MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

M. SORISIO · 2026 · Case ID: A26040524

GRANTED

Summary

The veteran, who served in the Navy from October 1968 to July 1970, appeals the denial of service connection for intestinal cancer, liver cancer, and a liver biopsy surgical scar. The veteran claimed intestinal cancer was due to in-service asbestos exposure. The Board found the initial VA examination inadequate because it relied on general literature and failed to address the veteran's specific exposure. However, a private medical opinion from Dr. J.C. in December 2025 provided a favorable nexus, linking the intestinal cancer to asbestos exposure, citing medical literature and the veteran's history. The Board found this opinion probative and granted service connection for intestinal cancer. Subsequently, the Board granted service connection for liver cancer as secondary to the service-connected intestinal cancer, citing favorable findings from the VA examination and the private opinion, as well as the veteran's medical history. Service connection for the liver biopsy surgical scar was also granted as secondary to the service-connected liver cancer, based on the June 2025 VA examiner's finding of the scar and the Board's conclusion that it was caused by the liver cancer. The Board resolved all reasonable doubt in the veteran's favor for the intestinal cancer claim.

Rationale

Private medical opinion found probative; VA examiner opinion inadequate; Resolved reasonable doubt in veteran's favor

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260120-617186

Full Decision Text

Citation Nr: A26040524
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260120-617186
DATE: April 30, 2026

ORDER

Service connection for malignant carcinoid tumor of the small intestine (intestinal cancer) is granted.

Service connection for liver cancer is granted.

Service connection for liver biopsy surgical scar is granted.

FINDINGS OF FACT

1. The evidence favors that the Veteran's intestinal cancer was causally or etiologically related to his service, including to exposure to asbestos therein.

2. The evidence persuasively favors that the Veteran's liver cancer is at least as likely as not caused by his service-connected intestinal cancer.

3. The evidence persuasively favors that the Veteran's liver biopsy surgical scar is at least as likely as not caused by his service-connected liver cancer.

CONCLUSIONS OF LAW

1. The criteria for service connection for intestinal cancer are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for liver cancer as secondary to the service-connected intestinal cancer are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for a liver biopsy surgical scar as secondary to the service-connected liver cancer are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1968 to July 1970.

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

In a January 2026 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket. On the January 2026 VA Form 10182, the Veteran listed June 26, 2026, as the date of the rating decision on appeal. The Board notes that the relevant rating decision was dated in June 2025; as such, the Board will construe the Veteran's VA Form 10182 liberally as an appeal of the June 2025 rating decision.

Therefore, the Board may only consider the evidence of record at the time of the June 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or the Veteran's 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.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

Establishing entitlement to direct service connection generally requires: (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 - which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Secondary service connection may be granted for a disability that is caused or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, (2) that there is an already service-connected disability, and (3) that there is "but for" causation or aggravation of the disability for which service connection is sought by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (invalidating the requirement of "proximate
67 (Fed. Cir. 2004).

In addition, the law provides that, where a veteran served ninety days or more of qualifying service and certain chronic diseases, such as malignant tumors, become manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id.

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Service connection for intestinal cancer is granted.

The Veteran contends that his intestinal cancer, specifically a neuroendocrine tumor, is due to his in-service exposure to asbestos while serving in the Navy. See February 2025 Toxic Exposure Risk Activity (TERA) Memorandum.

The March 2021 rating decision made a favorable finding that the Veteran has been diagnosed with a malignant carcinoid tumor of the small intestine. The June 2025 rating decision on appeal made a favorable finding that the Veteran participated in a toxic exposure risk activity; specifically, the February 2025 TERA Memorandum found exposure to asbestos. The Board is bound by these favorable findings. 38 C.F.R. § 3.104.

The Veteran's service treatment records do not include complaints, treatment, or a diagnosis of intestinal cancer, his intestinal cancer was not diagnosed within one year of his discharge from active duty, there were no characteristic manifestations of the disease to the required degree during that time, and there has been no continuity of symptomatology since service. Therefore, VA regulations governing presumptive service connection for certain chronic diseases do not apply, nor do the provisions regarding continuity of symptomatology. 38 C.F.R. §§ 3.303(b), 3.307, 3.309.

