Citation Nr: 1033533 Decision Date: 09/07/10 Archive Date: 09/15/10 DOCKET NO. 03-18 614A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for post-operative residuals of cervical spine astrocytoma-ependymoma with Brown-Sequard's syndrome, claimed as due to exposure to ionizing radiation. REPRESENTATION Appellant represented by: Charles D. Romo, Attorney WITNESSES AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD M. Tenner, Counsel INTRODUCTION The Veteran served on active duty from September 1985 to September 1990 and service thereafter in the U.S. Army Reserves. This case comes before the Board of Veterans' Appeals (Board) on appeal from a decision rendered by the St. Petersburg, Florida Regional Office (RO) of the Department of Veterans Affairs (VA). In June 2005, the Veteran and his spouse testified during a hearing held at the RO before the undersigned. A transcript of the proceeding is of record. In November 2005, the Board remanded this matter for additional development. In 2009, following substantial completion of the requested development, the matter was returned to the Board. Thereafter, the Board requested an independent medical examination opinion. 38 C.F.R. § 20.901(d). The matter was most recently remanded by the Board in April 2010 in order to have the RO consider the Veteran's Social Security disability determination records prior to the Board's review of such evidence. See Disabled American Veterans (DAV) v. Sec'y of Veteran's Affairs, 327 F.3d 1339, 1346 (Fed. Cir. 2003)(discussing the right to initial consideration of evidence by the agency of original jurisdiction). In August 2010, the Veteran submitted additional evidence accompanied by a waiver of initial RO review of such. FINDINGS OF FACT 1. The Veteran was diagnosed with cervical spine astrocytoma- ependymoma in July 1995. 2. The Veteran served as a single channel radio operator and did not participate in a "radiation-risk activity" as defined by regulation for purposes of presumptive service connection for diseases specific to radiation-exposed veterans. 3. The preponderance of the evidence is against a finding that post-operative residuals of cervical spine astrocytoma-ependymoma with Brown-Sequard's syndrome was incurred during service or is related to events in service, to include exposure to ionizing radiation; and there is no evidence that such manifested to a compensable degree within one year following discharge from service. CONCLUSION OF LAW The criteria to establish service connection for post-operative residuals of cervical spine astrocytoma-ependymoma with Brown- Sequard's syndrome are not met. 38 U.S.C.A. §§ 1110, 1112, 1131 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his or her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). I. The Veterans Claims Assistance Act of 2000 (the VCAA) With respect to the Veteran's claim decided herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2009). Under the VCAA, when VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claims. See 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2009); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004) (Pelegrini II), the United States Court of Appeals for Veterans Claims (the Court) held that VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claims; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. In May 2001 and December 2005 letters, VA satisfied these criteria. In the letters, the RO advised the Veteran of the basic criteria for service connection and explained VA's duties to assist him in obtaining evidence relevant to the claim. In addition, the United States Court of Appeals for Veterans Claims has observed that a claim of entitlement to service connection consists of five elements, of which notice must be provided prior to the initial adjudication: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473, 490 (2006); see also 38 U.S.C.A. § 5103(a) (2002). Compliance with the first Pelegrini II element requires notice of these five elements in initial ratings cases. See Dunlop v. Nicholson, 21 Vet. App. 112 (2006). Here, the Veteran has not been advised as to elements 4 and 5. Nevertheless, since the claim for service connection is being denied any failure to advise the Veteran concerning the degree of disability and how VA assigns effective date is rendered moot. The Board also concludes VA's duty to assist has been satisfied. The Veteran's service treatment records and service personnel records are in the file. In addition, the RO has obtained identified VA outpatient treatment records and Social Security disability records. The Veteran has submitted private treatment records. During the June 2005 hearing, the Veteran identified additional potentially relevant records from physicians in Ocala who originally diagnosed the cervical spine tumor. The Veteran, however, did not provide any address information in a release he provided VA. Therefore, VA could not assist him in obtaining the records. He was advised of this fact in the April 2008 supplemental statement of the case. Thus, in the absence of the Veteran's cooperation, no further assistance is owed in attempting to obtain these records. Based on the RO's efforts, the Board finds that there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998). The duty to assist includes, when appropriate, the duty to conduct a thorough and contemporaneous examination of the Veteran. See Green v. Derwinski, 1 Vet. App. 121 (1991). In addition, where the evidence of record does not reflect the current state of the Veteran's disability, a VA examination must be conducted. