Citation Nr: 21068529 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 18-54 578 DATE: November 10, 2021 ORDER Entitlement to service connection for a hemangioma is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran initially had a hemangioma during his time in service, within a year of his discharge, or that it is otherwise related or attributable to his service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for a hemangioma. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1968 to January 1970 and from November 1990 to April 1991. This appeal to the Board of Veterans' Appeals (Board) is from a January 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified in support of this claim during a hearing before the undersigned Veterans Law Judge (VLJ) in July 2019. A transcript of the hearing is of record. This claim was most recently before the Board in August 2021, at which time it was remanded back to the RO (Agency of Original Jurisdiction (AOJ)) for further development and consideration including to obtain an addendum opinion concerning the etiology of the Veteran's hemangioma, especially in terms of whether related or attributable to his military service. The remand instructions since have been completed, as directed. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for hemangioma The Veteran contends that his hemangioma was caused by his military service, including especially owing to sun exposure while stationed in the Persian Gulf region. Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or an injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain diseases, including malignant (cancerous) tumors, also will be presumed to have been incurred in service if they manifested to a compensable degree (generally meaning to at least 10-percent disabling) within a year of the Veteran's separation from service, although this presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Here, though, the Board ultimately concludes that, while the Veteran has a current diagnosis of a hemangioma, and he is competent to state that he had excessive sun exposure during his service, the preponderance of the evidence weighs against finding that his hemangioma originated during his service, or within a year of his discharge, or is otherwise related or attributable to his service including to sun exposure during his service. See Watson v. Brown, 4 Vet. App. 309, 314(1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."). VA treatment records show the Veteran was not diagnosed with any hemangioma until 2012 or 2013 or thereabouts which, at the earliest, was not until at least some 21 years after his separation from service. Moreover, in October 2017, a VA examiner opined that the Veteran's hemangioma was not present during his service, however, did not provide any further rationale or opinion. During his July 2019 hearing before this Board, the Veteran reiterated that he believes his hemangioma is the result of excessive sun exposure while serving in the Persian Gulf region. He also stated that sun exposure in his estimation was causing itching and red splotches on his skin. In March 2021, the Board found the October 2017 VA opinion inadequate since it did not address the Veteran's contention that his hemangioma was caused by excessive sun exposure. The Board consequently remanded the claim back to the RO (AOJ) to obtain an adequate VA medical opinion. In May 2021, a VA examiner opined that the Veteran's hemangioma was not related to his service, including to excessive sun exposure, because medical literature does not support a connection between development of hemangiomas and any particular occupation or exposure to chemicals, radiation, or sun. Nevertheless, in the additional August 2021 remand of this claim, the Board explained that, while there had been compliance with the prior March 2021 remand directive, another remand was necessary as the May 2021 VA opinion was inadequate for adjudication purposes. Specifically, the examiner did not provide adequate rationale supporting the opinion. Therefore, to this end, in September 2021 a VA examiner provided an additional opinion based on a review of the relevant records in the file. This examiner determined that it is at least as likely as not the Veteran's hemangioma is related to his service, but then gave rationale conversely against this posited correlation indicating there is no relation of the hemangiomas found on the Veteran's chest to sun exposure and pointing out that medical literature suggests that hemangiomas are a genetic vascular proliferation of the skin. Because that opinion was internally inconsistent, VA obtained an additional opinion in October 2021. The October 2021 VA examiner also reviewed the relevant records and ultimately determined that it is less likely than not the Veteran's hemangioma is related to his service, including to excessive sun exposure. The rationale was that the Veteran had developed two masses on his chest around 2013 that were removed and did not recur. This examiner explained that medical literature indicates that hemangiomas are "anomalies of the vasculature resulting from developmental defects involving the arterial and venous origins." Further, there is no evidence in medical literature supporting the notion that sun exposure causes or aggravates hemangiomas. The Veteran's hemangiomas developed many years after his separation from service and, therefore, there is no etiologic nexus between his hemangiomas and any incident during his active service. Finally, concerning the Veteran's July 2019 testimony that sun exposure causes red splotches and itching, this examiner explained that, after performing the October 2017 VA examination, there was no objective evidence of any red splotches, itching, or dermatitis. This October 2021 examiner's opinion is probative because it is based on an accurate medical history and provides an explanation containing clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Since multiple VA examiners have found that the Veteran's hemangiomas were not caused by excessive sun exposure or any other event during his service, a conclusion supported by medical literature, the preponderance of the evidence is against this claim. Moreover, because the Veteran is a layman, he does not have the competence to give a probative opinion concerning the etiology of his hemangiomas. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, the VA medical examiners' opinions against this claim, including especially the October 2021 opinion with complete supporting rationale, is more probative and, in fact, determinative of the ultimate disposition. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). In denying this claim for service connection, the Board finds the benefit of the doubt doctrine is not applicable since, for the reasons and bases discussed, the preponderance of the evidence is against this claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Pak 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.