The Veteran was provided with a VA examination in June 2025. In the opinion, the VA examiner opined that the Veteran's intestinal cancer was less likely than not incurred in or caused by service, including the TERA of the Veteran. The VA examiner rationalized that asbestos exposure is not recognized as a cause of malignant carcinoid tumors of the small intestine and the most robust epidemiologic studies and consensus guidelines do not identify asbestos as a risk factor for small bowel carcinoid tumors. The VA examiner reported that the North American Neuroendocrine Tumor Society, in its consensus guideline, specifically notes that the etiology of small bowel carcinoid tumors is largely unknown, with familial and some dietary factors implicated, but does not mention asbestos or other environmental toxins as established risk factors. Further, the VA examiner noted that large epidemiologic studies of small intestine carcinoid tumors also do not identify
was less likely than not incurred in or caused by service, including the TERA of the Veteran. The VA examiner rationalized that asbestos exposure is not recognized as a cause of malignant carcinoid tumors of the small intestine and the most robust epidemiologic studies and consensus guidelines do not identify asbestos as a risk factor for small bowel carcinoid tumors. The VA examiner reported that the North American Neuroendocrine Tumor Society, in its consensus guideline, specifically notes that the etiology of small bowel carcinoid tumors is largely unknown, with familial and some dietary factors implicated, but does not mention asbestos or other environmental toxins as established risk factors. Further, the VA examiner noted that large epidemiologic studies of small intestine carcinoid tumors also do not identify asbestos exposure as a risk factor; instead, age, male sex, body mass index, and family history of cancer are associated. This opinion is inadequate, as it provided only a general overview and does not discuss the specifics of the Veteran's TERA relative to his intestinal cancer. See Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018) (holding that a medical opinion was inadequate as a matter of law because the rationale was based solely on general articles and did not discuss any facts pertaining to a veteran's condition or individual circumstances). Thus, the Board does not afford it any weight of probative value.

In a December 2025 private medical opinion, submitted in January 2026, Dr. J.C. concluded that the Veteran's intestinal cancer with liver metastasis was as least as likely as not the direct result of his in-service asbestos exposure. Dr. J.C. noted that the Veteran was diagnosed with a metastatic neuroendocrine carcinoma of the small intestine with metastasis to the liver, and rationalized that the Veteran's medical history is positive for exposure to asbestos while in service, and medical literature identifies the causal connection between asbestos exposure with gastrointestinal cancers, as well as asbestos exposure with chronic inflammation, which promotes the development of malignancies. While the opinion is not flawless, the opinion has a clear conclusion and rationale based on the provider's examination of the Veteran's medical and service history and a thorough review of medical literature and serves to link the intestinal cancer to the Veteran's service. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, the Board assigns this opinion probative weight.

While the Board recognizes the Veteran's general alternative contention that he has intestinal cancer due to exposure to herbicide agents in service, a service connection analysis in this regard, including the related medical opinions, is unnecessary in light of the conclusion herein.

As such, the Board concludes that the evidence favors a finding that the Veteran's intestinal cancer is linked to his service. Therefore, the Board resolves all reasonable doubt in the Veteran's favor and grants service connection for intestinal cancer. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Service connection for liver cancer is granted.

The Veteran contends that he has liver cancer that metastasized from his intestinal cancer.

As outlined above, the Board has granted service connection for intestinal cancer. The Board is bound by this favorable finding. 38 C.F.R. § 3.104. See Green v. McDonough, 37 Vet. App. 127, 136 (2024) (holding that a decision by the AOJ or by the Board is not evidence and the Board can consider the favorable findings therein).

Additionally, the June 2025 rating decision made favorable findings that the Veteran is diagnosed with liver cancer and that his liver cancer metastasized from a neuroendocrine tumor. The Board is bound by these favorable findings. 38 C.F.R. § 3.104.

A March 2025 VA treatment record documents that the Veteran has a neuroendocrine tumor of the small intestine with metastatic disease in the liver.

The Veteran was provided with a VA examination in June 2025. In the opinion, the VA examiner opined that the Veteran's liver cancer metastasized from a neuroendocrine tumor.

In a December 2025 private medical opinion, submitted in January 2026, Dr. J.C. opined that in 2020, the Veteran's neuroendocrine tumor of the small intestines metastasized to his liver.

As such, the Board concludes that the evidence persuasively favors that the Veteran's liver cancer was caused by the Veteran's service-connected intestinal cancer. Therefore, the Board concludes that a grant of service connection for liver cancer is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

3. Service connection for a liver biopsy surgical scar is
opined that the Veteran's liver cancer metastasized from a neuroendocrine tumor.

In a December 2025 private medical opinion, submitted in January 2026, Dr. J.C. opined that in 2020, the Veteran's neuroendocrine tumor of the small intestines metastasized to his liver.

3. Service connection for a liver biopsy surgical scar is granted.

As outlined above, the Board has granted service connection for liver cancer. See Green, 37 Vet. App. 136. A review of the record indicates that the Veteran has complications related to his service-connected liver cancer. Specifically, the June 2025 VA examiner found the Veteran has a liver biopsy surgical scar on his anterior trunk. Therefore, the Board finds the evidence persuasively favors that the liver biopsy surgical scar was caused by the Veteran's liver cancer. As such, service connection for a liver biopsy surgical scar is warranted. 38 C.F.R. § 3.310.

M. SORISIO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Knerr

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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