Citation Nr: 0515344 Decision Date: 06/07/05 Archive Date: 06/15/05 DOCKET NO. 03-36 821 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for cutaneous T-cell lymphoma for purposes of accrued benefits. 2. Entitlement to service connection for post-traumatic stress disorder (PTSD), claimed as difficulty sleeping and concentrating, for purposes of accrued benefits. 3. Entitlement to service connection for a depressive disorder for purposes of accrued benefits. 4. Entitlement to service connection for right trick knee for purposes of accrued benefits. 5. Entitlement to service connection for left knee pain, claimed as joint pain due to undiagnosed illness, for purposes of accrued benefits. 6. Entitlement to service connection for muscle pain due to undiagnosed illness for purposes of accrued benefits. 7. Entitlement to service connection for headaches due to undiagnosed illness for purposes of accrued benefits. 8. Entitlement to service connection for chronic fatigue due to undiagnosed illness for purposes of accrued benefits. 9. Entitlement to service connection for stomach problems/diarrhea due to undiagnosed illness for purposes of accrued benefits. 10. Entitlement to service connection for folliculitis, parapsoriasis, and foot eczema, claimed as skin rashes due to undiagnosed illness, for purposes of accrued benefits. 11. Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Michelle L. Nelsen, Counsel INTRODUCTION The veteran had active service from September 1984 to February 1988 and from October 1990 to May 1991. He died in April 2001. The appellant is the veteran's widow. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2002 and July 2002 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required on her part. REMAND The appellant seeks service connection for a number of disorders for purposes of accrued benefits, as well as service connection for the cause of the veteran's death. The death certificate shows that the veteran died in April 2001 from lymphoma. Specifically, medical records indicate that the veteran was being treated for cutaneous T-cell lymphoma. VA is generally required to make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A(a) (West 2002). Specifically, VA is required to obtain relevant records held by any Federal department or agency that the claimant adequately identifies and authorizes VA to obtain. 38 U.S.C.A. § 5103A(c)(3). These records include military records, including service medical records. 38 C.F.R. § 3.159(c)(2) (2004). During the February 1997 VA examination, the veteran related that he first noticed a skin rash in February 1992. He sought treatment at a camp in Florida in June 1992. In his April 1998 notice of disagreement, he specified that he received treatment at Camp Blanding, Florida, in July 1992. In his written statement dated in July 1998, the veteran indicated that he was still attached to the military at that time. Review of the veteran's DD Form 214 shows that he was ordered to active duty in support of Operation Desert Shield/Desert Storm while he served with the Army National Guard. Thus, when he was released from active duty in May 1991, he presumably returned to regular National Guard duty. Independent research by the undersigned confirms that Camp Blanding is a training facility for the Florida Army National Guard. Thus, it appears that additional service medical records, in the form of medical records associated with National Guard service, may exist. There is no indication that the RO ever attempted to secure these records. In order to comply with VA's duty to assist, a remand is required. Because these records may contain information relevant to any of the issues on appeal, the Board defers adjudication on all issues pending completion of this development. The duty to assist also includes the responsibility to obtain any relevant records from the Social Security Administration. Voerth v. West, 13 Vet. App. 117, 121 (1999); Hayes v. Brown, 9 Vet. App. 67, 74 (1996). Review of the record reveals that the veteran was awarded Social Security disability benefits in or about 1998. No records from the Social Security Administration have been associated with the claims folder. The RO should secure this evidence on remand. Finally, the duty to assist includes providing a medical examination or obtaining a medical opinion when necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d). Such an examination or opinion is necessary to make a decision on a claim if all of the lay and medical evidence of record (1) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (2) indicates that the disability or symptoms may be associated with the claimant's active military, naval, or air service; but (3) does not contain sufficient medical evidence for VA to make a decision on the claim. Id. In this case, with respect to the claim for service connection for the cause of the veteran's death, the appellant submitted a medical opinion from C. Bash, M.D., in which he opines that the first symptoms of the cause of the veteran's death, cutaneous T-cell lymphoma, were present during service or shortly thereafter. Review of the report reveals that the opinion did not include review of the veteran's service medical records, and was based, in part, on historical information provided by the veteran. Therefore, the opinion has little probative value. See Swann v. Brown, 5 Vet. App. 229 (1993) (a medical opinion that relies on history as related by the veteran is no more probative than the facts alleged by the veteran); Reonal v. Brown, 5 Vet. App. 458 (1993) (a medical opinion based on an inaccurate factual premise has no probative value). See also LeShore v. Brown, 8 Vet. App. 406 (1995) (medical history provided by a veteran and recorded by an examiner without additional enhancement or analysis is not competent medical evidence). However, the Board finds that the opinion is sufficient to trigger VA's duty to secure a medical opinion pursuant to 38 U.S.C.A. § 5103A(d). On remand, after completing the development discussed above, the RO should seek an opinion as to the etiology of the cause of the veteran's death. Accordingly, the case is REMANDED for the following action: 1. The RO should obtain the veteran's medical records from the Florida Army National Guard. It should request all available medical records for any period of service in the National Guard. If the records are not available or do not exist, a reply to that effect is required and should be associated with the claims folder. 2. The RO should request from the Social Security Administration records associated with the veteran's disability claim adjudicated in or about 1998, including the disability determination and all associated medical records. If the records are not available or do not exist, a reply to that effect is required and should be associated with the claims folder. 3. The RO should arrange for an appropriate specialist in dermatology or oncology, or both, if necessary, to review the claims folder, including any additional evidence obtained as requested above, to determine the etiology of the cause of the veteran's death. The examiner should review the relevant evidence, with particular attention to the veteran's service medical records, including any records from the National Guard (discussed above), all relevant VA and private medical records, and the April 2005 opinion from C. Bash, M.D. Based on this record review, the examiner should state an opinion as to whether it is at least as likely as not that the cause of the veteran's death, cutaneous T-cell lymphoma, had its onset during his period of active service or within one year after his separation from active service in May 1991, or is otherwise related to service. For purposes of this opinion, the term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. Any opinion provided should include a complete explanation, with references to medical principles, literature, etc. If the examiner is unable to offer the requested opinion without resorting to speculation, the report should so state. 4. The RO should then readjudicate the issues on appeal. If the disposition of any issue remains unfavorable, the RO should furnish the appellant and her representative a supplemental statement of the case and afford the applicable opportunity to respond. Thereafter, the case should be returned to the Board for final appellate review, if in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans Benefits Act of 2003, Pub. L. No. 108-183, § 707(a), (b), 117 Stat. 2651 (2003) (to be codified at 38 U.S.C. §§ 5109B, 7112). _________________________________________________ GARY L. GICK Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2004).