Citation Nr: 1320714 Decision Date: 06/27/13 Archive Date: 07/05/13 DOCKET NO. 09-15 486A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to service connection for a pituitary tumor. 2. Entitlement to an initial compensable rating for hypertension. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Jarrette A. Marley, Associate Counsel INTRODUCTION The Veteran served on active duty from May 1986 to May 2006. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2007 rating decision by the San Diego, California Department of Veterans Affairs (VA) Regional Office (RO) that, in part, granted service connection for hypertension, rated noncompensable, effective June 1, 2006. The issue of entitlement to an initial compensable rating for hypertension is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDING OF FACT The Veteran's pituitary tumor had its onset in service. CONCLUSION OF LAW Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for a pituitary tumor are met. 38 U.S.C.A. §§ 1110, 1154(a), 5107(b) (West 2002); 38 C.F.R. §§ 3.102, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSIONS In this decision, the Board grants service connection for a pituitary tumor, which represents a complete grant of the benefit sought on appeal. As such, no discussion of VA's duty to notify or assist is necessary. The Veteran seeks entitlement to service connection for a pituitary tumor. The Board has reviewed all of the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on her behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C.A. § 1154(a); 38 C.F.R. § 3.303(a). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that the Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C.A. § 7104(a). Moreover, the Court has declared that in adjudicating a claim, the Board has the responsibility to weigh and address the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). 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. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a veteran for a long period of time or through a factually accurate medical history reported by the veteran. See id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodrigues, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran's service treatment records are silent for any complaints, findings, treatment or diagnosis relating to a pituitary tumor, including on February 2006 service retirement examination. Post-service treatment records include a September 2006 MRI of the brain from the Naval Medical Center that revealed a 1.0 x 1.1 x 1.0 cm mass arising out of the pituitary fossa extending into the suprasellar cistern with contact with the optic chiasm. Differential considerations include pituitary adenoma, optic nerve glioma or even meningioma. The instant claim for service connection for a pituitary tumor was received in October 2006. A December 2006 MRI of the sella from the Naval Medical Center revealed a stable macroadenoma in the sella/suprasellar region. An April 2007 MRI of the sella revealed a stable macroadenoma in the sella/suprasellar region. A February 2008 MRI of the sella showed a stable macroadenoma in the sella/suprasellar region. On December 2006 VA examination, it was noted that a September 2006 MRI of the brain revealed approximately a 1cm. pituitary mass. The diagnosis was a pituitary adenoma. The examiner found that he did not see any disability from the diagnosed pituitary adenoma. After a review of the evidence of record, the Board finds that entitlement to service connection for a pituitary tumor is warranted. While the Veteran's service treatment records are negative for any finding or diagnosis relating to a pituitary tumor, such was found within four months after his retirement from active duty. Resolving all reasonable doubt in the Veteran's favor, the Board finds that the pituitary tumor likely had its onset during his active duty. Accordingly, entitlement to service connection for a pituitary tumor is warranted. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. ORDER Service connection for a pituitary tumor is granted. REMAND Regarding the matter of entitlement to a compensable rating for hypertension, the Board notes a February 2006 rating decision granted service connection for hypertension, rated noncompensable, effective June 1, 2006. A February 2009 statement of the case listed the issue as entitlement to a rating in excess of 10 percent for hypertension, but continued a noncompensable disability rating in the body of the statement of the case. An April 2009 supplemental statement of the case continued a noncompensable disability for the Veteran's service-connected hypertension. Nonetheless, with no interim adjudication, a January 2011 supplemental statement of the case denied entitlement to a rating in excess of 10 percent for the Veteran's service-connected hypertension. In light of the above, the Board finds that it is unclear what the RO has actually rated the Veteran's hypertension, and if there are "staged" ratings, what those periods are. Accordingly, the Board finds that it must remand this matter for clarification from the RO to address the confusion as to the actual disability rating of the Veteran's service-connected hypertension. In addition, the record reflects that the most recent VA examination to evaluate the disability was conducted in December 2010. As the RO noted in the January 2011 Supplemental Statement of the Case, the Veteran receives care for this condition and is treating the disease with medication. In light of the state of the record, the Board finds that the claims must be remanded to associate those records and to afford him a VA examination to assess the current severity of his hypertension. See Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007) (an adequate VA medical examination must consider the Veteran's pertinent medical history). Finally, any relevant VA treatment records are constructively of record, and must be secured and reviewed for a complete picture of the disability on appeal. In addition, any outstanding post-service medical records, particularly from the Naval Medical Center, should be also be obtained on remand. Accordingly, the case is REMANDED for the following action: 1. Request that the Veteran provide the names and addresses of all medical care providers who provided treatment for his hypertension since his retirement from service (to include the Naval Medical Center since March 2010). After securing the necessary release(s), the RO should request any relevant records identified. The RO must make at least two requests to any custodian of private records in an effort to obtain such records, unless it is made evident by the first request that a second request would be futile in obtaining such records. Any negative response should be in writing and associated with the claims file. The RO should obtain for association with the claims file updated records of any VA treatment the Veteran may have received for his hypertension. 2. After the above has been completed to the extent possible, the RO should arrange for a VA examination to determine the current severity of the Veteran's hypertension. All necessary testing should be administered, with all relevant findings reported. The examiner must also indicate the impact the Veteran's hypertension has on his ability to secure and follow a substantially gainful occupation. All findings and conclusions should be set forth in a legible report. 3. After completion of the development requested above, as well as any additional development deemed necessary has been completed, to include clarification of the actual rating of the Veteran's service-connected hypertension, the record should again be reviewed. If the benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and be given the opportunity to respond thereto. The case should then be returned to the Board, if in order, for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ STEVEN D. REISS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs