Citation Nr: 18147900 Decision Date: 11/08/18 Archive Date: 11/06/18 DOCKET NO. 16-38 810 DATE: November 8, 2018 REMANDED Entitlement to service connection for cerebellar hemangioblastoma (residuals of brain tumor) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2002 to April 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada. That rating decision denied service connection for cerebellar hemangioblastoma (residuals of brain tumor). Service connection for cerebellar hemangioblastoma (residuals of brain tumor) is remanded. The Board regrets the delay that will result from remanding rather than immediately deciding this claim, but additional action is necessary before the Board proceeds. VA’s duty to assist requires it to make reasonable efforts to assist a claimant in securing evidence necessary to substantiate his or her benefits claim. 38 U.S.C § 5103A(a)(1). The Veteran had a hemangioblastoma removed from her cerebellum in April 2013 which she asserts was caused by exposure to toxic agents during deployment in Iraq and Kuwait during the Gulf War. As a result of that tumor and its subsequent removal the Veteran reports severe headaches, an inability to concentrate, and neck pain. The Veteran does not state specifically what toxins she was exposed to nor does the supporting August 2013 private medical opinion identify any toxins that may have caused the brain tumor. There is no indication in the record that any development was accomplished which concerns the Veteran’s claimed toxin exposure. Accordingly, efforts should be made to verify toxin exposure on a factual basis. VA’s duty to assist requires it to provide a medical examination or obtain a medical opinion if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (A) contains competent lay or medical evidence of a current diagnosed disability; (B) establishes that the Veteran experienced an event, injury or disease in service; and (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease. 38 C.F.R. § 3.159(c). Here, the Board recognizes that the Veteran has submitted an August 2013 opinion by a treating physician that her present condition is likely related to her service. However, for a medical opinion to be adequate it must not only contain clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Board finds the Veteran credible to describe the activities she performed while serving in the Gulf War, however, in this case, the exact nature of the various chemicals which the Veteran may have been exposed to in service has not been established. The August 2013 private medical opinion finds a nexus between the current disability and military service to be likely. However, it is unclear which “toxic agents,” if any, were the basis of this opinion or what in the Veteran’s records made the examiner believe the current disability is related to service. On remand an opinion should be sought, and the Veteran should be given the opportunity to have the private physician submit an addendum statement considering more fully the other relevant facts in arriving at a conclusion. The matter is REMANDED for the following action: 1. Contact the Veteran and request that she identify any outstanding records of pertinent medical treatment from VA or private health care providers. Follow the procedures for obtaining the records, as set forth by 38 C.F.R. § 3.159(c), and obtain VA Form 21-4142 releases if necessary. If any outstanding records are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 2. Contact the Veteran and her representative and request that she provide approximate dates, locations, and nature of alleged toxin exposure. Additionally, apprise her of her right to seek an addendum opinion from her private physician. Ideally, that opinion should clearly state, for any exposure, the nature of the toxic exposure and whether it at least as likely as not resulted in the Veteran’s current residuals of the cerebellar hemangioblastoma. The physician is encouraged to discuss factors such as the Veteran’s family history, literature supporting a relation between cerebellar hemangioblastoma and toxin exposure, and specifically, what in the Veteran’s records supports the conclusion. 3. Undertake appropriate development to verify any toxin exposure the Veteran may have experienced while in in Kuwait and Iraq. Any formal findings should be documented in writing and associated with the claims file. If there is insufficient information to verify exposure, issue a formal finding outlining the steps taken to assist the Veteran and the Veteran should be notified of any inability to verify exposure to toxins in service. 4. Schedule the Veteran for a VA examination with a medical doctor for a medical opinion regarding the etiology of the Veteran’s cerebellar hemangioblastoma. The specialist is requested to review all evidence on file, including any articles submitted by the Veteran in support of the claim. The examiner is requested to opine whether it is at least as likely as not (50 percent probability or greater) that the cerebellar hemangioblastoma is etiologically related to any incident of service, to include in-service toxin exposure. The Veteran’s medical history and any post-service exposures to toxins should also be considered, if shown in the record. A rationale is requested for any opinion and should include citation to evidence of record, medical treatise evidence, and known medical principles. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mondesir, Law Clerk