Citation Nr: 20008015 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 16-19 002A DATE: January 30, 2020 REMANDED Entitlement to service connection for left parietal meningioma, to include as secondary to in-service ionizing radiation and/or chemical exposure, is remanded. Entitlement to service connection for parasagittal arteriovenous fistula (AVF) with headaches, to include as secondary to left parietal meningioma, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1980 to September 1992 and has additional service in the Reserves. In November 2019, the Veteran and his spouse testified at a Department of Veterans Affairs (VA) Board of Veteran’s Appeals (Board) hearing before the undersigned Veterans Law Judge (VLJ) seated at the VA Regional Office (RO). Entitlement to service connection for left parietal meningioma, to include as secondary to in-service ionizing radiation and/or chemical exposure, and entitlement to service connection for AVF with headaches, to include as secondary to left parietal meningioma, is remanded. The Veteran asserts that his brain tumor, his left parietal meningioma, is related to service. In a February 2012 statement, he asserted that in July 2007, following several month of symptoms, he was diagnosed with a large meningioma on the left lobe, corrected by surgery. He reported that in 2010, he began to experience intermittent severe headaches and was diagnosed in January 2011 with AVF in the same general area as the meningioma, corrected by surgeries. He reported that his surgeons believe that the meningioma and AVF are related due to the growth of the meningioma over many years causing trauma and abnormal blood flow that created the AVF, or that the trauma associated with the surgery on the meningioma itself caused the AVF to form. He reported that while the causes of meningiomas are largely unknown, exposure to ionizing radiation is known to be positively correlated with meningioma occurrence. He asserted that he believed that either his in-service exposure to ionizing radiation, service in the Persian Gulf with exposure to oil well fires, or service aboard ship with exposure to spraying jet fuel, may have played a role in creating his meningioma. In a February 2012 statement, the Veteran’s spouse asserted that meningiomas are slow-growing tumors and often exist for many years, sometimes decades, and are not discovered until they present with symptoms; and that the Veteran’s meningioma was quite large, meaning that it had been around for a long time. She also asserted that the Veteran’s meningioma could be related to an in-service 1984 trauma wherein the Veteran fell, hit his head, and lost consciousness. In an undated Report of General Information, the RO recorded the Veteran’s assertion that his AVF was also due to his in-service head injury. In a February 2012 Radiation Risk Assessment, the Veteran self-reported his claimed in-service exposure to ionizing radiation and other chemicals during his active service dated. He reported that he was exposed to ionizing radiation aboard the USS Bergall in 1978, the USS Kitty Hawk from 1982 to 1984, the USS Blue Ridge in 1978, and the USS Eisenhower from 1987 to 1989. He reported exposure to chemicals, including smoke, particulates from oil well fires. In a December 2012 statement, the Veteran asserted that he had a fairly significant fall and head injury with loss of consciousness during service in 1984. He reported that prior to such, he was aboard the USS Eisenhower from 1991 to 1992 and exposed daily to smoke, chemicals, blowing sand from oil wells, and greasy and gritty black film, and that flights took him in close proximity to smoke clouds from oil wells. He asserted that studies have shown a correlation between head trauma and meningioma. A June 2013 response from the Department of Navy Naval Dosimetry Center indicates that the Navy estimated the Veteran’s in-service exposure to ionizing radiation considering exposure dated from September 1983 to December 1983. Of record is a July 2013 request from the Director, VA Compensation Service, to the VA Under Secretary for Health for an etiological opinion, considering the Veteran’s service aboard the USS Kitty Hawk from January 1984 to August 1994 and the Navy’s June 2013 estimate. It does not appear that the RO sought an estimate that considers the Veteran’s assertions as to in-service exposure to ionizing radiation beyond that of any time from September 1983 to December 1983. On remand, the RO should conduct the appropriate development to obtain an updated estimate that considers such, including a determination of the Veteran’s duty status in 1978, a time during which it appears the Veteran was a student at the US Naval Academy, prior to his enlistment into active service in May 1980, a time during which he asserts he was aboard the USS Bergall and USS Blue Ridge in 1978 and exposed to ionizing radiation. It also does not appear that the RO should an etiological opinion as