STOMACH NEOPLASM OF

EMILY TAMLYN · 2026 · Case ID: A26030612

GRANTED

Summary

The veteran, who served in the United States Marine Corps from July 1969 to July 1971, appeals the denial of service connection for neuroendocrine carcinoma of the stomach and intestinal metaplasia. The veteran asserts these conditions are due to toxic exposure from contaminated water during service at Camp Lejeune. The Board found that the veteran had the required service at Camp Lejeune and was presumed to be exposed to contaminants in the water supply. While the conditions are not statutorily presumed, the Board reviewed the evidence to determine if a direct service connection could be established. The Board found the VA examinations from December 2024 and February 2026 to be of diminished probative value because they relied on general medical literature without adequately addressing the veteran's specific history or reconciling the private medical opinion. In contrast, a private medical opinion submitted in February 2026 provided a detailed rationale, citing medical literature and explaining a mechanism by which toxic exposure could lead to the veteran's gastric pathology, including neuroendocrine carcinoma and intestinal metaplasia. The Board found this private opinion highly probative and assigned it great weight. Based on this evidence, the Board found a direct service connection nexus between the presumed in-service exposure at Camp Lejeune and the veteran's conditions. Service connection for both neuroendocrine carcinoma of the stomach and intestinal metaplasia is granted.

Rationale

Current diagnosis confirmed; Presumed exposure at Camp Lejeune; Private medical opinion found highly probative

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260220-628340

Full Decision Text

Citation Nr: A26030612
Decision Date: 04/03/26 Archive Date: 04/03/26

DOCKET NO. 260220-628340
DATE: April 3, 2026

ORDER

Entitlement to service connection for neuroendocrine carcinoma of stomach is granted.

Entitlement to service connection for intestinal metaplasia is granted.

FINDINGS OF FACT

1. The Veteran has a current diagnosis of neuroendocrine carcinoma of the stomach.

2. The Veteran has a current diagnosis of intestinal metaplasia.

3. The Veteran was exposed to contaminated water at Camp Lejeune during active service.

4. The most probative evidence of record establishes that the Veteran's neuroendocrine carcinoma of the stomach is related to in-service toxic exposure.

5. The most probative evidence of record establishes that the Veteran's intestinal metaplasia is related to in-service toxic exposure.

CONCLUSION OF LAW

1. The criteria for service connection for neuroendocrine carcinoma of stomach have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for intestinal metaplasia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served in the United States Marine Corps on Active Duty from July 1969 to July 1971.

In October 2024, the Veteran submitted a claim for service connection for neuroendocrine carcinoma of the stomach and intestinal metaplasia. See October 2023 VA Form 21-526EZ. In January 2025, the Agency of Original Jurisdiction (AOJ) denied the claims for service connection after obtaining VA examinations and medical opinions. See January 2025 Rating Decision. The Veteran timely filed a Decision Review Request: Supplemental Claim in February 2026. See February 2026 VA Form 20-0995. The AOJ denied the claims for service connection in February 2026 after obtaining VA medical opinions.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from the February 2026 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This decision constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the February 2026 AOJ decision on appeal. 38?C.F.R §?20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38?C.F.R. §§?20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38?C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

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, 1131, 5107; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: (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).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Competency of evidence differs from weight and credibility.

The Board must determine the value of all pertinent lay and medical evidence. Buchanan v. Nicholson, 451 F.
current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The Board must determine the value of all pertinent lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The evaluation of evidence generally involves three steps: competency, credibility and weighing the evidence. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159 (a)(2).

Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when 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); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377, n. 4 (Fed. Cir. 2007). However, laypersons have generally been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever).

The Board must then determine if the evidence is credible; in determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence considering the entirety of the record.

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical evidence. See Bloom v. West, 12 Vet. App. 185, 187 (1999).

VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with a claimant prevailing in either event. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The claimant is entitled to the benefit of the doubt when there is an "approximate" (meaning nearly equal) balance of positive and negative evidence regarding any material determination. See Lynch v. McDonough, 21 F.4th 776, 781 (2021).

1. Entitlement to service connection for neuroendocrine carcinoma of stomach

2. Entitlement to service connection for intestinal metaplasia

The Veteran seeks service connection for neuroendocrine carcinoma of the stomach and intestinal metaplasia, which he asserts are due to toxic exposure from contaminated water during service at Camp Lejeune. See October 2024 VA Form 21-526EZ.