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a) (2009). Here, the Veteran underwent a VA examination in September 1995, in conjunction with a then- pending claim for non-service connected pension benefits. This examination included findings documenting the Veteran's current disability and is considered adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examination did not contain an opinion as to the likely etiology of the cervical spine cancer. However, in October and December 2009, the Veteran's claims file was reviewed by an independent medical expert in hematology and oncology pursuant to the Board's authority under 38 C.F.R. § 20.901(d). The expert provided an opinion as to the issue on appeal. That opinion is also considered adequate. Id. Finally, the Board has considered the Veteran's request that the Board send tissue samples to the Armed Forces Institute of Pathology. The Board has authority, pursuant to 38 C.F.R. § 20.901(b), to send tissue samples to the Armed Forces Institute of Pathology (AFIP). That use of such authority is discretionary. Under 38 C.F.R. § 20.902, there must be a showing of good cause warranting such an opinion be obtained, such as a complex or controversial medical or legal issue. This case clearly involves a complex medical issue, and it was for this reason that the Board exercised its discretionary authority under 38 C.F.R. § 20.901(d) to obtain an independent medical opinion. In requesting an additional opinion be obtained from AFIP, the Veteran's attorney has provided no good cause, but has merely asked that the Board do so. In light of the clear independent medical opinion provided by an appropriate specialist, there must be some showing as to why further inquiry is warranted in this case. None has been provided by the attorney, and the Board is unable to identify any good cause from review of the file. In the absence of good cause, and in light of the fact that there is otherwise sufficient evidence to adjudicate the claim, the request to send pathologic material to AFIP is denied. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield, supra. II. Background and Analysis The Veteran contends that he was exposed to ionizing radiation in service while performing satellite computer terminal monitoring work. Specifically, he alleges that he sat in a confined workspace on 12-hour shifts, four days or nights a week, in close proximity to a keyboard, incription device, modem, and computer terminal. He states that the satellite transmission unit equipment had warning stickers advising that radiation was emitted during use. He states that the unit would send and receive encrypted messages via satellite and print them using thermal imaging paper. He states that the equipment required a cooling fan and it put out a lot of heat. He also alleges exposure to microwave radiation during field exercises on the roof where the satellite mobile transmission antennas were located. He attributes the long-term exposure to the development of a cervical spine tumor. The Veteran's service personnel and service medical records are associated with his claims file. The service personnel records reflect that his primary MOS was a Single Channel Radio Operator. He served overseas in Germany from June 1987 to July 1990. His service treatment records include a report of medical history dated in November 1990 in which the Veteran reported an eight- month history of shoulder pain. He reported no trauma but reported a history of weightlifting. He also reported a history of headaches that occurred during night shifts or when exposed to diesel fuel. A history of dizziness was noted as being orthostatic. When examined for enlistment into the Army Reserves in August 1991, the Veteran noted a history of right shoulder pain after lifting weights. In July 1995, the Veteran was seen for medical treatment with complaints of neck pain of a two-month duration. He attributed the pain to an injury while removing a kitchen countertop. He underwent an MRI of the cervical spine. Findings revealed a intradeullary cystic lesion. There were two focal nodules within the lesion that raised the possibility of a neoplastic process. On August 2, 1995, he underwent a surgical resection of the tumor. The tumor was characterized as a mixed type, with features of astrocytoma and ependymoma. The Veteran underwent a VA examination in September 1995. At that time, a social history indicated that the Veteran had been out of the service for about three years when he started to have difficulty. The examiner noted that following the surgical resection the Veteran had severe partial impairment, was wheelchair bound, and had weakness and spasticity. The pertinent diagnosis was Brown-Sequard's syndrome, and status post resection and radiation therapy of cervical mixed astrocytoma-ependymoma. An August 1998 examination by R. W. S., M.D. noted that the Veteran began having problems in 1995 with pain in his neck and some numbness and tingling in his left arm and hand. The Veteran underwent a physical examination with J. C. W., M.D., in August 1999. Therein, the examiner noted the Veteran's contention that exposure to radiation in the military caused the astrocytoma. The examiner