Citation Nr: 18160413
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 15-19 670
DATE:	December 26, 2018
The claim of entitlement to service connection for residuals of a traumatic brain injury (TBI) is remanded.
The claim of entitlement to special monthly compensation (SMC) based on the need for aid and attendance and/or being housebound is remanded.
The Veteran served on active duty from July 1964 to July 1968.
This matter comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. 
The Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing in July 2018.  A transcript of this proceeding has been associated with the claims file.
1. TBI
The Veteran contends that he experienced a TBI during his military service and that, as a result of this injury, he developed a meningioma in his brain which was removed in 2000/2001 with follow-up surgery in 2011.  Specifically, the Veteran contends that he slipped, fell down a flight of stairs, and injured his head while stationed aboard USS Betelgeuse in 1966.  During the July 2018 Board hearing, the Veteran testified that he began experiencing chronic headaches immediately following the in-service TBI which did not resolve until the meningioma was removed from his brain.  The Veteran also testified that, following his second brain surgery, the Veteran has been unable to walk due to complications from the surgery.  
Service treatment records are negative for a head injury in service.  Significantly, the Veteran’s July 1968 separation examination shows a normal head and a normal neurologic system.  
Post-service private treatment records show that the Veteran underwent removal of a meningioma in approximately 2000/2001 with follow-up surgeries in 2011 and 2012.  Specifically, an October 2013 magnetic resonance imaging (MRI) scan of the brain shows that the Veteran had a complex history of right convexity meningioma with subsequent radiation treatments (initial diagnosis was approximately 13 years earlier).  The Veteran experienced infection with repeat craniotomy and debridement and removal cranioplasty in 2011 and then cranioplasty PEEK implant in 2012 which was subsequently removed secondary to infection.  The Veteran then had an additional surgery on his brain in 2013.  
The Veteran submitted an initial claim for service connection for residuals of a TBI in October 2014.  In connection with this claim, updated VA treatment records dated through March 2015 were obtained.  Significantly, a June 2011 VA treatment record shows that the Veteran experiences a seizure disorder secondary to brain meningioma.
Initially, the Board notes that the medical records concerning the Veteran’s brain surgeries are not of record.  The only medical records in the claims file are October and November 2013 MRIs of the brain as well as a July 2018 statement from Dr. G.W. showing that he had previously treated the Veteran for surgical resection of a meningioma, a slow growing brain tumor.  On remand, an attempt to obtain these records should be made.
Also, the Veteran has not yet been afforded a VA examination for the purpose of determining whether his post-service meningioma and residuals may be related to his military service.  The medical documentation of a meningioma in the brain as early as 2000/2001 along with the Veteran’s allegation of an in-service TBI and headaches since an in-service TBI are sufficient to trigger the duty on the part of VA to provide an examination as to the TBI claim.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).  Therefore, the Veteran should be afforded a VA examination so as to determine the nature and etiology of his claimed brain disorder.  
2.  SMC
With regard to the SMC issue, the claims file contains multiple VA Forms 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance completed by the Veteran’s private physicians showing that the Veteran is homebound and in need of regular aid and attendance due to a seizure disorder and poor balance.  As above, a June 2011 VA treatment record shows that the Veteran experiences a seizure disorder secondary to brain meningioma.  As above, the Board is remanding the TBI issue to determine whether the Veteran’s post-service meningioma is related to an in-service TBI.  As the TBI issue is relevant to whether SMC can be awarded, the Board finds that the SMC issue is inextricably intertwined with the TBI issue and must first be addressed by the agency of original jurisdiction.  Harris v. Derwinski, 1 Vet. App. 180 (1991).
Finally, with regard to both remanded issues, the Board notes that the most recent VA treatment records in the claims file are dated in March 2015.  Given the necessity to remand these issues for other reasons, VA treatment records dated since March 2015 should be obtained prior to readjudication of the remanded issues.
The matters are REMANDED for the following action:
1. Obtain all updated VA treatment records dated from March 2015 to the present.
2. After obtaining any outstanding records, schedule the Veteran for a VA examination to determine the nature and etiology of his claimed TBI.  The claims file should be provided.
The examiner should then opine as to whether the Veteran’s post-service meningioma more likely, less likely, or at least as likely as not (50 percent or greater probability) began in or is otherwise related to his military service, to include as the result of an in-service TBI.
The examiner should consider the Veteran’s lay statements regarding symptomatology since service and any other pertinent evidence in the claims file, to include the Veteran’s service treatment records which are negative for a TBI and post-service treatment records showing a meningioma as early as 2000.
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	April Maddox, Counsel 

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