Citation Nr: 20021021 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 10-11 361 DATE: March 24, 2020 ORDER Service connection for postoperative residuals of an occipital meningioma and a pituitary microadenoma is denied. Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran’s postoperative residuals of an occipital meningioma and a pituitary microadenoma were not present during service or for many years thereafter, and were not caused by an event, injury or disease incurred in service. 2. The Veteran’s hypertension did not have its onset in service, did not manifest within one year of service, and was not caused by an in-service event, disease, or injury. CONCLUSIONS OF LAW 1. The criteria for service connection for postoperative residuals of an occipital meningioma and a pituitary microadenoma have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force from March 1949 to July 1969. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office in Cleveland, Ohio. In June 2017, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. In September 2017, the Board remanded this appeal for further development. In August 2018, the Board denied the claims. The Veteran appealed. In January 2019, the United States Court of Appeals for Veterans Claims (the Court) granted a Joint Motion for Remand (JMR), vacating the August 2018 decision and remanding the matter for further development consistent with the terms of the JMR. In July 2019, the Board remanded the claims so that the ordered development could be accomplished. As the requested records have been obtained or determined to be unavailable, and the requested VA examinations have been completed, the Board finds that there has been substantial compliance with its July 2019 remand instructions. 1. Postoperative Residuals of an Occipital Meningioma and a Pituitary Microadenoma The Veteran seeks service connection for postoperative residuals of an occipital meningioma and a pituitary microadenoma. He asserts that he suffered from multiple head injuries playing football in service, and that his occipital meningioma and a pituitary microadenoma were caused by these injuries. He further asserts that he suffered from headaches in service and after service, and that his occipital meningioma and a pituitary microadenoma were also related to these headaches, or that the headaches were evidence that he suffered trauma in service. He indicates that he was treated for concussions at the Tachikawa Air Force Base in Japan in the early 1950s. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). The Board finds that the most probative evidence weighs against a finding that the Veteran’s occipital meningioma or a pituitary microadenoma had an onset in service or are related to an in-service event, injury, or disease. The Veteran’s service treatment records do not specifically show complaints, findings, or diagnoses of an occipital meningioma; a pituitary microadenoma; or head injuries. Such records do show that the Veteran was noted to play football daily, and that he was treated for headaches on two occasions. A September 1950 treatment entry notes that the Veteran complained of sexual impotence for the previous month. The examiner reported that the Veteran played football daily and that his sexual impotence was probably due to fatigue. There was a notation that the Veteran was prescribed vitamin therapy. A treatment entry, apparently dated in February 1955, indicates that the Veteran complained of headaches for several days’ duration. A diagnosis was not provided at that time. An October 1963 treatment entry notes that the Veteran was treated for a headache and a cold. The impression was rhinitis. On Reports of Medical History prepared in March 1965 and December 1968, the Veteran affirmatively stated that he did not suffer from severe or frequent headaches. His physical examinations performed in April 1952, March 1955, and December 1958 showed normal head, face, neck, and scalp; normal endocrine system; and normal neurologic system. Post-service treatment records show treatment for postoperative residuals of an occipital meningioma and for a pituitary microadenoma beginning in 1986, decades after the Veteran’s retirement. A December 1986 operation report from the Medical Center at Wright Patterson Air Force Base in Ohio indicates that the Veteran had a history of right-sided headaches, and that he underwent a work-up with a computed tomography scan. The examiner indicated that the computed tomography scan shows an enhancing mass in the right parietal area, and that a neurological examination shows subtile papilledema, with subtle weakness of the left psoas muscle, as subtle incoordination of the left upper extremity. The Veteran underwent a right parietotemporal occipital craniotomy and a total gross removal of a right tentorial meningioma. A January 1987 hospital narrative summary from the Medical Center at Wright Patterson Air Force Base in Ohio notes that the Veteran was admitted to undergo a craniotomy. The examiner reported that the Veteran had suffered a pressure-type sensation for the previous six months on the right side of his cranium. It was noted that such had been persistent throughout the day and that it would usually worsen at night. The examiner stated that the Veteran denied having any numbness or tingling, as well as any weakness. The examiner indicated that the Veteran also denied having visual and gait disturbances. The examiner related that a computed tomography scan of the Veteran’s head was performed in December 1986 and that it shows a 5-cm enhancing mass in the right parietal region. The examiner indicated that the Veteran underwent a right temporoparietal occipital craniotomy with a total gross removal of a right tentorial meningioma. The diagnosis was a tentorial meningioma. A June 1991 history and physical report from the Medical Center at Wright Patterson Air Force Base in Ohio indicates that the Veteran presented with a five-year history of a slow growing pituitary microadenoma which had been asymptomatic. The examiner indicated that the Veteran was status post a craniotomy for a right parieto-occipital meningioma in 1986 and that he had been followed by serial computed tomography scans and magnetic resonance imaging studies which revealed the pituitary microadenoma. It was noted that the microadenoma had recently undergone some suprasellar extension and that despite the Veteran being asymptomatic, a physician recommended resection at that time. The initial impression was extension of a pituitary microadenoma. A July 1991 narrative summary from the Medical Center at Wright Patterson Air Force Base in Ohio relates diagnoses of a pituitary tumor and status post resection of an occipital meningioma. The examiner indicated that the Veteran underwent a transnasal, trans-sphenoid hypophysectomy. Thus, the Veteran’s post-service medical records show that his pituitary tumor and occipital meningioma started well after his retirement from service. The most probative evidence of record concerning the nexus element of service connection are the VA examinations and medical opinions from October 2017 and October 2019, in which two VA examiners found that it is less likely than not that the Veteran’s pituitary tumor and occipital meningioma were incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. Both examiners reviewed the Veteran’s pertinent medical history and concluded that the Veteran’s status post