Citation Nr: 18153771
Decision Date: 11/28/18	Archive Date: 11/28/18

DOCKET NO. 16-47 457
DATE:	November 28, 2018
REMANDED
Entitlement to service connection for chronic lymphocytic leukemia (CLL), also known as B-cell leukemia, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1976 to May 1998.
This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).  
The Veteran attributes his CLL to service, to include prescribed medication in service.  Private post-service medical treatment records in 2013 show that he was first diagnosed as having CLL in August 2005.  Although his service treatment records do not reflect this diagnosis, a May 1997 treatment record contains a notation of normocytic normochromic anemia, and a complete blood count in June 1997 reveals a high “lymphs” reading.  In light of this evidence, the Veteran should be afforded an appropriate VA examination to determine the etiology of this diagnosis.  38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).  
Also, as noted, private treatment records in 2013 note that the Veteran was first diagnosed as having CLL in 2005.  They also indicate that he completed chemotherapy in 1999.  However, there are no treatment records for this disability on file prior to 2012.  Accordingly, an attempt must be made to obtain these earlier identified records.  38 U.S.C. 5103A(b), (c).   
The matter is REMANDED for the following action:
1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file, to specifically include attempts to obtain records from private physicians and medical facilities that treated the Veteran for his CLL for the period from 2005 to 2012.  
2. Then, schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the nature and etiology of his CLL.  The claims file must be made available to, and reviewed by the examiner.  Any indicated studies must be performed.  
Based on the examination results and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that CLL had its onset during the Veteran’s active service, or is otherwise etiologically related to such service, to include any prescription medication prescribed during service.  
In forming the opinion, the examiner must specifically address the May 1997 treatment record showing a notation of normocytic normochromic anemia, and the June 1997 complete blood count report showing a high “lymphs” reading.  
The rationale for all opinions expressed must be provided. 
3. Confirm that the VA examination report and all medical opinions provided comport with this remand, and undertake any other development determined to be warranted.
4. Then, readjudicate the claim on appeal.  If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response.  Then, return the case to the Board.
 
Kristin Haddock
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Shawkey, Counsel