Citation Nr: 20021993 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 18-20 455 DATE: March 30, 2020 ORDER Entitlement to service connection for spinal schwannomas is granted. FINDINGS OF FACT 1. The Veteran served in-country in Vietnam during the Vietnam War. 2. The Veteran’s diagnosed schwannomas are related to active service. CONCLUSION OF LAW The criteria for service connection for spinal schwannomas have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from August 1964 to July 1966. In March 2020, the Veteran testified before the undersigned at a Board of Veterans’ Appeals (Board) videoconference hearing. A transcript of the hearing will be associated with the record. Service Connection The Veteran seeks service connection for spinal schwannomas, a form of soft-tissue sarcoma, which he claims are due to his exposure to herbicide agents in Vietnam. For the following reasons, the Board finds that service connection is warranted. 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 service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). In addition, several statutory presumptions operate in connection with section 1110. Of particular relevance, 38 U.S.C. § 1116 provides that, if a veteran was exposed to herbicide agents, to include Agent Orange, during service, certain listed diseases, including soft-tissue sarcomas, are presumptively service-connected. 38 U.S.C. § 1116(a)(1), (a)(2); 38 C.F.R. § 3.309(e). For purposes of this case, the Board notes that the term soft-tissue sarcoma includes malignant schwannomas. 38 C.F.R. § 3.309(e). First, the evidence shows that the Veteran was diagnosed with benign schwannoma. Thus, the first element of service connection has been met. See Holton, supra. Second, the record demonstrates that the Veteran served in-country in Vietnam during the Vietnam War. He is therefore presumed to have been exposed to herbicide agents, including Agent Orange, in service. See 38 C.F.R. § 3.307(a)(6)(iii). Thus, the second element of service connection has been met. See Holton, supra. With regard to presumptive service connection, the RO denied the claim on the basis that the Veteran did not have a current diagnosis of malignant schwannoma, noting that his schwannomas were observed to be benign. Therefore, the RO held, the presumption laid out above could not be applied in the Veteran’s favor. The Board notes that this denial was based in part on negative opinions provided by VA examiners in January 2016 and May 2016. On review, however, these opinions did not consider results from a biopsy performed by private medical providers. As such, the opinions do not constitute probative evidence in this matter. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (medical opinions are regarded as more probative when they include clear conclusions and supporting data with a reasoned analysis connecting the data and the conclusions). The Board notes that medical evidence of record suggest that the Veteran’s soft-tissue sarcoma may not be “benign”; indeed, as illustrated by January 2019 MRI results and physician letters, it appears the mass is growing and causing the Veteran painful symptoms. Nonetheless, even assuming that the Veteran’s condition is benign and therefore not necessarily presumptively related to service, the Board finds that the evidence of record still supports a finding of nexus. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The record includes multiple positive opinions from the Veteran’s private physicians, supportive lay evidence, and compelling testimony from the Veteran’s spouse who is a medical professional. These include a November 2015 letter confirming the diagnosis of a “large tumor in the sacral spine,” characterized as left sacral schwannoma, as well as multiple smaller schwannomas along the lumbar and cervical spine; an October 2015 letter noting the Veteran’s service in Vietnam and acknowledging that exposure to Agent Orange was a “suspect causative agent” in the development of his soft-tissue sarcoma; and a June 2018 letter indicating the Veteran was experiencing “symptoms in the form of sensory paresthesias of the leg and foot” as a result of the mass within his sacrum. Also of record is a January 2019 MRI report which revealed a “stable mildly enhancing expansile mass along the S1 nerve root which has been characterized as schwannoma.” The Veteran and his spouse have testified that physicians have advised them that because of the slow growth of the tumor and its current large size, it is possible that the tumor originated during service, and that after genetic testing, the Veteran was found not to carry the gene for schwannoma. The Board has considered remanding the claim to obtain a more definitive opinion as to nexus, however, given the positive medical opinions, the lay evidence of record, and the lack of adequate medical evidence to the contrary, the Board find that the evidence is, at minimum, in equipoise regarding the question of whether the Veteran’s schwannoma is related to service. 38 U.S.C. § 1131. The benefit of the doubt will be conferred in the Veteran’s favor, and remand is not necessary. 38 U.S.C. § 5107(b). In light of the above evidence, the Board finds that service connection for the Veteran’s spinal schwannomas is warranted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Minot, 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.