a meningioma resection was not caused by, or related to, his active duty. The October 2017 VA examiner reasoned that the Veteran’s condition was diagnosed post-service in 1986. The October 2019 VA examiner also noted that the Veteran was not evaluated or treated for occipital meningioma or pituitary microadenoma during service, but further observed that there is no medical evidence supporting the conclusion that these disorders are caused by cranial trauma or any other service-connected activities. Moreover, the October 2019 VA examiner considered the Veteran’s reports of headaches during service but noted that there was no medical evidence of treatment for post-concussion, post craniotomy or stress headaches during service. Although the JMR noted that the October 2017 VA examination alone was not adequate because it lacked an adequate rationale, when coupled with the additional reasoning provided by the October 2019 VA examiner, the Board finds the opinions highly probative because, when taken together, they contain clear conclusions with supporting data and a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board further notes that there are no positive opinions of record as to the Veteran’s claim. The Veteran asserts that his postoperative residuals of an occipital meningioma and a pituitary microadenoma had their onset during his period of service. However, while the Veteran is competent to report symptoms that he thought were due to an occipital meningioma and a pituitary microadenoma during service, or after service, he is not competent to relate his currently claimed postoperative residuals of an occipital meningioma and a pituitary microadenoma to service. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional); Buchanan v. Nicholson, 451 F.3d. 1331 (Fed. Cir. 2006) (lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself). In the Veteran’s case, such a nexus opinion requires a certain level of expertise given the medically complex question. A lay opinion is not sufficient in this case to prove nexus. The Board acknowledges that the Veteran is competent to report that he suffered from headaches during service and thereafter, and the Board previously indicated that the Veteran’s statements appeared credible; however, after considering the October 2019 VA examiner’s statement that there is no evidence of such headaches in service when coupled with the Veteran’s own reports of a lack of such symptoms in service, the Board affords these recent assertions little probative value. See, e.g., Buchanan v. Nicholson, 451 F.3d 1331, 1337(Fed. Cir. 2006) (“[T]he Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc.) Although the Veteran has submitted statements in support of his claim indicating that he suffered from recurrent, severe headaches in service, he stated on multiple Report of Medical History forms completed in service that he did not suffer from frequent or severe headaches. Specifically, on the Reports of Medial History completed in March 1965 and at his retirement in December 1968, he checked the box “no” when asked if he ever had, or had at that time, “frequent or severe headaches.” The Board affords more probative value to the statements made during the Veteran’s service and at separation than to those statements made decades later and in furtherance of his claim for benefits. See Cartwright v. Derwinski, 2 Vet. App. 24 (1991) (noting that interest in the outcome of the proceedings “may affect the credibility of testimony”). In sum, the preponderance of the evidence is against the claim for entitlement to service connection for postoperative residuals of an occipital meningioma and a pituitary microadenoma; there is no doubt to be resolved; and service connection is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Hypertension The Veteran contends that he has hypertension that is related to service. He specifically maintains that he was told that he had elevated blood pressure readings and hypertension during service. See Scott, 789 F.3d at 1375. The Board finds that the most probative evidence of record weighs against the claim. The Veteran’s service treatment records do not specifically show complaints, findings, or diagnoses of a hypertension or elevated blood pressure readings. As noted by both the October 2017 VA examiner and the October 2019 VA examiner, the available records reveal that at the time of a December 1968 separation examination, the Veteran’s blood pressure reading was 114/72 and did not show hypertension. The examiners also indicated that there was no evidence of hypertension during the Veteran’s period of service. Both the October 2017 and the October 2019 VA examiners concluded that the Veteran’s hypertension was less likely than not caused by, or related to, his active duty. The examiners reported the available medical records indicated that the diagnosis of, and treatment for, hypertension occurred post-service. The examiners maintained that although the Veteran stated that his hypertension was diagnosed during service, such is not confirmed by his service treatment records, including a December 1968 separation examination report with a blood pressure reading of 114/72. Significantly, the October 2019 VA examiner considered all of the evidence of record, including all of the Veteran’s service treatment records and post-service records, as well the Veteran’s reports of experience severe stress during service. The VA examiner found no evidence of hypertension based on the blood pressure readings found in the service treatment records. In an addendum medical opinion obtained in December 2019, the VA examiner noted that the medical records show numerous instances of normal blood pressures throughout service. The Board finds the October 2019 VA examiners’ opinions given in October 2019 and in December 2019, taken together, are highly probative as they contain clear conclusions with supporting data and a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Veteran essentially reports that his hypertension had its onset during service. However, while the Veteran is competent to report symptoms that he thought were due to hypertension during service, or after service, he is not competent to relate his currently claimed hypertension to service. Jandreau, 492 F.3d at 1372 (lay evidence can be competent and sufficient to establish a diagnosis of a condition when a layperson is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional); Buchanan, 451 F.3d. at 1331 (lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself). In the Veteran’s case, such a nexus opinion requires a certain level of expertise given the medically complex question. A lay opinion is not sufficient in this case to prove nexus. (Continued on the next page)   The weight of the competent shows that the Veteran’s hypertension began many years after his period of service and was not caused by any incident of service. The Veteran’s hypertension was neither incurred in nor aggravated by service. Moreover, there is no evidence that the Veteran’s hypertension became manifest within one year of service, and thus service connection is not warranted on a presumptive basis. In sum, the preponderance of the evidence is against the claim for entitlement to service connection for hypertension; there is no doubt to be resolved; and service connection is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.N.W. 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.