Citation Nr: 18132279
Decision Date: 09/06/18	Archive Date: 09/06/18

DOCKET NO. 18-18 135
DATE:	September 6, 2018
Service connection for small cell cancer, as secondary to service-connected gastroesophageal reflux disease (GERD), is granted.
The Veteran’s small cell cancer is due to service-connected GERD.
The criteria for service connection for small cell cancer, as secondary to service-connected GERD, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.
The Veteran served on active duty from April 1986 to September 2006.
The case is on appeal from a December 2017 rating decision.
In September 2018, the Veteran testified at a Board video conference hearing.
Service connection for small cell cancer secondary to service-connected GERD.
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.  Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury.  See 38 C.F.R. § 3.310.
At the September 2018 Board hearing and in multiple statements (February 2018 notice of disagreement, March 2018 substantive appeal (VA Form 9)), the Veteran contended that the medical evidence of record, to include private treatment records, shows that his small cell cancer is secondary to his service-connected GERD.  The Board notes that in a November 2006 rating decision, the RO granted service connection for GERD.
The record includes a December 2017 VA examination that notes a 2017 CT confirmation of diagnosis of small cell carcinoma and a July 2017 MRI report showing multiple hepatic metastases and retroperitoneal adenopathy with possible primary neoplasm arising from the pancreatic body.  Thus, the Veteran has the claimed current disability.  The VA examiner provided a negative nexus opinion, explaining that the Veteran’s extrapulmonary small cell cancer more likely arose from areas that are not related to GERD such as the pancreas, according to the examiner’s consultation with an oncologist.  The examiner noted that medical literature showed a connection to adenocarcinoma type of cancer instead.
However, as the Veteran and his representative contend, the record also includes opinions from his private physician linking his small cell cancer to his GERD.  Specifically, in a September 2017 letter, Dr. I.R. opined that the Veteran’s small cell cancer PET scan findings show it “arising from or adjacent to gastroesophageal junction . . . [and] could represent a primary origin of the cancer.”  Dr. I.R. reiterated this opinion in a May 2018 letter, stating that the PET scan showed the possibility of the GI junction as the primary tumor site and that GERD is a predisposing risk factor for small cell cancer in some patients, according to a study.  Additionally, the Veteran submitted multiple journal articles supporting this opinion connecting GERD and small cell cancer.  Moreover, an August 1, 2017, private treatment record shows that another physician (T.H., M.D.) reported that the Veteran’s extrapulmonary small cell carcinoma’s primary location is likely in the gastroesophageal junction and less likely in the pancreas.
Given the private opinions linking the Veteran’s small cell cancer to his GERD and the journal articles bolstering such opinions, the Board finds that the evidence is at least in equipoise regarding whether the Veteran’s small cell cancer was caused by his service-connected GERD.  Therefore, after resolving reasonable doubt in the Veteran’s favor, the Board finds that his small cell cancer was caused by the service-connected GERD, and accordingly, service connection for small cell cancer is warranted on a secondary basis.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Santiago, Counsel 

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