connection for involuntary facial movements are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307(a)(7), 3.309(f).

3. The criteria for service connection for a neurological disability, other than involuntary facial movements, are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307(a)(7), 3.309(f).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served in the United States Marine Corps from August 1979 to August 1983.

Procedural History

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2020 rating decision of the Department of Veterans Affairs' (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ), which, inter alia, denied entitlement to service connection for a stomach tumor, a neurological condition, an astigmatism, and for involuntary facial movements. The appellant's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), was timely received by VA in November 2021. The appellant elected the Board's Hearing docket.

The appellant testified before the undersigned Veterans Law Judge in July 2025. A transcript of this proceeding is associated with the record.

This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c).

Recharacterization of Issue on Appeal

The U.S. Court of Appeals for Veterans Claims (CAVC) has held that the scope of a claim for service connection for a disability includes any disability that reasonably may be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). In accordance with Clemons, the original issue on appeal of entitlement to service connection for an astigmatism has been expanded to entitlement to service connection for an eye disability, to include an astigmatism, and to include as a result of a TERA, and as secondary to a service-connected headache disability, as reflected on the title page of this decision.

Applicable Evidentiary Window

As the appellant elected the hearing docket, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal, evidence submitted by the appellant or his representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing. 38 C.F.R. § 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant may file a supplemental claim (VA Form 20-0995) and submit
the AOJ at the time of its decision on the issues on appeal, evidence submitted by the appellant or his representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing. 38 C.F.R. § 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). 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).

Pursuant to 38 C.F.R. § 3.307(a)(7), exposure to CLCW may be presumed based on official evidence of service at the camp for the required time during the presumptive period. Further, for those diseases listed in 38 C.F.R. § 3.309(f), a nexus to contaminants in the water may be presumed. Exposure to CLCW and/or a nexus between water contaminants and a non-presumptive disease may also be shown on a facts-found basis. In this case, the claimed stomach tumor, involuntary fascial movements, and neurological disability, are not listed in 38 C.F.R. § 3.309(f). As such, these claims are considered based on theories of entitlement other than presumptive service connection pursuant to 38 C.F.R. § 3.307(a)(7).

When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran's disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. §5107(b). It follows that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for a stomach tumor

Appellant's Contentions

The appellant contends that he developed a stomach tumor as a direct result of his military service. See Hearing Transcript, July 18, 2025.

Analysis

The November 2020 rating decision on appeal favorably found that the appellant had been diagnosed with a gastric tumor and that he was exposed to contaminated water at Camp Lejeune. See Rating Decision, November 6, 2020. The Board is bound by these favorable findings. See 38 C.F.R. §§ 3.104(c), 20.801(a). Accordingly, the first and second elements of service connection are met. See Shedden, supra.

With respect to the third element of service connection, a nexus between the in-service event or injury and the current disability, the appellant has submitted three opinions from his medical providers which support a nexus between his CLCW and his current disability. See Medical Opinion Letter of
2020 rating decision on appeal favorably found that the appellant had been diagnosed with a gastric tumor and that he was exposed to contaminated water at Camp Lejeune. See Rating Decision, November 6, 2020. The Board is bound by these favorable findings. See 38 C.F.R. §§ 3.104(c), 20.801(a). Accordingly, the first and second elements of service connection are met. See Shedden, supra.

With respect to the third element of service connection, a nexus between the in-service event or injury and the current disability, the appellant has submitted three opinions from his medical providers which support a nexus between his CLCW and his current disability. See Medical Opinion Letter of M.A., MD, August 17, 2020; Medical Opinion Letter of K.H., MD, August 11, 2020; Medical Opinion Letter of L.N., NFP and S.B., MD, September 29, 2025. Specifically, the September 2025 medical opinion found that the appellant's stomach tumor was likely caused by exposure to carcinogenic agents, including Benzene, trichloroethylene and vinyl chloride. See Medical Opinion Letter of L.N., NFP and S.B., MD, September 29, 2025.

The August 2022 and September 2025 medical opinions, taken together, are adequate for rating purposes. The examiners reviewed the claims file, and the September 2025 medical opinion provided a supporting rationale for the conclusions reached. In addition, the medical professionals adequately considered the statements and contentions of the appellant, to include the circumstances of his service, and the onset and continuity of his symptoms. The September 2025 medical opinion also has clear conclusions and supporting data, as well as reasoned medical explanations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). These opinions, taken together, are afforded significant probative weight. There is no contrary opinion of record. Accordingly, the third element of service connection is established. See Shedden, supra.

The evidence of record establishes that the appellant's stomach tumor is due to toxic exposures during service. As such, the criteria for entitlement to service connection for a stomach tumor has been met and the appellant's appeal is granted. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303.

2. Entitlement to service connection for involuntary facial movements

3. Entitlement to service connection for a neurological disability

Appellant's Contentions

The appellant contends that he currently suffers from involuntary facial movements and a neurological disability as a direct result of his military service. See Hearing Transcript, July 18, 2025.

Analysis

The November 2020 rating decision on appeal favorably found that the appellant has been diagnosed with a clonic hemifacial spasm of the left facial muscle and that he was exposed to CLCW. See Rating Decision, November 6, 2020. The Board is bound by these favorable findings. See 38 C.F.R. §§ 3.104(c), 20.801(a). Additionally, the appellant has been diagnosed with neurological impairments. See Medical Opinion Letter of M.A., MD, August 17, 2020; Medical Opinion Letter of L.N, NFP and SB, MD, September 29, 2025. As such, the first and second elements of service connection are established. See Shedden, supra.

Turning to the third element of service connection, a nexus between the in-service event or injury and the current disability, L.N., NFP opined that the appellant's hemifacial spasms and neurological impairments are likely related to in-service exposures to solvents and jet fuels. See Medical Opinion Letter of L.N., NFP and S.B., MD, September 29, 2025. Specifically, the September 2025 medical opinion noted that solvents and jet fuel exposure are associated with neurobehavioral impairment, tremors, memory loss, and visual/motor disturbance, and that the appellant has documented progressive facial spasms, cognitive decline, and emotional instability consistent with neurotoxic effects. Id.

The September 2025 medical opinion is adequate for rating purposes. The clinicians reviewed the claims file and provided a supporting rationale for the conclusions reached. In addition, the September 2025 clinicians adequately considered the statements and contentions of the appellant, to include the circumstances of his service, and the onset and continuity of his symptoms. The September 2025 medical opinion also has clear conclusions and supporting data, as well as reasoned medical explanations. Nieves-R
opinion noted that solvents and jet fuel exposure are associated with neurobehavioral impairment, tremors, memory loss, and visual/motor disturbance, and that the appellant has documented progressive facial spasms, cognitive decline, and emotional instability consistent with neurotoxic effects. Id.

The September 2025 medical opinion is adequate for rating purposes. The clinicians reviewed the claims file and provided a supporting rationale for the conclusions reached. In addition, the September 2025 clinicians adequately considered the statements and contentions of the appellant, to include the circumstances of his service, and the onset and continuity of his symptoms. The September 2025 medical opinion also has clear conclusions and supporting data, as well as reasoned medical explanations. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, these medical opinion are afforded significant probative weight. There is no contrary opinion of record. Thus, the third element of service connection is established. See Shedden, supra.

The evidence of record establishes that the appellant's involuntary facial movements and neurological conditions are due to toxic exposures during service. As such, the criteria for entitlement to service connection for the appellant's involuntary facial movements and neurological conditions are met and the appellant's appeal is granted. 38 U.S.C. §§ 1131; 38 C.F.R. §§ 3.303.

REASONS FOR REMAND

An appellant's claims must be remanded to the AOJ to correct pre-decisional duty to assist errors, including when the AOJ fails to make reasonable efforts to obtain VA treatment records, relevant federal or private treatment records; fails to obtain a VA examination; or provides an inadequate VA examination or opinion.? 38?C.F.R. §?20.802(a).

