Citation Nr: 21074790
Decision Date: 12/16/21	Archive Date: 12/16/21

DOCKET NO. 16-04 192
DATE: December 16, 2021

ORDER

Entitlement to service connection for multiple lipomas, to include as secondary to exposure to herbicidal agents is denied.

FINDING OF FACT

The Veteran's multiple lipomas are not shown to be the result of his military service, to include as due to exposure to herbicidal agents in Vietnam. 

CONCLUSION OF LAW

The criteria for entitlement to service connection for multiple lipomas, to include as secondary to exposure to herbicidal agents have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active-duty service in the U.S. Navy from July 1968 to December 1969, to include during the Vietnam War. 

This matter was previously before the Board in November 2018, when it was placed on hold due to pending litigation. It came before the Board again in May 2019, when it was remanded for further development to include providing a VA examination. The matter then came before the Board in March 2021 and July 2021, when it was remanded for additional VA examinations that took into consideration the lay statements and history provided by the Veteran. After reviewing the opinion obtained in August 2021, the Board finds that the remand directives have been appropriately met and no further remand is necessary.

Entitlement to service connection for multiple lipomas, to include as secondary to exposure to herbicidal agents

The Veteran seeks service connection for multiple lipomas, which he asserts developed after his separation from service, and which he believes are related to exposure to herbicidal agents. The Veteran served in the Navy during the Vietnam War and has been administratively determined to have been within the 12 nautical mile range from the Vietnam coast which meet the qualifications for presumed exposure to herbicidal agents, such as Agent Orange. (See VA Memo, 06/15/2020.)

A veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to certain designated herbicide agents during such service, absent affirmative evidence to the contrary. Service in the Republic of Vietnam includes service in other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, the law provides that specific diseases shall be service connected even though there is no record of such disease during service. 38 C.F.R. § 3.309 (e). While the list of such diseases includes several which affect the skin; however, lipomas are not included on this list. 

Where the disability on appeal is alleged to be the result of exposure to herbicides but is not a listed presumptive disability under 38 C.F.R. § 3.309(e), service connection is not precluded. Rather, the Veteran may demonstrate entitlement based on proof of direct causation in the form of medical evidence linking the Veteran's claimed disability to his service and his exposure to herbicides. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); see also Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). 

Service connection may also be granted on a presumptive basis for certain chronic diseases if they are manifested to a compensable degree within the first year after service separation. 38 C.F.R. § 3.309 (a). The Board notes that the skin conditions included in the list of presumptive diseases do not include lipomas.

The Veteran has reported that he began to develop lipomas after his separation from service. VA treatment records show a diagnosis of multiple lipomas in November 2003. (See Medical Treatment Record, 02/01/2003.) A treatment note in April 2004 noted that the Veteran had several skin tags and multiple lipomas on his back, abdomen, and arms and dermatitis on his hands. (See CAPRI, 06/26/2020.)

At the October 2020 VA examination, the Veteran reported that his lipomas were first diagnosed in 1970, shortly after he returned home from Vietnam. (See C&P Exam, 10/05/2020.) He didn't know exactly when they developed, they had just showed up over time. The condition had worsened over time and he now had eight or nine lipomas mostly on his upper torso. The lipomas  two on the right forearm, three on the left forearm, three on the back, and five on the abdomen  occupied between five and twenty percent of the exposed area of his body, but less than five percent of his total body surface. The examiner provided the opinion that lipomas are not associated with exposure to herbicidal agents and therefore the Veteran's lipomas were not due to his military service. 

At the May 2021 VA examination, the Veteran reported that he developed lipomas after he left service. He was told that they were fatty tumors; he had not received any treatment for them. The examiner offered the opinion that the Veteran's lipomas were not the result of Agent Orange exposure. (See C&P Exam, 05/19/2021.) The examiner noted that lipomas were most likely due to lipomatosis, which is believed to be due to a genetic condition. 

At the August 2021 VA examination, the Veteran reported that his lipomas first began in about 1969 after he returned from Vietnam. (See C&P Exam, 08/01/2021.) He was not treated for any skin complaints in service. The first documentation of lipomas was in 1996, more than twenty years after service separation. The examiner noted that the cause of lipomas is not known, but it is believed to be genetic because they often run in families. About one in one thousand people develop lipomas. Agent Orange and other herbicidal agents are not shown to contribute to the development of lipomas. For these reasons, the VA examiner offered the opinion that the Veteran's lipomas were not related to his service, to include any exposure to herbicidal agents in service. 

The Board has considered all of the evidence of record, with special attention to the documents discussed above, and finds that the elements of service connection have not been met. The evidence does not show, and the Veteran has not asserted, that the lipomas were manifested during his time in service. It is unclear whether they first manifested within a year after separation from service; however, presumptive service connection as a chronic disease is not warranted because lipomas are not one of the conditions included in 38 C.F.R. § 3.309(a). Nor are lipomas included in the list of conditions for which presumptive service connection based on exposure to herbicidal agents is permitted. 38 C.F.R. § 3.309(e). In addition, the medical evidence of record does not show any relationship between the Veteran's military service, to include herbicide exposure. The October 2020 and May 2021 VA examiners both noted that lipomas may be genetic or hereditary. Both examiners, including after due consideration of the lay history provided by the Veteran, offered the opinion that there was no medical basis to link the Veteran's lipomas to his service. Notably, there is no medical evidence of record which suggests otherwise. The preponderance of the evidence being against the claim, the benefit of the doubt standard does not apply. 38 U.S.C. § 5107(b).

  

 

Richard Kettler

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Cheryl E. Handy

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.