The first element of service connection, current diagnosis, has been met. The Veteran's current diagnosis of neuroendocrine carcinoma of the stomach and intestinal metaplasia were confirmed in VA examinations in December 2024 and February 2026. See December 2024 and February 2026 Intestinal Conditions VA Examination and Stomach and Duodenal Conditions VA Examination. Accordingly, the current disability requirement is met.

The next question is to determine if there was an in-service event or injury that caused the Veteran's current diagnosis of neuroendocrine carcinoma of the stomach and intestinal metaplasia. The Veteran's Military Personnel Record confirms that he served at Camp Lejeune from September 1969 to July 1971. See Military Personnel Record, Record of Service. Additionally, the VA found that the Veteran was exposed to Camp Lejeune Water Contamination (perchloroethylene, trichloroethylene, vinyl chloride, benzene) based on his service at Camp Lejeune. See December 2024 Toxic Exposure Risk Activity (TERA) Memorandum). As such, he is presumed to have been exposed to contaminants in the water supply during his time stationed at Camp Lejeune from 1969 to 1971. See 38 C.F.R. § 3.307. The second element of service connection is met.

The Board observes that if a veteran had no less than 30 days of service at Camp Lejeune during the period between August 1, 1953, and December 31, 1987, then the veteran is presumed to have been exposed to contaminants in the water supply at Camp Lejeune during military service, subject to the requirements of 38 C.F.R. § 3.307 (a)(7). If the veteran has such service, then the following diseases will be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of § 3.307(d): (1) kidney cancer; (2) liver cancer; (3) Non-Hodgkin's lymphoma; (4) adult leukemia; (5) multiple myeloma; (6) Parkinson's disease; (7) aplastic anemia and other myelodysplastic syndromes; and (8) bladder cancer. 38 C.F.R. § 3.309(f). Importantly, neuroendocrine carcinoma of the stomach and intestinal metaplasia are not listed as presumptive conditions for which service connection is available.

In order to benefit from the presumption of service connection for diseases associated with Camp Lejeune contaminants, the Veteran must have one of the diseases set forth in 38 C.F.R. § 3.309 (f). While no legal presumption exists that would allow VA to presume that the Veteran's neuroendocrine carcinoma of the stomach and intestinal metaplasia specifically are related to his in-service toxic exposure at Camp Lejeune, the absence of a disease from inclusion in a statutory or regulatory presumption of service connection does not preclude a Veteran from otherwise proving that the disability directly resulted from such exposure. See Combee v. Brown, 34 F.3d 1039 (Fed Cir. 1994).

Therefore, the final question before the Board is whether the Veteran's neuroendocrine carcinoma of the stomach and intestinal metaplasia are due to the presumed exposure to contaminants in the water supply while stationed at Camp Lejeune. The Board has considered the Veteran's diagnoses of neuroendocrine carcinoma and intestinal metaplasia as separate claims. However, since both conditions involve the same physiological system, arise from the same in-service toxic exposure at Camp Lejeune, and are addressed by the same private nexus opinion, they are discussed together here.

In order to determine nexus, the Veteran was afforded VA examinations for both conditions in December 2024 and February 2026. Both opinions found that the conditions claimed are less likely than not due to toxic exposure. See December 2024 and February 2026 VA Examinations. However, the Board finds them to be of diminished probative value as noted below.

Following the first VA examinations in December 2024 addressing the Veteran's neuroendocrine carcinoma and intestinal metaplasia, the examiner relied on general medical literature indicating that no established association exists between the water contamination at Camp Lejeune and the claimed conditions, without applying the literature to the Veteran's specific history, to come to the conclusion that the Veteran's neuroendocrine carcinoma and intestinal metaplasia are less likely than not related to service. See December 2024 VA Examinations. A medical opinion must be supported by a complete rationale and consideration of all pertinent medical records. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295; see also Stefl v. Nicholson, 21 Vet. App. 120 (2007). In both exams in December 2024, the examiner did not adequately address the Veteran's individual exposure history or explain why his particular circumstances would not support a nexus when coming to their conclusion. To the extent the opinion relies on the absence of medical literature demonstrating a causal relationship, such reasoning alone is not sufficient without discussion of whether the Veteran's conditions could nevertheless be related to his specific exposure. See Polovick v. Shinseki, 23 Vet. App. 48 (2009) (finding an examiner's opinion inadequate if not based on a Veteran's specific medical history, risk factors, and military history). Accordingly, the Board assigns the December 2024 VA opinions reduced probative weight.

