Citation Nr: 18144961 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 18-02 764 DATE: October 25, 2018 ORDER Entitlement to service connection for medulloblastoma, also claimed as tumors on the cerebellum, is granted. REMANDED Entitlement to service connection for left shoulder pain is remanded. Entitlement to service connection for right shoulder pain is remanded. Entitlement to service connection for neck pain is remanded. Entitlement to service connection for left knee is remanded. Entitlement to service connection for right knee is remanded. Entitlement to service connection for left ankle pain is remanded. Entitlement to service connection for right ankle pain is remanded. Entitlement to service connection for sore left heel is remanded. Entitlement to service connection for sore right heel is remanded. Entitlement to an initial rating in excess of 10 percent for lumbosacral strain and arthritis of the thoracolumbar spine is remanded. FINDING OF FACT It is at least as likely as not that the Veteran’s medulloblastoma had its onset during his active duty wartime service. CONCLUSION OF LAW The criteria for service connection for medulloblastoma, also claimed as tumors on the cerebellum, have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 2010 to August 2013. He received the Army Commendation Medal; Army Achievement Medal; Meritorious Unit Commendation; Army Good Conduct Medal; National Defense Service Medal; Afghanistan Campaign Medal with two campaign stars; Global War on Terrorism Service Medal; Army Service Ribbon; Overseas Service Ribbon; and, NATO Medal. Service Connection for Medulloblastoma Direct service connection generally requires credible and 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. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). The Veteran has submitted evidence of a diagnosis of medulloblastoma. See August 2016 Private Treatment Records, p. 6. Accordingly, the Board finds that the first element of service connection is established. See Holton, 557 F.3d at 1366. The Board also finds that the evidence regarding in-service incurrence and nexus is at least in equipoise. Specifically, the Veteran submitted a private opinion dated in March 2016 that indicated that it is likely that the Veteran’s medulloblastoma tumor likely started while he was in service and that it grew over a period of time until it was symptomatic enough to warrant treatment. See August 2016 Private Treatment Records, p. 1. As there is no evidence to the contrary, the Board finds that the evidence is at least in equipoise. When the evidence for and against a claim is in relative equipoise, the Board has an obligation to resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1. Vet. App. 49 (1990). In resolving all reasonable doubt in the Veteran’s favor, the Board finds that the second and third elements of service connection are established. See Holton, 557 F.3d at 1366. Accordingly, service connection for medulloblastoma, also claimed as tumors of the medulla, is warranted. REASONS FOR REMAND Service Connection for Bilateral Shoulder Pain, Neck Pain, Bilateral Knee Pain, Bilateral Ankle Pain, and Bilateral Sore Heel The Veteran has not been afforded a VA examination in connection with the claims for service connection for disabilities of his bilateral shoulders, neck, bilateral knees, bilateral ankles and bilateral heels. The evidence demonstrates that the Veteran has reported pain and functional impairment in each of these body parts, but there is no clear current diagnosis for any of these conditions. Moreover, he contends that his in-service physical training and work responsibilities caused these impairments and submitted several buddy statements which corroborate his contentions. See May 2016 Statement in Support of Claim, pp. 1-2; See March 2016 Statement in Support of Claim, p. 1; May 2016 Statement in Support of Claim, p. 1; May 2016 Statement in Support of Claim, p. 1. Accordingly, on remand the Veteran should be afforded an opportunity to undergo VA examinations to determine the nature and etiology of these conditions. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Increased Rating for Lumbosacral Strain and Arthritis of the Thoracolumbar Spine During the June 2016 and December 2015 VA examinations, the Veteran reported experiencing flare-ups of back pain. Both examination reports indicated that it was not possible to predict the potential loss of range of motion manifested as a consequence of a flare outside the clinical setting. However, neither examiner elicited information from the Veteran about the flares’ severity and functional loss manifestations. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). On remand, the Veteran should be afforded a new examination that fully addresses all functional impairment which results from flare-ups of the Veteran’s back disability. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to ascertain the nature and etiology of his bilateral shoulder pain. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. The examiner must elicit a complete history of the Veteran’s bilateral shoulder pain, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that addresses the following: (a) Identify all diagnoses that pertain to the Veteran’s bilateral shoulder pain. (b) For each diagnosis identified, is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral shoulder disability was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s service? The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 2. Schedule the Veteran for an examination to ascertain the nature and etiology of his neck pain. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. The examiner must elicit a complete history of the Veteran’s neck pain, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that addresses the following: (a) Identify all diagnoses that pertain to the Veteran’s neck pain. (b) For each diagnosis identified, is it at least as likely as not (50 percent probability or greater) that the Veteran’s neck disability was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s service? The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 3. Schedule the Veteran for an examination to ascertain the nature and etiology of his bilateral knee pain. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. The examiner must elicit a complete history of the Veteran’s bilateral knee pain, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that addresses the following: (a) Identify all diagnoses that pertain to the Veteran’s bilateral knee pain. (b) For each diagnosis identified, is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral knee disability was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s service? The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 4. Schedule the Veteran for an examination to ascertain the nature and etiology of his bilateral ankle pain. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. The examiner must elicit a complete history of the Veteran’s bilateral ankle pain, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that addresses the following: (a) Identify all diagnoses that pertain to the Veteran’s bilateral ankle pain. (b) For each diagnosis identified, is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral ankle disability was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s service? The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 5. Schedule the Veteran for an examination to ascertain the nature and etiology of his bilateral sore heels or heel pain. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. The examiner must elicit a complete history of the Veteran’s bilateral sore heels or heel pain, and the examination report should include a discussion of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that addresses the following: (a) Identify all diagnoses that pertain to the Veteran’s bilateral sore heels or heel pain. (b) For each diagnosis identified, is it at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral heel disability was incurred in, aggravated by, or is otherwise etiologically related to the Veteran’s service? The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 6. Schedule the Veteran for an examination to ascertain the severity of the Veteran’s service-connected back disability. All indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion. (a) The examiner should describe all symptomatology due to the Veteran’s service-connected back disability. (b) The examiner must comment as to whether there is pain, weakened movement, excess fatigability, or incoordination on movement. The examiner should also note the degree to which any additional range of motion is lost due to (1) pain on use, including during flare-ups; (2) weakened movement; (3) excess fatigability; or (4) incoordination. IF THE EXAMINATION DOES NOT TAKE PLACE DURING A FLARE-UP, THE EXAMINER MUST GLEAN INFORMATION REGARDING THE FLARES’ SEVERITY, FREQUENCY, DURATION, AND FUNCTIONAL LOSS MANIFESTATIONS FROM THE VETERAN, MEDICAL RECORDS, AND OTHER AVAILABLE SOURCES. THE EXAMINER MUST PROVIDE THE DEGREE TO WHICH RANGE OF MOTION IS LOST DURING A FLARE-UP AND MUST DESCRIBE ANY OTHER FUNCTIONAL IMPAIRMENT DUE TO FLARE-UPS. EFFORTS TO OBTAIN SUCH INFORMATION MUST BE DOCUMENTED. If the Veteran denies any additional pain and/or functional limitation, such should be noted in the report. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W.V. Walker, Associate Counsel