MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The Veteran, a Marine Corps Veteran who served from October 1968 to October 1988 and February 1991 to March 1991, including service at Camp Lejeune, appeals the denial of service connection for diverticular disease and the grant of service connection for colon cancer. The Veteran claimed both conditions were due to exposure to contaminated water at Camp Lejeune. The Board found that while colon cancer is not a presumptive condition under the Camp Lejeune regulations, a private medical opinion persuasively linked the Veteran's colon cancer to Camp Lejeune contaminants, specifically TCE, finding it at least as likely as not related to service. This opinion was given greater weight than contrary VA opinions due to its thorough rationale. Consequently, service connection for colon cancer was granted. For diverticular disease, the Board noted the Veteran's diagnosis occurred over 30 years after service and found no in-service complaints or evidence supporting a link to Camp Lejeune exposure. The Board assigned greater weight to VA medical opinions which concluded it was less likely than not that diverticular disease was incurred during service or due to Camp Lejeune contaminants, as the medical literature did not support such a link. As the evidence weighed against the claim and was not in equipoise, the benefit of the doubt was not applied, and service connection for diverticular disease was denied.

Rationale

Private medical opinion found colon cancer causally associated with Camp Lejeune contaminants (TCE).; Private opinion provided well-reasoned rationale and was given high probative weight.; VA opinions were contrary but less persuasive due to weaker rationale.

Full Decision Text

Citation Nr: A26039966
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251217-624004
DATE: April 29, 2026

ORDER

Service connection for adenocarcinoma colon (colon cancer) due to contaminated water at Camp Lejeune is granted.

Service connection for diverticular disease, to include as secondary to Camp Lejeune contaminated water exposure, is denied.

FINDINGS OF FACT

1. The Veteran's colon cancer is related to his exposure to contaminated water at Camp Lejeune.

2. The evidence persuasively weighs against finding that the Veteran's diverticular disease, diagnosed as diverticulosis and diverticulitis, had its onset in service, or was caused or related to service, to include conceded exposure to contaminated water at Camp Lejeune. 

CONCLUSIONS OF LAW

1. The criteria for service connection for colon cancer have been met.  38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309.

2. The criteria for service connection for diverticulitis have not been met.  38 U.S.C. §§ 1110, 1131, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from October 1968 to October 1988 and February 1991 to March 1991, including service at Camp Lejeune. 

The rating decision on appeal was issued in December 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

On the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Board's Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.303, 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 a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.  A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service."  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection may be established for disability that is proximately due to or the result of a service-connected disability.  38 C.F.R. § 3.310(a).  Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown.  38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown,
1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection may be established for disability that is proximately due to or the result of a service-connected disability.  38 C.F.R. § 3.310(a).  Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown.  38 C.F.R. § 3.310; El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995).

Effective March 14, 2017, 38 C.F.R. §§ 3.307 and 3.309 were amended to add eight diseases found to be associated with contaminants present in the water supply at Camp Lejeune.  As amended, 38 C.F.R. §§ 3.307 and 3.309 establish presumptive service connection for veterans who served at Camp Lejeune for no less than 30 days from August 1, 1953, to December 31, 1987, and who have been diagnosed with certain diseases.  38 C.F.R. § 3.309(f).  The Board notes that colon cancer, diverticulitis, or diverticulosis are not a disease listed as presumptively related to contaminated water exposure under 38 C.F.R. § 3.309(f).  

When a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during service, to include as based on exposure to contaminated water.  See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).  

The AOJ favorably found the evidence shows the Veteran has current diagnoses of adenocarcinoma colon, diverticulitis, and diverticulosis; performed service at Camp Lejeune during the recognized exposure period for contaminated water; and was exposed to contaminants in the water supply at Camp Lejeune during military service.  See December 2024, Rating decision. 

1. Entitlement to service connection for colon cancer.

The Veteran contends that his colon cancer is due to exposure to contaminated water while stationed at Camp Lejeune.  See January 2026, Third party correspondence; August 2024, VA Form 21-526EZ. 

Considering the AOJ's favorable findings and the Veteran's current diagnosis, the critical inquiry in this case is whether the Veteran's diagnosed colon cancer is directly related to his exposure to Camp Lejeune contaminants.   

In December 2025, L.B., a private board-certified medical professional who is also credentialed as a contract VA examiner, conducted a thorough review of the Veteran's claims file and considered the Veteran's relevant medical and service history.  The medical professional noted the Veteran's conceded exposure to contaminated water at Camp Lejeune (CL) and his medical history leading to diagnosed colon cancer.  After a detailed discussion of the CL contaminants and synthesizing multiple epidemiological, toxicological, toxicokinetic, and mechanistic studies, L.B. concluded that CL contaminants, specifically trichloroethylene (TCE), was known to be a human carcinogen.  L.B. also addressed the August and December 2024 VA negative nexus opinions and, based on the research and conclusions referenced earlier, persuasively supported the premise that colorectal cancer is causally associated with the contaminants found in CL water.  It was then concluded that the Veteran's colon cancer was at least as likely as not due to his exposure to contaminated water during his service at Camp Lejeune.  See January 2026, Private medical record. 