The Board has also considered the February 2026 VA medical opinions addressing the Veteran's neuroendocrine carcinoma and intestinal metaplasia. However, these opinions are likewise of diminished probative value. Most notably, the opinions were given after the Veteran's submission of a private medical nexus opinion, but they did not meaningfully address or reconcile the private opinion that was submitted by the Veteran. A medical opinion that fails to consider and discuss relevant evidence is of reduced probative weight. See Nieves-Rodriguez, 22 Vet. App. 295. Further, a medical opinion must consider all relevant evidence of record, including lay evidence. Id.; Buchanan v. Nicholson, 451 F.3d 1331, 1336; Dalton v. Nicholson, 21 Vet. App. 23 (2007). Furthermore, similar to the earlier opinions, the examiner relied primarily on general medical literature and the absence of a recognized association between Camp Lejeune water contamination and the claimed conditions, without adequately applying those principles to the Veteran's specific history. See Stefl, 21 Vet. App. 120. Additionally, the opinions also relied upon the lack of supporting medical literature without addressing whether the Veteran's particular exposure could be nevertheless etiologically related to his claimed conditions. See Polovick, 23 Vet. App. 48. Therefore, the Board assigns the February 2026 VA medical opinions reduced probative weight.

In contrast and as mentioned above, the Veteran submitted a private medical opinion in February 2026 which found that the Veteran's stomach conditions are at least as likely as not related to toxic exposure from contaminated water at Camp Lejeune. See February 2026 Medical Treatment Record - Non-Government Facility. In coming to this conclusion, the physician provided a very detailed rationale, citing medical literature and explaining a mechanism by which toxic exposure may result in chronic gastric pathology and subsequent disease processes. Id. The opinion reflects consideration of the Veteran's history and applies medical principles to the specific facts of the case. The Board finds this opinion to be highly probative. See Nieves-Rodriguez, 22 Vet. App. 295.

Additionally, the Board acknowledges that the private physician explicitly addressed the Veteran's neuroendocrine carcinoma in coming to their opinion. However, the opinion also describes a broader disease process involving gastrointestinal malignancy resulting from toxic exposure. See February 2026 Medical Treatment Record - Non-Government Facility. The Board finds the private opinion reasonably opined on a positive relationship between the Veteran's service at Camp Lejeune and toxic exposure and their diagnosed intestinal metaplasia, as metaplasia is defined as an abnormal replacement of cells of one type by cells of another. See Merriam-Webster, 11th Ed., p 780 (2007). In this regard, malignancy is a different phrasing of the term metaplasia based on the fact that "malignant tumor" is defined as one that has the properties of invasiveness and metastasis and that shows a greater degree of anaplasia than do benign tumors. See Dorland's Illustrated Medical Dictionary, p. 2014 (31st ed. 2007). Therefore, it follows that intestinal metaplasia and the term "gastrointestinal
exposure and their diagnosed intestinal metaplasia, as metaplasia is defined as an abnormal replacement of cells of one type by cells of another. See Merriam-Webster, 11th Ed., p 780 (2007). In this regard, malignancy is a different phrasing of the term metaplasia based on the fact that "malignant tumor" is defined as one that has the properties of invasiveness and metastasis and that shows a greater degree of anaplasia than do benign tumors. See Dorland's Illustrated Medical Dictionary, p. 2014 (31st ed. 2007). Therefore, it follows that intestinal metaplasia and the term "gastrointestinal malignancy" can be considered as the same gastrointestinal process.

In this case, the physician explained that toxic exposures due to water contamination at Camp Lejeune caused the "Veteran's gastric pathology [which] includes chronic mucosal changes in which sustained oxidative injury can contribute to mutational accumulation and dysregulated cellular proliferation in gastric epithelial and neuroendocrine cell compartments," which reflects a disease process involving structural changes of the gastric mucosa and reasonably encompasses the Veteran's intestinal metaplasia. See February 2026 Medical Treatment Record - Non-Government Facility, P 5. As the private medical opinion was drafted by a competent and credible medical professional and provides a detailed rationale supported by medical literature and application of the Veteran's health history to the facts of his case, the Board finds the February 2026 private medical opinion to be highly probative and assigns it great weight.

After careful review, the Board finds that the most probative evidence of record supports a finding of direct service connection nexus between the Veteran's presumed in-service exposure to contaminated water at Camp Lejeune and the development of neuroendocrine carcinoma of the stomach and intestinal metaplasia. As all three elements of service connection have been met, the claims for service connection of neuroendocrine carcinoma of the stomach and intestinal metaplasia are granted.

EMILY TAMLYN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Pieper, C.

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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