noted, however, that the Veteran did not present any evidence to indicate that he was exposed to radiation in the work place. The examiner also noted that the Veteran did not present any evidence of other coworkers who had similar maladies. In addition, he stated that there were no reports of any hair loss during service or other stigmata that would be indicative of excessive radiation exposure. The examiner noted the Veteran's history of shoulder pain in service. Following a physical examination, the examiner stated: Based on the patient's history he was noted to suffer signs and symptoms which would be directly related to the cervical tumor prior to his discharge from the military. Unfortunately, without documentation such as that noted in the history it would be difficult for me to make an equivocal statement that the patients tumor in the cervical region was directly related to radiation exposure. In April 2000, the RO contacted the National Personnel Records Center and requested a DD 1141, or other record of exposure to radiation. A response indicated that the document or information was not a matter of record. In a May 2001 examination report from M. I. S., M.D., the physician indicated that the Veteran used to work with satellite communication terminals in Germany with exposure to ionizing radiation. He stated that it was "very possible that the tumor and the current problem are related to the exposure during the service time to the radiation and of course the awkward positions and manipulation of the cervical spine in general." In June 2001, the RO contacted the Army Radiation Standards and Dosimetry Lab and requested information concerning any possible occupational exposure to ionizing radiation. A response indicated that there was no record of the Veteran's exposure to ionizing radiation. An August 2001 opinion from J. P., M.D. stated that the Veteran worked with radio transmitting equipment while in the military. The examiner noted that the data suggesting a link between cancer and exposure to radio and microwaves was "controversial." He described a study from the Journal of Occupational and Environmental Health which stated that "the findings suggest that young persons exposed to high levels of RF/MV (radio frequency / microwave) for long periods in settings where preventive measures were lax were at increased risk for cancer." He went on the state that he "did not know the exact exposure or even the exact type of exposure from his military experience, so [he] can not give a more precise statement, than there is a potential connection between that exposure and his cancer." Social Security Administration disability determination records indicate that the Veteran is disabled due to status post cervical cord tumor. The disability began, for Social Security purposes, on July 20, 1995. In a May 2008 statement, the Veteran's wife indicated that his reports of shoulder pain during service were real and were not due to weightlifting. She stated her belief that the Veteran's cancer was due to occupational exposure to ionizing radiation. As noted, in June 2009, the Board referred this matter for an independent medical examination opinion. In a September 2009 opinion letter, the examiner, a medical director at the Hematology Oncology Clinic at the Virginia Commonwealth Medical Center cited to research which indicated a case study involving 5 radar workers who developed brain cancer after a short latency period. He stated that the cancer associated with radiation exposure in radar workers was leukemia. He stated that there was not consistent data available in the epidemiologic literature to conclusively support that microwave/radar exposure is directly responsible for the development of malignant brain tumors. The Board returned the opinion to the examiner after determining that it was insufficient. It requested that the examiner provide an opinion as to the likelihood that the Veteran's cervical astrocytoma-ependymoma was the result of microwave/radio frequency exposure during service. In a December 2009 supplemental opinion, the independent medical examiner stated that: Cervical astrocytoma-ependymoma [sic] arises predominantly in the cerebellum or brainstem but also in the cerebral hemispheres and spinal cord when oncogenes become activated and tumor suppressor genes become deleted. The etiology of these changes is unknown. The etiology or cause for this Veteran's astrocytoma-ependymomo is therefore unknown. The examiner noted that the medical literature did not include conclusive data on the relationship between brain tumor or cancer and microwave radiation exposure. After discussing the reported data, the examiner concluded that it was "unlikely that the Veteran's brain tumor was caused by exposure to microwave radiation." The laws pertinent to the claims for service connection are as follows: Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131. Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247 (1999). Service connection may also be granted for certain chronic diseases, including malignant tumors or tumors of the spinal cord, if manifested to a compensable degree within one year following discharge from active military service. 