The appellant contends that he currently suffers from an eye condition as a direct result of his military service, including as a result of toxic exposures at Camp Lejeune, Camp Pendleton, and aboard the U.S.S. PONCE. See VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits, September 14, 2020; Hearing Transcript, July 18, 2025.

Pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), VA must provide a VA examination and medical opinion when there exists evidence of a disability and evidence of participation in a TERA when such evidence is not sufficient to establish service connection for the disability. 38 U.S.C. § 1168(a).

The record reflects that the appellant participated in a TERA while on active duty. See VA Memorandum, October 28, 2024.

A TERA examination is required unless the claimed disability (1) is based on physical trauma, (2) is a mental disorder, (3) did not manifest during service, or (4) has an etiology not associated with toxic exposure. VBA Letter 20-22-10, pp. 10-12 (Dec. 22, 2022). A TERA examination is required because there is currently insufficient information to decide the claim and the appellant's claimed eye disability does not fall within any of the exceptions. Therefore, a remand for a TERA examination under the PACT Act is warranted. 38 U.S.C. § 1168(a).

The matters are REMANDED for the following action:

1. Schedule the appellant for an examination to determine the nature and etiology of his claimed eye disability. The clinician must review the claims file and a complete copy of this remand in conjunction with rendering any opinion. This review should be noted in the examination report. The clinician is asked to address the following:

(a.) Please state any diagnoses associated with the appellant's eye.

For each diagnosed disability, the clinician is requested to state whether it is likely (an approximate balance of negative and positive evidence) that the condition had its onset during service or is otherwise etiologically related to the appellant's service, to include as secondary to the appellant's service connected headache disability.

The VA clinician should note that the appellant's service at Camp Lejeune qualifies as a TERA under the PACT Act [and that exposure to contaminated water has been conceded by VA]. See Rating Decision, November 6, 2020. In this regard, the examiner must consider: 1) the total potential exposure through all applicable deployments; and 2) the synergistic, combined effect of all toxic exposure risk activities of the appellant.

The clinician should further note that the appellant's treating physician and nurse practitioner have indicated that there is a "neurological overlay" to the
or is otherwise etiologically related to the appellant's service, to include as secondary to the appellant's service connected headache disability.

The clinician should further note that the appellant's treating physician and nurse practitioner have indicated that there is a "neurological overlay" to the appellant's diagnosed astigmatism. See Medical Opinion Letter, September 29, 2025. In this regard, the clinician must determine if the appellant's astigmatism was subject to any superimposed disease or injury during service.

In providing the requested opinion, consider the appellant's description of his in-service symptoms as well as his post-service symptoms. The clinician should note that the appellant describes his eye condition as a twitch and a light that appears and "runs down the side of my eyelid and then runs down the side of my face." See Hearing Transcript at 10-13.

The clinician is advised that the appellant is competent to report his symptoms and history, and such reports must be considered. If the clinician rejects the appellant's reports, the clinician must provide a reason for doing so. The Board does not make any credibility determinations at this time with respect to the appellant's lay statements.

Following direction from the?United States Court of Appeals for the Federal Circuit in Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021), the proper standard of review for service connection claims is whether the factors of the case are in an "approximate balance."? Lynch?held that the appellant is entitled to the benefit of the doubt when the evidence is in an approximate balance - i.e., nearly equal - and does not require the evidence to be in exact equipoise.? See Id.?

The mere absence of evidence of contemporaneous treatment in the service treatment records cannot, standing alone, serve as the sole basis for an unfavorable opinion. However, it is permissible to consider this as one factor in the determination regarding the origins of the claimed disability, providing there is also sufficient explanation as to why it is reasonable to have expectation of treatment in the circumstance presented.

All opinions must be supported by a clear rationale. The clinician is asked to explain in detail the underlying reasoning for his or her opinion, to include citation to relevant evidence, supporting factual data, prior medical opinions, and medical literature, as appropriate.

If any requested opinion cannot be provided without resorting to mere speculation, the clinician must explain why a more definitive response is not possible or feasible. In other words, merely saying he or she cannot respond will not suffice.

2. Thereafter, readjudicate the claim.

K.A. KENNERLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jennifer Sullivan-Brief, 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.

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