Entitlement to service connection for meningioma is remanded.

Citation Nr: 26001418 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 15-42 347 DATE: January 30, 2026 REMANDED Entitlement to service connection for meningioma is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to May 1978. This case comes before the Board of Veterans' Appeals (Board) from an May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ), which denied service connection for meningioma. The Veteran timely appealed that decision with a July 2014 Notice of Disagreement (NOD), VA Form 21-0958. The AOJ issued a Statement of the Case (SOC) in November 2015. The Veteran timely submitted a November 2015 Substantive Appeal, VA Form 9. The Veteran requested a hearing, which was held in July 2018. The transcript is of record. The appeal was remanded by the Board in March 2019, October 2020, and September 2021 for additional development and adjudicative action. The AOJ completed the requested development and most recently issued May 2024 and October 2024 Supplemental Statements of the Case (SSOC). The case has thereafter been returned to the Board for further appellate review at this time. A January 2025 letter informed the Veteran that the Veterans Law Judge (VLJ) who conducted his July 2018 hearing was no longer available to participate in his appeal. The letter stated the law requires the VLJ who conducts a hearing on a legacy appeal must participate in any decision made on that appeal. 38 C.F.R. § 20.604. The letter informed the Veteran that he had the right to request another optional Board hearing. The letter stated if the Veteran did not respond within 30 days from the date of the letter, the Board would assume he did not want another hearing and would decide the case based on the evidence in the record (including the prior hearing). The Veteran did not respond to the letter; therefore, the Board will proceed with adjudication. Subsequent to the September 2021 Board remand in this case, Congress has passed the PACT Act addressing toxic exposures during military service. Specific development is required under 38 U.S.C. § 1168, to identify all toxic exposures and to obtain a medical opinion related to that. Consistent with 38 U.S.C. § 1168, an April 2024 Toxic Exposure Risk Activity (TERA) Memorandum identified evidence of non-deployment related exposure to minimal asbestos due to his Military Occupational Specialty (MOS) as a radioman. The AOJ obtained a May 2024 VA medical opinion finding the claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The rationale stated there is no pathology to warrant a diagnosis or condition that can be related to the claimed toxic exposure. An April 2025 TERA Memorandum identified evidence of non-deployment related exposure to asbestos and AFFF firefighting foam. The Veteran submitted an article, "Cancer-causing chemical in drinking water traced to fire-fighting foam." In this regard, the Board reflects that this case was remanded by the Board 3 previous times for radiation exposure development. In this regard, it appears that VA has previously been told to consider whether the Veteran was exposed to dental x-ray radiation and microwave radiation as a result of such service. In October 2024, the AOJ obtained an ionizing radiation opinion, which appears that VA has otherwise conceded some sort of toxic exposure in this regard; such exposure is not otherwise documented in either of the TERA Memorandums of record. Accordingly, the Board finds a remand is necessary in order for the AOJ to properly develop and document the full breadth of the toxic exposures in this case as required under 38 U.S.C. § 1168. The Board finds the May 2024 VA medical opinion addressing TERA was inadequate as it provided insufficient rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Horn v. Shinseki, 25 Vet. App. 231, 240-42 (2012) (stating "an unexplained conclusory opinion is entitled to no weight in a service-connection context"). See also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, a subsequent TERA memo identified an additional TERA of AFFF firefighting foam for which a medical opinion has not been obtained. Lastly, a review of the record shows the July 2014 NOD for meningioma stated "[a]lso believe my current disability contributed to it as my rapid heart beat and increase blood flow to my head." The Veteran is service connected for paroxysmal tachycardia. This statement raised the theory of entitlement to service connection on a secondary basis, which a medical opinion has not been obtained. The November 2015 VA Form 9 for meningioma stated, "Tumor has been growing for many years. Doctor's opinion that tumor dates back in service due to slow growth rate of this tumor." At the July 2018 hearing, the Veteran reported his tumor did not manifest until 2000, but it was the size of a grapefruit, his doctors said it had been growing for decades. A March 2020 VA medical opinion found meningioma was less likely than not incurred in or caused by service, stating there was no objective evidence of brain meningioma diagnosis during active duty and the Veteran was diagnosed with a meningioma with resection in 2001, many years after service. The opinion did not address the Veteran's contention that he was told by his doctor that the tumor dates back to service due to slow growth rate of this tumor. In addition to the requested TERA opinion, the AOJ should obtain a medical opinion addressing direct and secondary service connection. ? The matters are REMANDED for the following action: 1. Properly develop the claim under 38 U.S.C. § 1168 for any and all conceded toxic exposures in this case. Although the AOJ has already conceded AFF firefighting foam and asbestos exposure, it does not appear that the TERA Memorandums of record contemplated the Veteran's exposure to microwave and dental x-ray exposure that has already otherwise been conceded in prior Board remands and development. The AOJ needs to consider these exposures, as well as any other exposures as a result of his military occupational specialty (MOS) as a radioman and issue another, fully comprehensive TERA Memorandum. 2. Obtain a medical opinion from an appropriate clinician addressing whether the Veteran's meningioma is related to military service. The examiner must review the claims file and a copy of this remand. Following review of the claims file, the examiner should provide an opinion as to whether the Veteran's meningioma began during service, within one year of discharge therefrom, or is otherwise the result of military service, to include any toxic exposures as a result of such service, to include exposure to asbestos and AFFF firefighting foam. See April 2025 TERA memo. In addressing whether the meningeoma began in service, the examiner should discuss any and all lay statements regarding onset of symptomatology as well as any statements regarding continuity of symptomatology since onset and/or since discharge from service, including the Veteran's statement that his doctor told him the tumor dates back to service due to slow growth rate of this tumor. See November 2015 VA Form 9. The examiner must specifically consider and evaluate the Veteran's statements that a doctor told him that his meningeoma started in service due to the slow-growing nature of that type of tumor and the size of it at excision. In providing an opinion regarding toxic exposures, the examiner is asked to consider total potential exposure through all applicable military deployments and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. In this regard, the examiner should specifically address asbestos and AFF firefighting foam, as well as any microwave, dental x-ray and/or ionizing radiation exposures during service, as well as any other conceded exposures by the AOJ pursuant to the above requested 1168 development process. In this regard, the examiner must also discuss the article submitted by the Veteran, "Cancer-causing chemical in drinking water traced to fire-fighting foam." If direct service connection is not found, the examiner must opine whether the Veteran's meningioma is (a) caused by; or (b) aggravated (i.e., worsened) by his service-connected disabilities, to include paroxysmal tachycardia. Finally, if the examiner cannot find a direct secondary relationship, the examiner must then consider whether the Veteran's service-connected disabilities have caused his obesity and thus, in turn, caused or aggravated his meningenoma. In this regard, the examiner should opine as to: (a) whether the Veteran's service-connected disabilities- paroxysmal tachycardia and ulcerative colitis-have caused or aggravated (i.e., worsened) his obesity. If so, then (b) whether the Veteran's obesity has either caused, substantially contributed to, or otherwise aggravated the Veteran's meningenoma. And, if so, finally (c) whether the Veteran's meningenoma would not have occurred if-but-for his obesity due to his service-connected disabilities. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. The examiner is reminded that a separate and distinct opinion with supporting rationale is required for all theories of entitlement addressed, including secondary causation and secondary aggravation. MARTIN B. PETERS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Winkler 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.