BENIGN NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The Veteran, a Veteran who served from November 1987 to November 1991, seeks service connection for retroperitoneal teratoma, alleging it is related to in-service exposure to trichloroethylene (TCE) while serving as a weapons specialist and gunner's mate. The Board reviewed the evidence of record from the time of the prior agency of original jurisdiction (AOJ) decision in March 2021, along with evidence submitted during the appeal period. The Veteran submitted a private medical opinion from a nurse practitioner and physician in October 2020, which linked the retroperitoneal teratoma to frequent TCE exposure during service, citing the rarity of the condition and absence of other known carcinogen exposures. The Board found this opinion probative, establishing an etiological relationship. Two VA opinions were also considered: one in August 2020, which was deemed not probative for failing to adequately address the TCE exposure nexus, and another in March 2021, which was also not probative for similar reasons. The Board found the private opinion persuasive, establishing the necessary link between the Veteran's condition and his in-service TCE exposure. Resolving all reasonable doubt in the Veteran's favor, the Board granted service connection for retroperitoneal teratoma.

Rationale

Veteran alleges in-service exposure to TCE.; Private medical opinion linked teratoma to TCE exposure.; VA opinions were not probative.; Board resolved doubt in favor of Veteran.

Full Decision Text

Citation Nr: A26032528
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 210804-176977
DATE: April 8, 2026

ORDER

Service connection for retroperitoneal teratoma is granted.

FINDING OF FACT

The Board resolves all reasonable doubt in favor of the Veteran by finding that service connection for retroperitoneal teratoma is warranted as directly related to in-service exposure to trichloroethylene (TCE).

CONCLUSION OF LAW

The criteria for service connection for retroperitoneal teratoma have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from November 1987 to November 1991.

In May 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a March 2021 rating decision. In July 2021, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior March 2021 decision. In the August 4, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 27, 2025.

Given this procedural history, the Board may only consider the evidence of record at the time of the March 2021 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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. 

1. Service connection for retroperitoneal teratoma

The Veteran seeks service connection for retroperitoneal teratoma based on exposure to TCE while serving as a weapons specialist and gunner's mate in service. See VA Form 21-526EZ received March 2020.

The July 2021 rating decision made favorable findings in conjunction with this claim, namely that the use of TCE would be consistent with the Veteran's duties as a gunner's mate during service and that he had a current diagnosis of retroperitoneal mass. The Board is bound by these findings. See 38 C.F.R. § 3.104(c). The question that remains to be resolved is whether the current disability is related to the in-service exposure. There are several opinions of record.

The AOJ obtained an opinion in August 2020. For reasons that are unclear, the requested opinion was whether it is as likely as not that retroperitoneal teratoma was incurred in/caused by a surgery the Veteran had while on active duty service. The VA examiner provided a negative opinion to this question. More pertinent to the assertions raised by the Veteran, the examiner noted that the Veteran related the development of the teratoma to his frequent exposure to TCE during active duty service as a gunner's mate but reported that there is no statement from private specialists who have followed the Veteran for this rare condition since 2016 noting that it is caused by exposure to the chemical TCE. Since this opinion did not adequately address whether the Veteran's current condition is etiologically related to his in-service exposure to TCE, it is not afforded any probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion).

The Veteran submitted an opinion in October 202
 during active duty service as a gunner's mate but reported that there is no statement from private specialists who have followed the Veteran for this rare condition since 2016 noting that it is caused by exposure to the chemical TCE. Since this opinion did not adequately address whether the Veteran's current condition is etiologically related to his in-service exposure to TCE, it is not afforded any probative value. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion).

The Veteran submitted an opinion in October 2020 from nurse practitioner K.S. and signed by Dr. Z.F. that his retroperitoneal teratoma is at least as likely as not directly related to military service. The rationale was based on the rarity of this diagnosis and the absence of other known exposures to known carcinogens such that it is at least as likely as not that the tumor developed from the frequent exposure to the known carcinogenic agent TCE while the Veteran was in service.

The AOJ obtained another opinion in March 2021. The examiner determined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that no chronic diagnosis had been made for cystic retroperitoneal teratoma (claimed as retroperitoneal teratoma) during service years or within one year of separation; that objective examination was normal and that symptoms were only subjective; that the finding for asymptomatic cystic retroperitoneal teratoma was incidental and of no clinical significance; and that there was no objective evidence of record for chronicity of care. The Board finds that this opinion also did not adequately address whether the Veteran's current condition is etiologically related to his in-service exposure to TCE; therefore, it is not afforded any probative value. See Id.  

Since the opinions obtained by the AOJ are not afforded any probative value, that leaves the opinion submitted by the Veteran in support of his claim. Given that this opinion establishes an etiological relationship between the Veteran's retroperitoneal teratoma and his exposure to TCE while serving as a gunner's mate, the Board resolves all reasonable doubt in favor of the Veteran by finding that service connection for retroperitoneal teratoma is warranted. The claim is granted.  

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Van Wambeke, 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.