Citation Nr: 18154717 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 14-39 818 DATE: November 30, 2018 ORDER Service connection for residuals of a brain aneurysm is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s brain aneurysm is related to active service, to include a physical assault during service. CONCLUSION OF LAW The criteria for service connection for residuals of a brain aneurysm have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1977 to December 1977. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2012 rating decision by the Department of Veterans Affairs (VA). In a November 2014 substantive appeal, the Veteran requested a hearing before the Board. Thereafter, in February 2016, the Veteran withdrew his hearing request. Accordingly, the Board finds that his hearing request has been withdrawn. See 38 C.F.R. § 20.704(d), (e). 1. Entitlement to service connection for residuals of a brain aneurysm In 2011, the Veteran suffered from a right middle cerebral artery (MCA) brain aneurysm. The Veteran contends that his aneurysm is due to a physical assault he suffered from during military service. The Board concludes that, while the Veteran has a current diagnosis of a brain aneurysm, and evidence shows that the Veteran was physically assaulted during military service, the preponderance of the evidence weighs against finding that the Veteran’s aneurysm began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Initially, the Board notes that the Veteran is not asserting, and the evidence does not suggest, that his aneurysm began during service or has continued since military service. Instead, he specifically asserts that his aneurysm from 2011 is the delayed result of a physical assault he suffered from in 1977. The Veteran’s physical assault in 1977 already forms the basis of his stressor for his service-connected posttraumatic stress disorder. According to the Veteran, when he was lying down on his bunk, he was pulled off and kicked by others in the ribs and face. They also hurt his fingers when he tried to defend himself. He suffered from a swollen face, busted lip, and a bloody nose. As a result, he had three days of bed rest. The Board notes that the Veteran underwent another significant event in June 2004 after he was in a motorcycle crash. An August 2004 medical record documents that he fell from his motorcycle at 50 miles per hour with no helmet. He fell and hit the left side of his head against the pavement. He could not move all of his extremities at the scene of the accident was diagnosed with resulting cervical spondylosis with recent central cord syndrome. The question for the Board is whether the Veteran’s aneurysm is etiologically related to his physical assault during service or whether it is instead related to any intervening factors. The Board concludes that the Veteran’s aneurysm is etiologically related to a severe motorcycle crash in August 2004 rather than his physical assault during military service. As a result of the Veteran’s complex medical history, the Board requested a specialized medical opinion from the Veteran’s Health Administration (VHA) to determine the etiology of the Veteran’s brain aneurysm. In July 2018, the neurosurgeon provided an opinion that the Veteran’s aneurysm is less likely than not due to trauma that the Veteran suffered from his physical assault during service. Instead, the neurosurgeon concluded that there is a more likely causal relationship to the Veteran’s last major trauma, which was the motorcycle crash that led to his cervical fractures. The neurosurgeon stated that it is clear from the Veteran’s treatment notes that it was an unruptured aneurysm rather than a dissecting aneurysm. However, regardless of whether it was an unruptured or dissecting aneurysm, the neurosurgeon stated that he would still find that it is most likely from the motorcycle crash. The neurosurgeon also stated that it could also be a non-traumatic aneurysm, but the Board notes that in such a case, that it would still have no relationship to the physical assault during service. The neurosurgeon’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board acknowledges that the Veteran submitted a medical opinion from a VA director of cerebrovascular neurological surgery. In that opinion, the physician stated that the Veteran had a military history with reported traumatic injuries. The physician thought the aneurysm was possibly connected to his military trauma as trauma can cause intracranial arterial dissections with aneurysm formation. However, as noted by the VA neurosurgeon, it appears that the Veteran did not relay the history of his significant motorcycle crash and that the physician did not adequately review the Veteran’s medical chart that contained information about the motorcycle crash. The Board concurs and finds that the physician’s lack of knowledge regarding the severe motorcycle crash renders the opinion to be of significantly less probative value. In any event, to the extent that the physician stated that the Veteran’s current disorder was “possibly” related to in-service injuries, such a statement is speculative, in insufficient for service-connection purposes. Additionally, the Board recognizes the argument by the Veteran’s representative that cites the VHA neurosurgeon’s admission that he was not 100 percent certain that the Veteran’s aneurysm was not a dissecting aneurysm. In his opinion, the VA neurosurgeon requested to be able to view the operative notes and reports to make that confirmation. The representative casts doubt on the probative value of the opinion based on the above statement. However, the VHA neurosurgeon himself said that it was actually immaterial which type of aneurysm it was as it would still be most likely that the aneurysm is due to the motorcycle crash. Moreover, the Board notes that VA is only required to show that the preponderance of the evidence is against the Veteran’s claim. VA is not required to grant benefits in cases simply because it has less than absolute certainty. While the Veteran believes his aneurysm is related to an in-service injury, event, or disease, including his physical assault during service, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires advanced medical knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).   The Board finds that the weight of the competent evidence does not attribute the Veteran’s brain aneurysm to military service despite his contentions to the contrary. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Borman, Associate Counsel