BVA9507592 DOCKET NO. 92-23 122 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: New York Division of Veterans Affairs ATTORNEY FOR THE BOARD Robert E. P. Jones, Associate Counsel INTRODUCTION The appellant is the widow of the veteran. The veteran served on active duty from January 1941 to November 1945. He was a prisoner of war from January 1945 to May 1945. The veteran died on February 17, 1992. This matter came before the Board of Veterans' Appeals (Board) on appeal from an April 1992 rating decision by the Buffalo, New York, Regional Office (RO). The appellant's claim was remanded for further development in July 1993. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that service connection for the cause of the veteran's death is warranted in that he had been a prisoner of war and his service-connected disabilities contributed to his death. A statement by his private doctor to this effect augments the death certificate. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991, has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against entitlement to service connection for the cause of the veteran's death. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained by the RO. 2. The veteran died of metastatic colon cancer. 3. The veteran's fatal carcinoma of the colon was not present until many years after service and was not causally or etiologically related to any service-connected disability or any other incident of service. 4. The veteran's service-connected disabilities did not contribute to cause or otherwise hasten his death. CONCLUSION OF LAW Metastatic colon cancer was not incurred (directly or presumptively) or aggravated during service and was not proximately due to or the result of a service-connected disability; and, a service-connected disease or disability did not cause or contribute substantially or materially to the cause of the veteran's death. 38 U.S.C.A. §§ 1110, 1112, 1113, 1310, 5107 (West 1991); 38 C.F.R. §§ 3.307, 3.309, 3.310, 3.312 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the appellant's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, she has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran had active service from January 1941 to November 1945. He was a prisoner of war from January 1945 through May 1945. The veteran's report of separation reflects that he had participated in extensive combat as a tank destroyer unit commander and that his awards and decorations included the Purple Heart. The service medical records reveal no reference to colon cancer. At the time of his death, the veteran had been granted service connection for bilateral trenchfoot which was 30 percent disabling, generalized anxiety disorder which was 30 percent disabling, residuals of a gunshot wound to the left hand which were 10 percent disabling, residuals of a recurrent duodenal ulcer with known post-bulbar stricture which were 10 percent disabling, and irritable bowel syndrome by history which was no percent disabling. The combined schedular evaluation was 60 percent disabling. The veteran received a Department of Veterans Affairs (VA) gastrointestinal examination in April 1989. In a review of medical history, it was noted that since 1971, he had had recurrent epigastric distress that would be relieved by eating. A duodenal ulcer had been diagnosed and he had been treated medically. Since that time, he had been having spring and fall recurrences almost annually. In 1983, he had had an episode of nausea and vomiting. Barium studies revealed a duodenal ulcer. His symptoms had continued, he had been endoscoped, and a small esophageal hiatus hernia had been found. Two small duodenal ulcers and a post bulbar stricture were also found. His symptoms subsided and he had continued to have his normal twice-a-year flareups. There had been no further nausea or vomiting. Weight had been maintained and he generally followed a regular diet, avoiding most irritating spices. The veteran had had diarrhea while a prisoner of war. He had not had any trouble with his colon afterwards until sometime in the 1950's, when he had an episode of diverticulitis. That problem had promptly subsided and he had had no further difficulty until September 1988, when he began to notice some crimson blood in his stool and also some lower abdominal cramps. He saw a physician who did not find occult blood in his stool. He had had a sigmoidoscopy at that time but, apparently, the findings were negative or the examination was unsuccessful because of spasm. A barium enema was nonrevealing. However, a sigmoidoscopy in April 1989 had revealed a lesion approximately 12 centimeters above the anus. According to the veteran, a biopsy had been positive for malignancy and he was scheduled for admission to a local hospital for a colon resection. On examination, the veteran's sigmoid colon was palpable and nontender along its course. The diagnoses included history of recurrent duodenal ulcer with a known post- bulbar stricture, clinically inactive at the current time. The VA physician also noted in the diagnoses that other than the history of diverticulitis in the 1950's, the veteran had not had any colon symptoms prior to September 1988. The record contains a hospital discharge summary from Community General Hospital, Syracuse, New York, dated in May 1989. The veteran had given a history of intermittent lower abdominal discomfort of several months' duration which seemed to be worse preceding bowel movements. Sigmoidoscopy revealed the presence of a rectal tumor with biopsy demonstrating the presence of carcinoma. A lower anterior resection of the rectosigmoid colon with primary side-to-end anastomosis was performed. The final pathology report revealed moderate to poorly differentiated adenocarcinoma extending through the muscular wall into the pericolonic adipose tissue and metastatic involvement with 3 of 12 mesenteric lymph nodes. Because of the transmural extension of the tumor and the presence of axillary node metastases, the veteran underwent radiation therapy. In September 1990, the veteran was hospitalized for shock from a bleeding ulcer and he sustained a myocardial infarction when severely anemic. In June 1991, the veteran underwent surgical removal of a small bowel obstruction at the Community General Hospital. Records from the Syracuse University Hospital dated from April 1990 to February 1992 provide detailed summaries of the veteran's ongoing treatment up to the time of his death. These do not reflect any recurrence of ulcer activity during the six months preceding death. In March 1992, the RO received a claim for entitlement to service connection for the cause of the veteran's death from the appellant. The appellant submitted an August 1992 statement by David B. Duggan, M.D. Dr. Duggan stated that he was the veteran's attending oncologist. He further stated that in his opinion, the veteran's prisoner-of-war service-connected disabilities "possibly contributed to his colon cancer." The veteran did not have colon cancer during service or within one year of discharge from service, nor did he exhibit symptoms of colon cancer until nearly 43 years after discharge from service. While the veteran's oncologist, Dr. Duggan, stated in August 1992 that, in his opinion, the veteran's service-connected disability "possibly contributed to his colon cancer," he did not provide any supporting explanation. In March and then again in May 1994, the RO wrote letters to Dr. Duggan requesting that he supply reasons and bases for his opinion of a possible connection between the veteran's terminal colon cancer and his prisoner-of-war experience. No reply was received from Dr. Duggan. The Board does not question the good faith of Dr. Duggan, who provided extensive care of the veteran over the last years of his life. However, we note that this physician's August 1990 statement was phrased in terms of general possibility. As it merely suggests a possibility of a relationship, and since Dr. Duggan has not responded to requests for amplification, the Board concludes that the statement is of limited probative value. Stegman v. Derwinski, 3 Vet.App. 228 (1992); Tirpak v. Derwinski, 2 Vet.App. 609 (1992). With regard to whether the veteran's service-connected disabilities hastened or otherwise contributed to cause his death, the Board has carefully reviewed the extensive medical records covering the several months preceding the veteran's death. These do not reflect that the service-connected disabilities played a causative role in the veteran's death. While there had been duodenal ulcer activity in September 1990, this had evidently resolved with treatment and had not recurred. The evidence shows that the veteran's death was attributable to the overwhelming effects of the nonservice-connected carcinoma of the colon. Thus, the Board concludes that entitlement to service connection for the cause of the veteran's death is not warranted. The Board has carefully reviewed the entire evidence of record and finds that the evidence is not so evenly balanced that there is doubt as to any material issue. 38 U.S.C.A. § 5107. ORDER Entitlement to service connection for the cause of the veteran's death is denied. JAMES R. ANTHONY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.