Citation Nr: 21062027 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-54 351 DATE: October 6, 2021 REMANDED Entitlement to service connection for Paget's disease (claimed as abnormal skull, residuals of meningioma tumor) to include as secondary to service-connected benign brain tumor is remanded. Entitlement to service connection for mass in lungs is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1977 to October 1980 and from January 1988 to September 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. 1. Entitlement to service connection for Paget's disease is remanded. 2. Entitlement to service connection for mass in lungs is remanded. In this case, the Veteran seeks service connection for Paget's disease also claimed as abnormal skull or residuals of meningioma tumor to also include as secondary to his service-connected benign brain tumor and for mass in lungs. In October 2012, the RO denied the Veteran's claim for service connection for Paget's disease given the lack of evidence of an in-service event, injury, or disease. The Veteran is currently service-connected for a number of disabilities that are related to his service-connected benign brain tumor. No examination was provided but an opinion was obtained in June 2016. The examiner wrote that the Veteran's Paget's disease is an incidental finding on imaging and not related to the tumor. However, the Board finds this opinion to be of little probative value. The examiner failed to provide an adequate rationale and failed to opine as to whether the Veteran's Paget's disease was caused by, related to, or aggravated by his benign brain tumor. Therefore, the Board finds a remand is necessary in order to provide the Veteran with an appropriate VA examination and etiological opinion regarding direct and secondary service connection. With regard to the Veteran's claim for service connection for mass in lungs, the RO denied the Veteran's claim given the lack of a current diagnosis. An opinion was obtained in June 2016 which stated that the lung mass is not related to his brain tumor because the brain tumor does not constitute "a metastatic tumor from the lung." However, this rationale does not address whether the lung mass could have metastasized from brain tumor. Thus, the stated rationale is not adequate and there is no opinion as to direct service connection. The Board also finds this opinion to be of little probative value. Therefore, the Board finds a VA examination and etiological opinion should be obtained in order to determine whether the Veteran has a current disability and, if so, whether it is related to or caused by his active-duty service or service-connected disability. In addition, no medical records, VA or otherwise, have been associated with the Veteran's file since July 2014 and June 2016. Therefore, the RO should undertake all necessary efforts to obtain any outstanding records to include any VA or private medical records. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claim, to include updated VA outpatient treatment records from July 2014, to the present, and any private treatment records identified by the Veteran. If any requested records are unavailable, or the search for such records otherwise yields negative results, that fact should clearly be documented in the record and the Veteran so notified in accordance with 38 C.F.R. § 3.159(e). All steps taken to attempt to obtain the above records should clearly be documented in the record. 2. Provide the Veteran with an appropriate VA examination to determine the nature and etiology of the Veteran's Paget's disease. (a.) After a complete review of the file, the VA examiner should opine as to the nature and etiology of the Veteran's Paget's disease, to include as to whether this disability is at least as likely as not (50 percent or greater probability) related to his active duty service; OR, (b.) Secondary to his service-connected benign brain tumor. Specifically, the examiner shall opine as to whether the Veteran's Paget's disease is caused or aggravated (worsened beyond its normal progression) by his service-connected benign brain tumor. 3. Provide the Veteran with an appropriate VA examination to determine whether the Veteran has a current disability to include mass in lungs. (a.) If found to have a current disability, the examiner should opine as to the nature and etiology of the mass in lungs, to include as to whether this disability is at least as likely as not (50 percent or greater probability) related to his active duty service; OR, (b.) Secondary to his service-connected benign brain tumor. Specifically, the examiner shall opine as to whether the Veteran's mass in lungs is caused or aggravated (worsened beyond its normal progression) by his service-connected benign brain tumor. 4. Following the review and any additional development deemed necessary, readjudicate the claims. If the claims are not granted in their entirety, issue a supplemental statement of the case (SSOC) to the Veteran and his representative, provide an appropriate time for response, and thereafter forward the claims to the Board for further review. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. DeBoer, 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.