MALIGNANT NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The veteran served from May 1968 to December 1969. He appeals the denial of service connection for adenocarcinoma of the duodenum, contending it is due to his service, including herbicide exposure. The Board found that while the veteran's herbicide exposure was conceded, adenocarcinoma of the duodenum is not a presumptive condition under the relevant regulations (38 U.S.C. § 1116; 38 C.F.R. § 3.309(e)). Service treatment records were silent regarding digestive issues or adenocarcinoma. The veteran was diagnosed with duodenal cancer in 2023, well outside any presumptive period. Regarding direct service connection, a February 2025 VA examination concluded that the cancer was less likely than not caused by herbicide exposure, citing the rarity of the cancer, identified risk factors like diet and alcohol, and the lack of known association with Agent Orange. The Board found this opinion probative. The veteran submitted a January 2025 statement from his treating physician, Dr. J.L.F., suggesting a potential link due to other correlated illnesses, but the Board found this opinion inadequate due to its conclusory nature and lack of rationale. The Board also noted that gastrointestinal cancers are not presumptively linked to herbicide exposure under VA guidance. As the evidence weighed against a service connection and the benefit-of-the-doubt doctrine was not applicable due to a lack of equipoise, service connection for adenocarcinoma of the duodenum was denied.

Rationale

No in-service diagnosis or manifestation within presumptive period; Service treatment records silent regarding digestive issues; Post-service diagnosis outside presumptive period; VA examiner found less likely than not related to TERA/herbicide exposure; Treating physician opinion found inadequate due to conclusory nature

Full Decision Text

Citation Nr: A26040952
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 251229-618626
DATE: April 30, 2026

ORDER

Entitlement to service connection for adenocarcinoma of the duodenum is denied. 

FINDING OF FACT

The Veteran's adenocarcinoma of the duodenum did not manifest during service or to a compensable degree within the applicable presumptive period; continuity of symptomology is not established; and the disability is not otherwise etiologically related to service, to include exposure to herbicides. 

CONCLUSION OF LAW

The criteria for service connection for adenocarcinoma of the duodenum have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from May 1968 to December 1969. 

The matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). 

By way of procedural background, in May 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2025 decision. In May 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2025 decision.  

In the December 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 April 2025 decision, which was subsequently subject to HLR. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to HLR, the Board did not consider it in its decision. 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Lastly, in Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims (Court) held that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). Accordingly, in February 2026, the Board wrote to the Veteran and advised that if he wanted to preserve the entire docket switch period he should do nothing, but that if he wanted to waive his time to switch dockets he should return the enclosed waiver form. On February 13, 206, the Board received the Veteran's waiver form. Thus, the Board finds appellate review is proper at this time.

Entitlement to service connection for adenocarcinoma of the duodenum. 

The Veteran contends that his adenocarcinoma of the duodenum is due to his service, to include herbicide exposure. 

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).

Certain chronic diseases such as malignant tumors will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology
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).

Certain chronic diseases such as malignant tumors will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Certain diseases warrant presumptive service connection for veterans who were exposed to designated herbicide agents during their active service. See 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a), 3.309(e). Cancers of the digestive organs are not presumptively associated with herbicide agent exposure.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) provides that where a Veteran submits a service connection claim with evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) during active military service, and such evidence is not sufficient to establish service connection for the disability, the Secretary shall provide the Veteran with a medical examination and secure a nexus opinion unless VA determines that there is no assertion that the claimed disorder is related to the TERA. See 38 U.S.C. § 1168; see also Pub. L. No. 117-168, 136 Stat. 1759 (2022).  

The Board notes that although the Veteran's herbicide exposure has been conceded, adenocarcinoma of the duodenum is not entitled to service connection on this presumptive basis. See 38 C.F.R. § 3.309(e). 

Additionally, the evidence does not show that the Veteran was diagnosed with adenocarcinoma of the duodenum during service or that it manifested to a compensable degree within one year after separation from service. The Veteran's service treatment records (STRs) are silent as to complaints, signs, or symptoms suggestive of a digestive condition or adenocarcinoma of the duodenum. Further, the available medical evidence does not indicate, and the Veteran does not contend, that his adenocarcinoma of the duodenum manifested within one year after separation from service. Notably, the Veteran's post-service treatment records reveal that he was diagnosed with duodenal cancer in 2023 and underwent Whipple surgery. Accordingly, service connection on a presumptive basis as a chronic disease or based on continuity of symptomatology is not warranted.

Regarding direct service connection, the evidence of record persuasively weighs against finding that the Veteran's adenocarcinoma of the duodenum is etiologically related to service, to include in-service herbicide exposure. 

Notably, a February 2025 VA examiner opined that the Veteran's adenocarcinoma of the duodenum was less likely than not caused by the indicated TERA, to include herbicide exposure. The examiner reasoned that duodenal adenocarcinoma is a relatively rare cancer that accounts for less than one percent of gastrointestinal cancers. She noted that while causative factors have not been identified some risk factors that have been identified include dietary factor like increase bread, pasta, sugar, or red meat consumption with decrease fruits and vegetables; alcohol; coffee; and tobacco. She also indicated that there is no known association between duodenal adenocarcinoma and Agent Orange. Thus, the examiner concluded that the Veteran's duodenal adenocarcinoma was less likely than not due to his in-service Agent Orange exposure. The Board finds this opinion probative, as it provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). 

Moreover, the Board acknowledges that VA's sub-regulatory guidance for the PACT Act establishes that cancers of the digestive organs have no positive association with herbicide exposure. See VBA Letter 
; coffee; and tobacco. She also indicated that there is no known association between duodenal adenocarcinoma and Agent Orange. Thus, the examiner concluded that the Veteran's duodenal adenocarcinoma was less likely than not due to his in-service Agent Orange exposure. The Board finds this opinion probative, as it provided a clear conclusion with supporting data, and reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). 

Moreover, the Board acknowledges that VA's sub-regulatory guidance for the PACT Act establishes that cancers of the digestive organs have no positive association with herbicide exposure. See VBA Letter 20-22-10, Exception to TERA Examination and Medical Opinion Requirement (December 22, 2022). 

The Board acknowledges that the Veteran submitted a statement in January 2025 from his treating physician, Dr. J.L.F., requesting consideration under the PACT Act as gastrointestinal cancers have been included in the list of presumptive conditions related to exposure to Agent Orange. She further indicated that as multiple other illness have been correlated with Agent Orange exposure "we are supportive that this a potential cause." To the extent that this statement constitutes a medical opinion regarding nexus to service, it is considered inadequate as it is conclusory and does not provide sufficient rationale to support its findings. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, pursuant to the PACT Act, gastrointestinal cancer of any type is presumed for Persian Gulf veterans with exposure to burn pits and other toxins (BPOT) not herbicide exposure. See 38 U.S.C. § 1120. For these reasons, the Board finds the January 2025 statement is entitled to no probative weight. 

(Continued on the next page)

?

In sum, the evidence of record 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 adenocarcinoma of the duodenum is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

Nathaniel J. Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Robinson

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.