to whether the Veteran’s left parietal meningioma is related to either his in-service head injury or in-service exposure to chemicals beyond that of ionizing radiation. The Veteran’s service treatment records dated in July 1984 indicate that he presented intoxicated, having fallen down stairs and hitting the back of his head, resulting in a loss of consciousness. He was diagnosed with a cerebral concussion and had was treated with sutures for a occipital laceration. On remand, the RO should afford the Veteran a VA examination and obtain adequate etiological opinions as to whether his left parietal meningioma and/or AVF is related to service, considering his in-service exposure to ionizing radiation, chemicals, smoke, oil particulates, and jet fuel, and/or his in-service head injury, and whether his AVF is secondary to his left parietal meningioma. The most recently dated VA treatment records available for Board review are dated in July 2017; on remand, the RO should obtain the Veteran’s updated VA treatment records. In April 2011, the Veteran authorized VA to obtain his private treatment records from Drs. Weingart and Laterra at Johns Hopkins University, and in February 2012, he authorized VA to obtain his private treatment records from Drs. Tamargo and Gandhi from Johns Hopkins University. Of record are some limited private treatment records from Johns Hopkins University, however, it is unclear if the Veteran or Johns Hopkins University submitted such. On remand, the RO should seek the Veteran’s complete private treatment records from Johns Hopkins University. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 2017 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for his outstanding private treatment records from physicians at Johns Hopkins University. Inform him that his prior authorization cited Drs. Weingart, Laterra, Tamargo, and Gandhi, and it is unclear if he or Johns Hopkins University submitted the limited private treatment records currently associated with the claims file. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Conduct the appropriate development to obtain an updated estimate of the Veteran’s in-service ionizing radiation that considers his assertions that he was so exposed aboard the USS Bergall in 1978, the USS Kitty Hawk from 1982 to 1984, the USS Blue Ridge in 1978, and the USS Eisenhower from 1987 to 1989. In this regard, the RO should determine the Veteran’s duty status in 1978, prior to his enlistment into active service in May 1980. 4. Then, once the updated estimate of in-service ionizing radiation has been obtained from the appropriate agency, the RO should conduct the appropriate development to obtain an adequate etiological opinion from the appropriate party as to whether the Veteran’s left parietal meningioma is at least as likely as not related to any in-service exposure to ionizing radiation. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the etiology of his left parietal meningioma and his AVF. All indicated tests and studies must be completed. (a) The examiner must opine as to whether the Veteran’s left parietal meningioma and/or AVF is/are at least as likely as not related to an in-service injury, event, or disease. In this regard, the examiner must specifically consider: (1) the Veteran’s in-service service in the Persian Gulf and exposure to chemicals, smoke, oil particulates, and jet fuel; (2) his July 1984 in-service head injury wherein he fell down stairs and hit the back of his head, resulting in a loss of consciousness, and was diagnosed with a cerebral concussion and was treated with sutures for a occipital laceration; and (3) and the lay statements that meningiomas are slow-growing and present for years prior to symptoms presenting, and that his meningioma was large such that it must have been present for many years prior to diagnosis. (b) If the left parietal meningioma is a brain tumor, the examiner must opine as to whether it is at least as likely as not that the Veteran’s left parietal meningioma: (1) manifested within one year of separation from service in September 1992; or (2) was noted during service with continuity of the same symptomatology since service, considering the lay statements that meningiomas are slow-growing and present for years prior to symptoms presenting, and that his meningioma was large such that it must have been present for many years prior to diagnosis. (c) As to the Veteran’s AVF, the examiner must opine as to whether such is at least as likely as not: (1) proximately due to the Veteran’s left parietal meningioma, or (2) aggravated beyond its natural progression by the Veteran’s left parietal meningioma, considering the lay statements that the growth of the left parietal meningioma over many years caused trauma and abnormal blood flow that created the AVF, or that the trauma associated with the surgery on the left parietal meningioma itself caused the AVF to form. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.