38 C.F.R. §§ 3.307, 3.309 (2009). In addition, service connection for a disability claimed to be attributable to exposure to ionizing radiation during service can be demonstrated by three different methods. See Hilkert v. West, 12 Vet. App. 145 (1999); aff'd, 232 F.3d 908 (Fed. Cir. 2000). First, there are certain types of cancer that are presumptively service connected specific to radiation-exposed veterans under 38 U.S.C.A. § 1112(c); 38 C.F.R. § 3.309(d). "Cancer of the brain" is among the diseases specific to radiation-exposed veterans. 38 C.F.R. § 3.309(d)(2)(xviii). Second, direct service connection may be established under 38 C.F.R. § 3.303(d) by showing that the disease or malady was incurred during or aggravated by service. Third, service connection may be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311, if the condition at issue is a "radiogenic disease." See 38 C.F.R. § 3.311(b)(2),(4) (2008). The Board notes that "any other cancer" is one of the diseases listed as a radiogenic disease. 38 C.F.R. § 3.311(b)(2)(xxiv). The Board will review each method, addressing the issue of direct service connection last. First, the evidence shows that the Veteran was not diagnosed with the cervical spine cancer until over 4 and half years following discharge from active duty. While there are some vague reports to a history of shoulder problems during and following discharge from service, there is no probative evidence that he had a chronic disease manifest to a degree of 10 percent within the first post-service year. Hence, the provisions concerning presumptive service connection for certain chronic diseases is not for application. 38 C.F.R. § 3.307(a)(3). Second, while the Veteran arguably had a disease specific to radiation-exposed veterans (brain cancer); the weight of the competent and probative evidence does not show that he was a "radiation-exposed veteran." The term "radiation-exposed veteran" has a very specific definition under law and means a veteran who participated in a "radiation-risk activity." See 38 U.S.C.A. § 1112(c)(3)(A); 38 C.F.R. § 3.309(d)(3)(i). The term "radiation-risk activity" means onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima or Nagasaki during the period beginning on August 6, 1945, and ending on July 1, 1946; internment as a prisoner of war of Japan during World War II resulting in an opportunity for exposure to radiation comparable to those occupying Hiroshima or Nagasaki; certain presence on the grounds of a gaseous diffusion plant located in Paducah, Kentucky, Portsmouth, Ohio, or the area identified as K25 at Oak Ridge, Tennessee; or certain service before January 1, 1974, on Amchitka Island, Alaska. 38 U.S.C.A. § 1112(c)(3)(B); 38 C.F.R. § 3.309(d)(3)(ii); 67 Fed. Reg. 3,612- 16 (Jan. 25, 2002). Here, the Veteran did not participate in a "radiation risk activity" as that term is defined and thus is not a "radiation- exposed Veteran." Hence, the presumptive provisions of 38 C.F.R. § 3.309 are not for application. Third, the Board has considered whether service connection may be established under 38 C.F.R. § 3.303(d) with the assistance of the procedural advantages prescribed in 38 C.F.R. § 3.311, if the condition at issue, here cervical spine cancer, is a "radiogenic disease." 38 C.F.R. § 3.303(d) permits for the granting of service connection for a disease diagnosed after discharge, when the evidence establishes that the disease was incurred during service. VA has established special procedures to follow for those seeking compensation for diseases related to exposure to radiation in service. See Veterans' Dioxin and Radiation Exposure Compensation Standards Act, Pub. L. No. 98-542, 98 Stat. 2725 (1984); 38 C.F.R. § 3.311. This regulation provides that: In all claims in which it is established that a radiogenic disease first became manifest after service . . . and it is contended the disease is a result of exposure to ionizing radiation in service, an assessment will be made as to the size and nature of the radiation dose or doses. When dose estimates provided . . . are reported as a range of doses to which a veteran may have been exposed, exposure at the highest level of the dose range reported will be presumed. 38 C.F.R. § 3.311(a)(1). This regulation establishes a series of chronological obligations upon both parties. Wandel v. West, 11 Vet. App. 200 (1998). First, there must be evidence that the veteran suffered from a radiogenic disease. 38 C.F.R. § 3.311(b)(2), (4). This disease must manifest within a certain time period after exposure. 38 C.F.R. § 3.311(b)(5). Once a claimant has established a diagnosis of a radiogenic disease within the specified period and claims that the disease is related to radiation exposure while in service, VA must then obtain a dose assessment. 38 C.F.R. § 3.311(a)(1). Here, the Veteran suffered from a cervical spine cancer which is characterized as "any other cancer" under 38 C.F.R. § 3.311(b)(2)(xxiv). As the claimant established a diagnosis, VA was required to obtain a dose assessment. Here, VA requested any information pertaining to the Veteran's exposure to ionizing radiation, to include obtaining a DA 1141 and any dose estimate. There was no record of any exposure. Hence, no dose estimate was prepared. Accordingly, in the absence of evidence of a dose assessment, the presumptive provisions of 38 C.F.R. § 3.311 are not for application. The United States Court of Appeals for the Federal Circuit has held that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1040 (1994). Here, the Board has considered whether direct service connection is warranted, but finds, however, that the preponderance of the evidence is against the claim. First, the Board finds that the service treatment records are silent for any findings of cervical spine cancer. They contain an isolated reference to shoulder pain but do not indicate that the pain was centered over the cervical spine. In addition, they suggest that the pain may be related to strain from weight lifting. The Board is precluded from using medical judgment in evaluating the claim and has reviewed the competent medical opinion evidence of record. Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Court has found that guiding factors in evaluating the probative value of a medical opinion are whether the opinion was based on sufficient facts or data, whether the opinion was the product of reliable principles and methods, and whether the medical professional applied the principles and methods reliably to the facts of the case. See Nieves-Rodriguez, 22 Vet. App. 295, 302 (2008). An opinion that contains only data and conclusions is afforded no weight. The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. Although being fully and accurately informed of the relevant medical history is necessary, the most probative value of a medical opinion comes from its reasoning. Id. First, regarding J. C. W.'s August 1999 opinion, the physician's opinion is equivocal and admittedly is based on incomplete data. The examiner notes that he is unaware of the Veteran's level of exposure to radiation. He also admits that without such data he cannot make a more precise statement. The Court has held that medical opinions which are speculative, general or inconclusive in nature, cannot support a claim. Id. The Board thus places little weight of probative value on that statement. Similarly, M. I. S., M.D., in his May 2001 examination report is also equivocal stating that the relationship is "very possible." It is unclear what the examiner means by this expression and the Board is left to conclude that the opinion is too speculative in nature. Id. See also Bostain v. West, 11 Vet. App. 124, 127-28 (1998). In addition, the August 2001 opinion from J. P., M.D. is also not probative. While this examiner reviews the literature for guidance, he notes that the relationship between radio and microwaves and the subsequent development of cancer is controversial. Other than generally providing information concerning the relationship, he is unable to provide a specific opinion concerning the Veteran's possible occupational exposure. The Board has considered the statement from the Veteran and the Veteran's wife. While the Veteran's statements concerning cancer symptoms has been considered, the Board finds that due to the highly complex nature of the disability in question, they are not competent to offer an opinion as to the etiology of the cervical spine cancer. Indeed, opinions as to medical causation are generally outside of the competency of a lay person, and the Veteran's and his spouse's contended causal relationship between cervical spine cancer residuals and service cannot be given significant probative weight. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Additionally, the Board has reviewed the scientific journal articles submitted. These articles for the most part address the relationship between exposure to radar waves. They tend not to address astrocytoma and ependymoma. While these articles are instructive, the Board finds that they are afforded less probative weight than the opinions from medical examiners who have had the opportunity to review the Veteran's claims file and consider his specific circumstances. In this respect, the Board finds most probative the opinion from the independent medical examiner. First, this examiner has expertise in oncology and hematology. In addition to being the medical director of a hematology and oncology clinic, the examiner is also a professor of medicine. In providing an opinion that the Veteran's cervical spine cancer was unlikely related to service, the examiner conducted a review of the Veteran's claims and reviewed the appropriate medical literature. Following such review, the independent medical examiner provided an opinion that is reasoned and appears to apply the medical principles and methods reliably to the facts of the case. Accordingly, the Board finds that the supplied opinions in support of the Veteran's claim do not place the evidence in a state of equipoise and are afforded less probative weight than the opinion of the independent medical examiner. The Board is sympathetic to the Veteran's claim and recognizes the sincerity of his belief that the residuals of cervical astrocytoma-ependymoma are due to in-service radiation exposure. As noted, however, for complex medical matters such as this one, the Veteran is not competent to provide a medical etiology opinion. See Espiritu v. Derwinski, 2 Vet. App. 492, 494- 95 (1992). The Board has reviewed the record in detail and finds that a preponderance of the evidence is against the claim for service connection and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. There is no basis under the applicable laws and regulations for awarding the benefit sought. (CONTINUED ON NEXT PAGE) ORDER Service connection for post-operative residuals of cervical spine astrocytoma-ependymoma with Brown-Sequard's syndrome is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs