MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The Veteran served from February 1981 to February 1984. The Veteran sought service connection for esophageal cancer and Barrett's esophagus, contending that his esophageal cancer was related to toxic exposure risk activity (TERA) during service, and that his Barrett's esophagus was secondary to his esophageal cancer. The Veteran's service record indicated service at Camp Lejeune, and a January 2025 VA Memorandum conceded Camp Lejeune Water Contamination with exposure to perchloroethylene (PCE), trichloroethylene (TCE), vinyl chloride, and benzene. A January 2025 VA examination concluded that the Veteran's esophageal cancer and Barrett's esophagus were less likely than not related to service. The examiner noted that while the chemicals are carcinogens, there was no direct causation between the Veteran's TERA and his esophageal cancer. The examiner also highlighted that the Veteran had numerous risk factors for Barrett's esophagus, such as age, male sex, smoking history, and GERD, which outweighed the TERA factors. The Board found the evidence persuasively weighed against a service connection, giving more weight to the VA examiner's opinion due to its thoroughness and the Veteran's lack of medical expertise on causation. Service connection for esophageal cancer and Barrett's esophagus was denied. The claim for a prostate disability was remanded for an addendum opinion to determine its etiology and relationship to Camp Lejeune water contamination, as the initial VA examination was deemed inadequate for failing to address prostatic hypertrophy and narrowly concluding other prostate conditions were distinct from the claimed prostatitis.

Rationale

Persuasively weighs against service connection; VA examiner opined less likely than not related to service; Veteran's risk factors outweighed TERA factors

Full Decision Text

Citation Nr: A26039201
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250314-527892
DATE: April 27, 2026

ORDER

Service connection for esophageal cancer (claimed as adenocarcinoma) is denied.

Service connection for Barrett's esophagus is denied.

REMANDED

Service connection for a prostate disability is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that esophageal cancer began during active service or is otherwise related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that Barrett's esophagus began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for esophageal cancer are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for Barrett's esophagus are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served from February 1981 to February 1984.

The rating decision on appeal was issued in March 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the March 2025 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 March 2025 agency of original jurisdiction (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. 

However, because the Board is remanding the claim of service connection for a prostrate disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). 

Service Connection

1. Service connection for esophageal cancer (claimed as adenocarcinoma)

2. Service connection for Barrett's esophagus

The Veteran seeks service connection for esophageal cancer and Barrett's esophagus. He contends that his esophageal cancer is related to toxic exposure risk activity (TERA) during service, and that his Barrett's esophagus is secondary to his esophageal cancer.

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. 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).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

Toxic exposure risk activity (TERA) is conceded. The Veteran's service record shows service at Camp Lejeune, and a January 2025 VA Memorandum conceded Camp Lejeune Water Contamination with exposure to perchloroethylene (PCE), trichloroethylene (TCE), vinyl chloride, and benzene. 

The Veteran was afforded a VA examination in January 2025. The examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the
2004).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

Toxic exposure risk activity (TERA) is conceded. The Veteran's service record shows service at Camp Lejeune, and a January 2025 VA Memorandum conceded Camp Lejeune Water Contamination with exposure to perchloroethylene (PCE), trichloroethylene (TCE), vinyl chloride, and benzene. 

The Veteran was afforded a VA examination in January 2025. The examiner opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner noted service at Camp Lejeune and exposures to PCE, TCE, vinyl chloride and benzene. The examiner indicated that the medical research noted that these chemicals are carcinogens and can increase general cancer risk, but that there was no direct causation between the Veteran's TERA and his esophageal cancer. Further, the examiner explained that Barretts esophagus is a condition in which the lining of the esophagus becomes damaged by acid reflux, causing the lining to thicken and become red. The exact cause is unknown, but many people have had longstanding GERD. Risk factors include family history, male sex, white race, age over 50, smoking history, obesity and chronic acid reflux. The Veteran in this case had numerous risk factors to include age, male sex, and smoking history and GERD. Thus, the examiner concluded that risk factors identified outside of service that far outweigh the factors identified in the TERA.

The Board concludes that, while the Veteran has a current diagnosis of esophageal cancer and Barrett's esophagus, and evidence shows that exposure to Camp Lejeune contaminated water occurred, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of esophageal cancer and Barrett's esophagus began during service or is otherwise related to an in-service injury, event, or disease. 

The January 2025 VA examiner opined that the Veteran's esophageal cancer and is not at least as likely as not related to an in-service injury, event, or disease, including contaminated water exposure. The examiner explained that the Veteran's other risk factors far outweighed his toxic exposure, and that a direct causative link had not been found between esophageal cancer and the Veteran's TERA. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Veteran/ believes the claimed esophageal cancer and Barrett's esophagus is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examination and opinion.

Accordingly, the evidence is persuasively against the claim.  As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for esophageal cancer and Barrett's esophagus is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Service connection for a prostate disability is remanded.

The Veteran seeks service connection for prostatitis. To afford the Veteran the broadest possible scope for his claim, the issue has been recharacterized accordingly to that of entitlement to service connection for a prostate disability, to include prostatitis. Clemons v. Shinseki, 23 Vet. App. 1,6 (2009).

The Veteran was afforded a VA examination in January 2025. The examiner opined that the Veteran's claimed condition was less likely than not related to service, because a diagnosis of prostatitis was not warranted. However, the examiner also noted diagnoses of prostate cancer and
 § 3.102.

REASONS FOR REMAND

1. Service connection for a prostate disability is remanded.

The Veteran seeks service connection for prostatitis. To afford the Veteran the broadest possible scope for his claim, the issue has been recharacterized accordingly to that of entitlement to service connection for a prostate disability, to include prostatitis. Clemons v. Shinseki, 23 Vet. App. 1,6 (2009).

The Veteran was afforded a VA examination in January 2025. The examiner opined that the Veteran's claimed condition was less likely than not related to service, because a diagnosis of prostatitis was not warranted. However, the examiner also noted diagnoses of prostate cancer and erectile dysfunction on examination. Further, underlying treatment records reveal history of prostatic hypertrophy. 

The Board finds the 2025 VA medical opinion of record to be inadequate to decide the claim. First, the examiner did not address the VA treatment notes, which showed a diagnosis of prostatic hypertrophy. Moreover, the examiner diagnosed a history of prostate cancer and erectile dysfunction on examination, but narrowly concluded that these were clinically distinct from the claimed prostatitis disability.

The failure to obtain adequate medical opinions constitutes a pre-decision duty to assist error. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007) and Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) (holding a mere conclusory opinion is insufficient to allow the Board to make an informed decision as to the weight assigned to the opinion against contrary opinions). On remand an addendum opinion addressing service connection must be obtained for the Veteran's prostate disability.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion with an appropriate clinician to determine the etiology of the Veteran's prostate disability. An examination should only be scheduled if the clinician deems one is necessary to provide the requested opinions. 

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below.

The examiner is asked to provide a response to the following:

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?

Is the claimed prostate disability at least as likely as not related to contaminants in the water during service at Camp Lejeune?

The examiner is advised that a negative opinion cannot be based solely on the fact that the prostate disability is not on the list of diseases that are presumptively associated with exposure to contaminants in the water supply at Camp Lejeune.

 

 

M. MILLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Lauritzen

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.