Citation Nr: A21017435 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 191130-50769 DATE: October 27, 2021 ORDER Entitlement to service connection for right ear schwannoma is granted. Entitlement to service connection for a back disability is granted. Entitlement to service connection for right knee arthritis is granted. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran's favor, the Veteran's right ear schwannoma is related to service. 2. Resolving all reasonable doubt in the Veteran's favor, the Veteran's back disability is related to service. 3. Resolving all reasonable doubt in the Veteran's favor, the Veteran's right knee arthritis is related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for right ear schwannoma have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a back disability have been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for right knee arthritis have been met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1976 to January 1980. This matter comes before the Board of Veterans' Appeals (Board) from a November 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Veteran filed a VA Form 10182, electing the Hearing docket under the Appeals Modernization Act (AMA). Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). In May 2021, the Veteran testified at a Board hearing before a Veterans Law Judge. A transcript of that hearing is of record. During the hearing, the Veteran's attorney clarified that the arthritis claim was actually for right knee arthritis. The issue has been amended accordingly. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Where a veteran served continuously for 90 days or more during active service and certain chronic diseases, including arthritis, become manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice- connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for right ear schwannoma The Veteran seeks service connection for right ear schwannoma. During her May 2021 Board hearing, the Veteran testified that her complaints and treatment for ear pain and ear infections during service were symptoms of the schwannoma diagnosed in 2015. As an initial matter, the Board finds that the Veteran has a current diagnosis of right ear schwannoma, as shown by a January 2018 VA treatment record. Thus, the question becomes whether the Veteran's right ear schwannoma is related to service. In an August 2021 opinion submitted by the Veteran, Dr. R.M. noted that the Veteran's service treatment records show that in June 1979 she complained of earaches in her right ear which became so severe that she was unable to chew. Dr. R.M. also noted that the Veteran continued to complain of right ear pain in July 1979, and in August 1979, the Veteran reported that the ear pain had spread to the right half of her face. Based on a review of the record and citing medical literature which shows that ear fullness and trouble swallowing are symptoms of a schwannoma, Dr. R.M. concluded that it is at least as likely as not that the Veteran's schwannoma began during service and has continued since. There is no competent medical opinion to the contrary. Upon review of the record, the Board finds that the competent and probative evidence is at least in equipoise as to whether the Veteran's right ear schwannoma is related to his military service. Accordingly, affording the Veteran the benefit of the doubt, service connection for right ear schwannoma is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Entitlement to service connection for a back disability 3. Entitlement to service connection for right knee arthritis The Veteran seeks service connection for a back disability and right knee arthritis. Specifically, the Veteran asserts that her current back disability is related to a fall she suffered during a climbing exercise in service, and that her right knee arthritis is secondary to her back disability. With regard to the Veteran's claimed back disability, the Board finds that the Veteran has been diagnosed with degenerative disc disease of the lumbar spine, as shown by VA treatment records. Thus, the question for the Board is whether the Veteran's current back disability is related to service. Service treatment records reveal the Veteran was treated for splinters in his left leg after she fell while descending a pole in April 1976. In March 1977, the Veteran was diagnosed with a low back strain after she complained of low back pain for two months, and in June 1978, she reported experiencing for chronic low back pain for a year. Thereafter, post-service treatment records show no complaints of or treatment for a back disability until May 2006 when the Veteran reported intermitted low back pain. The Veteran underwent a VA examination in March 2019, at which time the examiner acknowledged the Veteran was diagnosed with a lumbosacral strain during service, but found the Veteran did not have a current diagnosis of a back condition. As such, the examiner opined that the Veteran's claimed back disability was less likely than not incurred in or caused by service. In an August 2021 private opinion submitted by the Veteran, Dr. R.M. found that the Veteran currently had a diagnoses of degenerative disc disease of the lumbar spine and right knee osteoarthritis. Dr. R.M. opined that the Veteran's current degenerative disc disease is as least as likely as not caused by her injury and chronic pain exhibited during her time in active duty. Moreover, Dr. R.M. explained that because of the pain from her back disability the Veteran has an altered gait that likely led to her right knee osteoarthritis. As such, he opined that the Veteran's right knee osteoarthritis is at least as likely as not secondary to her degenerative disc disease of the lumbar spine. The Board notes that in providing his opinion Dr. R.M cited to medical literature and indicated that his opinions were based on review of the Veteran's service and VA treatment records. Upon review of the evidence of record, the Board finds that the evidence is at least in equipoise as to whether Veteran's current back disability is related to service, and whether the Veteran's right knee disability is related to his now service-connected back disability. Accordingly, resolving all doubt in the Veteran's favor, service connection for a back disability on a direct basis and for a right knee disability on a secondary basis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, 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.