Citation Nr: 21068106 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 14-42 914 DATE: November 9, 2021 REMANDED Entitlement to service connection for meningioma, to include as due to exposure to asbestos, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1974 to August 1978. This matter is before the Board of Veterans' Appeals (Board) on appeal of a January 2012 rating decision. In July 2017, a videoconference hearing was held before the undersigned; a transcript is in the record. In May 2018, March 2021, and July 2021, the case was remanded for further development. The Board sincerely regrets the further delay inherent with another remand but, unfortunately, finds that the July 2021 remand instructions were not adequately fulfilled. An August 2021 VA memorandum indicates that due to the Veteran's MOS having a minimal probability of exposure to asbestos, some exposure to asbestos during military service was conceded. However, the August 2021 VA opinion provided is inadequate, as is discussed in detail below. See Stegall v. West, 11Vet. App.268 (1998). The Veteran claims his meningioma is due to exposure to asbestos while working on a Navy ship. In the August 2021 VA opinion, the provider opined that the Veteran's meningioma was less likely than not related to his exposure to asbestos in service. He explained that risk factors for meningioma include age, gender, radiation exposure, genetic disorders, and race and/or ethnicity. The provider indicated that there was no medical literature to support the Veteran's claim, since the cause of meningiomas was unknown it would be difficult to determine the actual etiology of the Veteran's meningioma, and that the only risk factor he had [of those identified] was his age. The opinion is inadequate because it is speculative and although the provider indicated that it would be difficult to determine the etiology of the Veteran's meningioma, no attempt was made to identify a likely etiology. Notably, the Board, in its July 2021 remand, specifically requested that the Veteran's record be forwarded to an appropriate clinician other than the previous opinion provider, it was sent to the same provider, who essentially submitted the same as before (albeit less thorough) opinion. Therefore, remand for a fully adequate medical advisory opinion is necessary. Additionally, the July 2021 Board remand directed that formal findings of fact for the record should be made (as is customary in adjudicating claims based on exposure to asbestos) regarding the nature and extent of the Veteran's exposure to asbestos during service and postservice (specifically addressing an October 2011 statement, wherein he reported that he did not know of anything else he could have been exposed to during or after service, as before service he was a custodian at a public school, and after service he was also a custodian at a public school until he retired in May 2010). As noted above, that the Veteran had some exposure to asbestos during service has been conceded by VA. However, the nature and extent of his exposure to asbestos after service was not addressed in a finding for the record. Therefore, a finding of fact for the record regarding the nature and extent of his exposure to asbestos postservice must be completed prior to the record being forwarded to an appropriate provider for an addendum medical advisory opinion. The matter is REMANDED for the following: 1. Arrange for any further development indicated and make findings of fact for the record regarding the nature and extent of the Veteran's postservice exposure to asbestos (specifically addressing his October 2011 statement regarding his preservice and postservice employment as custodian at a high school custodian). 2. After the above development is completed, arrange for the Veteran's record to be forwarded to an appropriate clinician (other than the August 2021 opinion-provider), for review and an addendum opinion regarding the likely etiology of his claimed meningioma. The entire record must be reviewed by the consulting provider (to include the findings regarding the nature and extent of the Veteran's exposures to asbestos in service and postservice, and this remand) and based on a review of the record, the provider should: (a) Identify the likely etiology for the Veteran's meningioma (any residuals diagnosed). Specifically, is it at least as likely as not (a 50% of greater probability) that the meningioma was incurred during the Veteran's active service, to include as due to his exposure to asbestos therein? (b) If the opinion is that the Veteran's meningioma was not incurred in service/due to exposures therein, identify the etiology that is considered to be more likely, (and explain why it is so). (c) If an opinion requested cannot be provided without resort to mere speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The provider should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the provider (i.e., additional facts are required (and identification of such needed facts), or the provider lacks the knowledge or training needed). All opinions must include rationale with citation to supporting factual data and medical principles (with citation to medical text or treatise as deemed appropriate). GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.