Citation Nr: 21073069 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 15-20 769 DATE: December 7, 2021 ORDER Entitlement to service connection for intraosseous meningioma is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's intraosseous meningioma had its onset in or is otherwise etiologically related to an in-service event, injury, or illness, to include exposure to herbicide agents. CONCLUSION OF LAW The criteria for entitlement to service connection for intraosseous meningioma, to include as due to herbicide agent exposure, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to January 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a July 2018 videoconference hearing. A transcript of that hearing is associated with the claims file. This case was most recently before the Board in May 2021 when it was remanded for additional development. It has returned for adjudication. Entitlement to service connection for intraosseous meningioma The Veteran asserts that service connection is warranted for his intraosseous meningioma. Specifically, he contends that he developed intraosseous meningioma due to in-service exposure to herbicide agents. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). VA laws and regulations also provide that a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam War (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to an herbicide agent (to include Agent Orange) during active service, certain enumerated diseases will be presumed to have been incurred in service if manifest to a compensable degree within specified periods, even if there is no record of such disease during service. 38 U.S.C. § 1116(a)(2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). Initially, the Board notes that the Veteran's herbicide agent exposure is presumed and conceded. As stated above, his service personnel records document his service in the Republic of Vietnam during the applicable period. Additionally, the Veteran has a current diagnosis of intraosseous meningioma. However, intraosseous meningioma is not on the list of diseases presumptively associated with herbicide agent exposure. Nonetheless, the Veteran is not precluded from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). Accordingly, the question before the Board is whether there is a nexus between the Veteran's diagnosed disability and his period of active service, to include his exposure to herbicide agents. The Veteran does not assert that he was diagnosed with intraosseous meningioma in service or that such had its onset therein. Indeed, his post-service medical treatment records indicate that intraosseous meningioma was diagnosed in November 2009 after complaining of decreased vision for an unknown period of time. During the July 2018 Board hearing, the Veteran testified that he began noticing symptoms of his brain tumor around 2007, about 3 years prior to his first surgery. The Veteran's representative stated that the Veteran's intraosseous meningioma was a slow-growing tumor. While it is not a presumptive disease, she thought there was some indication that his brain tumor was related to in-service herbicide agent exposure based on the increased rates of various types of cancer in those exposed. In October 2020, a VA examiner stated that it is not understood what causes meningioma, but risk factors have been identified and it is more common in women. The examiner searched PubMed and was unable to find any well-established connection between meningioma and Agent Orange but noted that little research had been done in that area. An addendum VA opinion was obtained in September 2021. After a review of the claims file, the examiner opined that the Veteran's intraosseous meningioma was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that there is no evidence of meningioma in service, and it was not diagnosed until around 2009 or 2010. The examiner noted that the disability is not associated with Agent Orange exposure and a review of the current, widely accepted, peer-reviewed literature fails to return articles linking Agent Orange exposure with the development of meningiomas decades later. The examiner further pointed to literature specifically addressing intraosseous meningioma and stated that the disability has not been linked to Agent Orange exposure. The Board has considered the Veteran's testimony and statements relating his currently diagnosed intraosseous meningioma to his in-service exposure to herbicide agents. The Veteran, as a lay person, is competent to comment on that which comes to him through his senses, such as experiencing decreased vision or headaches. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran has not demonstrated that he has the expertise to comment on the diagnosis and etiology of a brain tumor. The causes of meningioma and the effects of herbicide agents are complicated and require expertise in the areas of health, pathology, and chemistry. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Board finds that the September 2021 VA opinion is the most probative evidence of record on the question of a nexus to service. The opinion was based on an extensive review of all of the evidence, including statements from the Veteran and the Veteran's treatment records, and provided a clear and reasoned analysis citing to relevant medical literature to support his conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The VA opinion is also consistent with the evidence of record. (Continued on next page) After a review of the above, the Board finds that the weight of the probative evidence of record is against a finding that the Veteran's intraosseous meningioma is causally or etiologically related to his period of active service, to include his in-service exposure to herbicide agents. Accordingly, the claim for entitlement to service connection for intraosseous meningioma must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.