Citation Nr: 20004841 Decision Date: 01/23/20 Archive Date: 01/21/20 DOCKET NO. 18-02 013 DATE: January 23, 2020 ORDER Entitlement to service connection for a lipoma of the right-side abdomen is granted. REMANDED Entitlement to service connection for bilateral pes planus is remanded. FINDING OF FACT The competent and credible evidence of record indicates the lipoma of the right-side abdomen developed after blunt trauma to the area in service. CONCLUSION OF LAW The criteria for service connection for a lipoma of the right-side abdomen have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from July 1954 to July 1956. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2019. This case was previously before the Board in June 2019, when it was remanded for Agency of Original Jurisdiction (AOJ) development. The case has been returned to the Board for further appellate review. Entitlement to service connection for a lipoma of the right-side abdomen Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also 38 C.F.R. § 3.303, Hickson v. West, 12 Vet. App. 247, 252-53 (1999). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Here, the Veteran filed a claim in June 2016 for service connection for “knot on right side of abdomen due to injury with a crane” while serving with the Army Engineering Unit in England. The Board notes the Veteran also filed a claim in June 1972 for “right side near stomach been bothering Veteran” and noted that he was hospitalized in England for this condition in 1955. At the April 2019 Board hearing, the Veteran testified that he was building a runway in approximately April 1955 when he was struck in the side by an object being moved by a crane. He testified that he sought treatment for the injury approximately two weeks later, as it continued to bother him, and he was hospitalized for approximately two weeks for treatment. The Veteran testified that he continued to experience residuals from this injury to the present, and treated it using a variety of methods, including soaking and ice packs. The Veteran’s 55-year-old daughter also testified at the hearing, reporting that the Veteran had always had the knot on his side as long as she could remember, and that it continued to grow larger. The Veteran submitted a written statement from a fellow servicemember who was with the Veteran when he sustained the injury to his side. The servicemember reported that the Veteran was struck in the side by a crane while working on a strip of concrete being laid on an airstrip, and that he was hospitalized for days. The Board notes that the Veteran’s service treatment records do not contain any notation of treatment for an injury to his right side. There is treatment in June 1955 for pain in the left side, which resulted in hospitalization and a diagnosis of herpes zoster. The Veteran’s July 1956 separation examination does not note any irregularities of the skin or abdomen. The Board further notes that the Veteran’s service treatment and personnel records were apparently destroyed in the 1973 fire at the National Personnel Record Center, and the records available for upload to the claims folder may be incomplete. An April 2019 treatment note in the Veteran’s private treatment records indicates a diagnosis of chronic lipomatous mass of the right flank, measuring approximately 30 by 30 centimeters. The private physician noted that the mass may have resulted from being hit during military service many years ago. In July 2019, the Veteran attended a VA examination in conjunction with this claim, at which the examiner identified a diagnosis of lipoma. The Veteran reported having been struck in the right side by a piece of pipe being moved by a crane and seeking treatment a few days later. He reported being treated in the hospital for approximately two weeks but did not recall the diagnosis or type of treatment. The Veteran reported that he experienced intermittent discomfort and development of an enlarging mass in the area of the injury since service. The examiner opined that the current lipoma is unrelated to the herpes zoster diagnosed during service, as he was treated for several days and recovered. The examiner noted medical research indicating that lipomas are benign tumors of mature adipose cells which may occur on any part of the body and which tend to enlarge over time. The examiner further noted that etiology and pathogenesis of lipomas are still unknown, although one study noted a link between blunt soft tissue trauma and formation of lipomas, in that 31 of 170 patients presenting with lipomas reported previous blunt trauma. The examiner noted that the study concluded that the mechanisms leading to the formation of lipomas remain unclear. Based on this study and on the lack of documentation of soft tissue trauma in the service treatment records, the examiner opined that the Veteran’s right-side lipoma is less likely than not caused by active service. In August 2019, VA sought an addendum opinion from another VA examiner, who opined that lipomas are not related to trauma, but did not provide any rationale for this conclusion. After review of the evidence of record and resolving reasonable doubt in favor of the Veteran, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s current lipoma was caused by the injury in service or had its onset during service. To begin with, the Veteran is competent to report that the mass on his side appeared after he was hit by the crane. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (except in limited circumstances, a layperson is not competent to provide evidence of diagnoses); see also Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (a layperson is competent to offer an opinion on simple medical conditions). The formation and persistent enlargement of a “knot” on his right side is something observable by a layperson. Although there is no record of right-side pain or injury in his service treatment records, the Veteran consistently reported that he was struck on his right side by an object being moved by a crane during service. Supporting this contention is the written statement from his fellow servicemember who served with the Veteran, as well as the Veteran’s previous service connection claim in June 1972 claiming pain in his right side for which he was treated in England. The Board thus finds the Veteran’s reports of an in-service injury to his right side to be credible. Next, the medical evidence shows that, in some cases, traumas are thought to be the cause of lipomas, although the cause of all lipomas is not medically certain. Although the July 2019 VA examiner opined that the Veteran’s lipoma was not caused by blunt trauma to the area in service, this opinion was premised on there being no documentation of the injury. As noted above, the Board finds the Veteran’s reports of such an injury credible and therefore concedes the occurrence of the in-service blunt trauma to the right side. The Veteran has further credibly stated that the lesion on his right side developed after the in-service trauma and has persisted since. This report is supported again by the June 1972 service connection claim as well as by the testimony of the Veteran’s daughter. The “knot” is now diagnosed as a lipoma. As there is competent and credible evidence of the lipoma forming after blunt trauma in service and persisting since, the Board finds that service connection is appropriate, as the evidence indicates the lipoma had its onset in service. See 38 C.F.R. § 3.303(d). REASONS FOR REMAND Entitlement to service connection for bilateral pes planus is remanded. In the prior remand, the Board directed the RO to obtain an examination to determine whether the Veteran’s pes planus was aggravated beyond the natural progression of the disability during service. The examiner based a negative aggravation opinion solely on the lack of medical treatment for the condition during and after service, despite noting the Veteran’s reports of foot pain during service. In other words, the examiner appears to have impermissibly dismissed the Veteran’s otherwise competent and credible reports of foot pain solely because these complaints were not documented in service treatment records. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (that reports of symptomatology are not supported by contemporaneous clinical evidence does not render them inherently not credible). The Board notes that, at the April 2019 hearing, the Veteran specifically testified that he did not seek treatment and attempted to alleviate the foot pain on his own. Therefore, a new examination is necessary to obtain an adequate opinion regarding whether the pre-existing pes planus disability was aggravated beyond the natural progression of the condition by service. The matter is REMANDED for the following action: Schedule the Veteran for an examination with an appropriate clinician who has not previously evaluated the Veteran to determine whether the pes planus disability was aggravated by military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine: (a) whether it is at least as likely as not (50 percent or greater probability) that the pes planus disability increased in severity in service; and (b) if an increase in severity is found, whether any increase in severity was clearly and unmistakably (undebatable) due to the natural progress of the condition. In providing the above opinions, the examiner must elicit and address the Veteran’s lay statements describing the foot pain he experienced in service as well as since discharge from service. The examiner should address any other pertinent evidence of record, including the Veteran’s April 2019 Board hearing testimony and medical treatment and evaluations in the record since service. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Josey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.