The Board assigns high probative weight to the December 2025 private medical opinion as it was based on an examination, considered the Veteran's lay statements, relevant medical records, addressed the contrary VA medical opinions of record, and provided a well-reasoned medical opinion.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board acknowledges the August and December 2024 VA negative nexus opinions but assigns more probative weight to the December 2025 private nexus opinion as it provided a thoroughly supported rationale grounded in the Veteran's relevant medical history.  Further, the August 2024 VA examiner opined, "The [medical] literature cited below does not support a strong relationship between contamination with PCE and TCE and colon cancer."  Thus, the VA examiner was acknowledging
 considered the Veteran's lay statements, relevant medical records, addressed the contrary VA medical opinions of record, and provided a well-reasoned medical opinion.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Board acknowledges the August and December 2024 VA negative nexus opinions but assigns more probative weight to the December 2025 private nexus opinion as it provided a thoroughly supported rationale grounded in the Veteran's relevant medical history.  Further, the August 2024 VA examiner opined, "The [medical] literature cited below does not support a strong relationship between contamination with PCE and TCE and colon cancer."  Thus, the VA examiner was acknowledging there was a causal relationship between CL contaminants and colon cancer.  

In light of the evidence of record, the Board's findings regarding the probative weight of the evidence, and resolving all reasonable doubt in the Veteran's favor, the Board finds service connection is warranted for colon cancer.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  

2. Entitlement to service connection for diverticular disease, diagnosed as diverticulitis and diverticulosis.

The Veteran contends that diverticulitis is the result of exposure to contaminated water at Camp Lejeune.  See August 2024, VA Form 21-526EZ. 

A June 1976 service treatment record indicated the Veteran was seen for complaints of diarrhea for two days and abdominal pain.  The Veteran was assessed as having gastroenteritis and treated with Trigan.  There is no additional evidence of complaints or diagnosed intestinal problems.  Additionally, subsequent in-service medical examinations reflect normal gastrointestinal system.   See STR dated August 1972, June 1976, August 1977, January 1979, March 1982, and September 1986. 

The evidence of record includes two VA examinations and medical opinions provided in August and December 2024.  The cumulative findings of those examinations indicated diverticulosis with complications of diverticulitis were diagnosed in 2022 by CT scan and the Veteran underwent a partial colectomy laparoscopically for diverticular disease in February 2023 with anastomosis; it was noted that the Veteran's diagnoses occurred more than 30 years post discharge from active service in 1991.  The Veteran's diverticular disease and diverticulitis were explained to be digestive conditions that affect the large intestine (colon) and symptoms may include lower abdominal pain and feeling bloated, but the majority of people are asymptomatic.  After citing several medical and epidemiologic studies, it was opined that it was less likely than not that the Veteran's diverticular disease was incurred during service or due to exposure to CL contaminants as the medical literature does not support finding PCE, TCE, vinyl chloride, or benzene are known to cause diverticulosis with complications of diverticulitis.

While the Veteran believes that his diverticular disease is related to his active military service, and specifically his conceded CL contaminated water exposure during service, he is not competent to provide the medical etiology in this case.  The issue is medically complex, as it requires specialized medical education.  Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  

There is no competent scientific or medical evidence of record to support the Veteran's contention that diverticular disease, to include diagnosed diverticulosis and diverticulitis, resulted from CL contaminated water exposure during active service or is otherwise related to his active military service.  The Veteran does not contend, and the record does not show, that his diverticular disease manifested during service or within a year of separation.  Medical records do not show diagnosed diverticular diseases until approximately 30 years following service.  Thus, service connection for diverticular disease, diagnosed as diverticulosis and diverticulitis, is not available on a direct basis.

After a review of the evidence of record, the Board finds that the evidence is persuasively against the Veteran's claim.  

In reaching this determination, the Board notes that the only competent opinions addressing the etiology of the Veteran's diverticular disease are the August and December 2024 VA opinions, which are against the Veteran's claim.  Inasmuch as the opinions were based on a review of the Veteran's claims file, provided by a medical professional competent to opine as to the etiology of the Veteran's diverticular disease, and supported by rationale, the Board finds that the August and December 2024 VA opinions to be persuasive.  Overall, the evidence does not indicate that the Veteran's diverticular disease is related to service, to include his presumed exposure to CL water contaminants and T
 the evidence is persuasively against the Veteran's claim.  

In reaching this determination, the Board notes that the only competent opinions addressing the etiology of the Veteran's diverticular disease are the August and December 2024 VA opinions, which are against the Veteran's claim.  Inasmuch as the opinions were based on a review of the Veteran's claims file, provided by a medical professional competent to opine as to the etiology of the Veteran's diverticular disease, and supported by rationale, the Board finds that the August and December 2024 VA opinions to be persuasive.  Overall, the evidence does not indicate that the Veteran's diverticular disease is related to service, to include his presumed exposure to CL water contaminants and TERA during service.  Notably, the August and December 2024 VA opinions considered whether the Veteran's diverticular disease were related to service, to include his conceded CL contaminated water exposure and TERA during service, and both provided a negative nexus opinion that was supported by rationale after review of the medical evidence.  

In light of the foregoing, because the evidence is persuasively against the Veteran's claim and not in approximate balance, the benefit-of-the-doubt rule is not applicable, and therefore service connection for diverticular disease, to include diverticulosis and diverticulitis, is not warranted.  See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).  As such, service connection for diverticular disease must be denied.  

 

 

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Straughn, Shavonne

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.