Citation Nr: 18155139 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 12-16 174 DATE: December 4, 2018 REMANDED Entitlement to an initial rating in excess of 10 percent for as residuals for non-Hodgkins lymphoma with left forearm scar is remanded. REASONS FOR REMAND The Veteran served on active duty for the US Army from August 1965 to May 1968. A hearing was conducted by the travel board in March 2016 before the undersigned Veterans Law Judge, at which the Veteran and his spouse both testified; a transcript is of record. The Board previously remanded this case for additional development in June 2016 and July 2017. The case has now been returned to the Board for appellate review. The Board finds that additional development is warranted to address the directives for service connection for chronic fatigue syndrome from the July 2017 remand. Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where remand orders of the Board are not followed, the Board errs as a matter of law when failing to ensure compliance). The Board notes that any increased rating would not change any payment to the Veteran and that the Veteran has been assigned a total rating based on individual unemployability and special monthly compensation at the housebound rate effective September 2013. However, the appeal has been certified to the Board, so the Board must continue. Entitlement to a rating in excess of 10 percent for residuals for non-Hodgkins lymphoma with left forearm scar is remanded. After the March 2016 hearing, the matter was remanded for further development. Specifically, the Board directed the Agency of Original Jurisdiction (AOJ) to have the Veteran examined for the purpose of analyzing the Veteran’s fatigue symptoms relating to the criteria set forth for Diagnostic Code 6354. It was noted that the Non-Hodgkin’s Lymphoma had been rated in part under Code 6354, but pertinent findings were not of record. However, in its July 2017 remand, the Board found that the VA examination of July 2016 was inadequate for rating purposes because it failed to comply with remand directives to evaluate the Veteran based on Diagnostic Code 6354. Specifically, in the July 2016 examination the examiner failed to evaluate the Veteran for his fatigue symptoms; rather, the examination was based on the Veteran’s past history of non-Hodgkins lymphoma. Therefore, the case was again remanded and a subsequent VA examination was conducted in June 2018. The June 2018 examination, however, also does not address the Veteran’s symptoms of fatigue. Rather, the examiner completed a Disability and Benefits Questionnaire (DBQ) for Hematologic and Lymphatic Conditions including Leukemia, instead of completing a DBQ for chronic fatigue syndrome. Consequently, the Veteran was once again not evaluated for signs and symptoms consistent with those outlined in Diagnostic Code 6354 (chronic fatigue syndrome), as previously directed by the Board in the July 2017 remand. The VA examiner simply opined that the Veteran has been in remission for non-Hodgkins lymphoma for over a decade and that there are currently no residuals present. As such, the June 2018 VA examination does not provide sufficient information for the Board to determine the nature and extent of the Veteran’s residuals of lymphoma, specifically his reported symptoms of fatigue, cognitive impairment and frequent falls. Therefore, an additional medical examination using the DBQ for Diagnostic Code 6354 must be completed to rectify the inadequacies of the VA examination report. Accordingly, the case is REMANDED for the following action. 1. Arrange for the Veteran to have a VA examination by an appropriate examiner to determine the current severity of the Veteran’s fatigue symptoms. In accordance with the rating criteria for chronic fatigue syndrome under Diagnostic Code 6354, the examiner must provide a detailed review of the Veteran’s pertinent medical history, current complaints, and the nature and extent of his fatigue. The examiner must specifically address the Veteran’s signs and symptoms associated with his fatigue with degree of severity and frequency of occurrence and to what extent the Veteran’s disability restricts routine daily activities. The examiner is advised that a lay person, including the Veteran, is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the lay person, the examiner should explain why. A complete and fully explanatory rationale must be provided for any and all opinions expressed. If the examiner finds that the requested opinion cannot be rendered without resorting to speculation, he or she should so state, and should indicate whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given the state of medical science and the known facts) or by a deficiency in the record (i.e. additional facts are required), or that the examiner does not have the necessary knowledge or training. 2. After the development requested has been completed, the AOJ should review any examination report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Scanlan, Associate Counsel