BVA9502248 DOCKET NO. 93-10 063 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for organic brain syndrome as a residual of a meningioma. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL The veteran and his spouse ATTORNEY FOR THE BOARD R. E. Coppola, Associate Counsel INTRODUCTION The veteran had active service from September 1953 to November 1972. This matter came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of November 1992 from the Philadelphia, Pennsylvania, Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for "organic brain syndrome, residual of meningioma." The RO granted service connection for residuals of a fracture of the right ulna with a 10 percent rating, and service connection for epicondylitis of the right elbow with a noncompensable rating. These issues are not before the Board. REMAND The veteran seeks service connection for organic brain syndrome as a residual of a cerebral meningioma. He argues that his current organic brain syndrome was either caused by or is a residual of removal of the brain tumor; therefore, service connection is warranted. The service medical records do not contain evidence of a meningioma during active duty. The November 1972 separation examination does not indicate any neurologic or psychomotor abnormalities, and the evidence does not show that a meningioma was manifested to a compensable degree within the initial post- service year. The post-service medical records do not show evidence of a cerebral meningioma until September 1988. The veteran has not reported any post-service treatment for a brain tumor other than shown in the medical records already obtained. The medical evidence shows that the veteran was admitted to the Methodist Hospital in September 1988. The records indicate that a computerized tomography (CT) scan that had been completed on an outpatient basis showed a large mass in the frontal region of the brain. The history provided by the veteran's spouse was that she noticed a gradual withdrawal from social activities, hobbies and lethargy beginning one-to-two years prior to the hospitalization. An electroencephalogram (EEG) showed bifrontal slow activity consistent with the known CT abnormalities. An angiogram showed bi-lobed frontal masses which the physician opined were consistent with a bi-lobed meningioma. The discharge record reports a primary diagnosis of cerebral neoplasm-meningioma, and secondary diagnoses which included organic brain syndrome secondary to tumor. The veteran was transferred to the Bethesda Naval Hospital where he was admitted with a pre-operative diagnosis of frontal lobe brain tumor. His medical records contain a reported two-to-three year history of increased sleeping and lethargy, and a one month history of periods of disorientation and memory difficulties. The operative report indicates a several year history of confusion and a four month history of progressive lassitude. The operative diagnosis was frontal interhemispheric meningioma and the veteran underwent a bifrontal craniotomy with excision of a frontal meningioma. The veteran and his spouse testified that the veteran received in-service and post-service treatment for headaches which consisted of Tylenol or aspirin. Tr., pp. 3-5. However, the service medical records do not show evidence of a meningioma, organic brain syndrome, or recurrent headaches during active duty. The veteran's spouse also testified that she observed symptoms, including lack of comprehension and concentration, both during and subsequent to service which she believes establishes that the meningioma began during service. Tr., pp. 10, 12, 14. Since they are not physicians, the veteran and his spouse are not competent to proffer opinions as to the etiology of the meningioma, or the medical significance of any in-service or post-service subjective complaints of headaches. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992), see also Grottveit v. Derwinski, 5 Vet.App. 91, 93 (1993). However, the veteran's spouse, who reportedly is a licensed practical nurse, testified that she was informed by a neurologist and a neurosurgeon at the Methodist Hospital that the tumor had been present for approximately 25 years. Tr., p. 6. She also testified that prior to removal of the tumor, she was informed by a physician at the Bethesda Naval Hospital that the tumor had been present for approximately 20-to-25 years. Tr., p. 8. Although the United States Court of Veterans Appeals (Court) has held a lay statement as to what a doctor told the appellant was insufficient to establish a medical diagnosis or causation, See Warren v. Brown, 6 Vet.App. 4, 6 (1993), in the present case the evidence shows that the veteran's spouse is a licensed practical nurse. Accordingly, the Board finds that this testimony triggers a duty to contact these physicians. See Ivey v. Derwinski, 2 Vet.App. 320 (1992); see also White v. Derwinski, 1 Vet.App. 519 (1991). Under the circumstances of this case, the Board is of the opinion that additional development is required. The case is REMANDED for the following actions: 1. The veteran should be asked to identify any medical care providers by whom he was seen for headaches, mental confusion or other claimed symptoms of a brain tumor from the time of his discharge from service until 1988. The RO should then request copies of the veteran's medical records from identified sources. 2. The veteran and his spouse should be requested to identify which physicians at the Methodist Hospital and the Bethesda Naval Hospital who stated that the veteran's tumor had been present for approximately 20-to-25 years, and the veteran should submit a written release for information from each physician listed. The RO should then contact the physicians and ascertain whether the statement related by the veteran's spouse is accurate. Any physician who recalls making a similar statement should be requested to submit the opinion in writing, including the rationale for the opinion. Any evidence obtained should be associated with the claims folder. 3. If indicated, the RO should request from the veteran written authorization for the release of any tissue blocks and any other pathology specimens of the meningioma, accession number S88-12422, located at Bethesda Naval Hospital. Any material obtained should be securely attached to the claims folder. 4. Following completion of these actions, the RO should readjudicate the veteran's claim for benefits. If the benefit sought is not granted, the veteran and his representative should be provided with a supplemental statement of the case, and the case should be returned to the Board for further appellate consideration. No action by the veteran is required until he is contacted by the RO. JANE E. SHARP Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.