Citation Nr: 18158656 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 17-02 388 DATE: Entitlement to service connection for Castleman's disease. December 17, 2018 REMANDED Entitlement to service connection for Castleman's disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1984 to April 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. Entitlement to service connection for Castleman's disease is remanded. The Veteran was afforded a VA hematologic and lymphatic conditions examination in July 2016. The examiner noted that the Veteran was diagnosed with unicentric Castleman’s disease in 2006 and that it is currently in remission. The examiner opined that it is less likely than not that the Veteran’s Castleman’s disease was incurred in service, stating that “[i]t is impossible to definitively ascertain the contribution of a particular risk factor for an individual without resorting to mere speculation. Viral symptoms and common symptoms related to Castleman's disease are symptoms that are similar to a variety of illnesses.” The examiner then stated that he is unable to suggest that the Veteran’s “dime sized lump” is solely related to the claimed condition without resorting to mere speculation as a biopsy was not performed and there was no follow up. The examiner concluded that it is “theoretically possible”, but “could have been related to other factors.” When VA undertakes to provide a Veteran with an examination, that examination must be adequate for VA purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). Here, the examiner failed to address the Veteran’s statement that his growth had remained the same since it was discovered in service, as noted in the July 2003 treatment record from Dr. A. K., which notes the Veteran reported a painful lump in his left groin which was found to be a lymph node inferior to his inguinal ligament. The Board notes that this is the same lymph node that was biopsied and removed in 2006, leading to the diagnosis of Castleman’s disease. Further, the examiner noted that the Veteran’s Castleman’s disease was “theoretically” the cause of the lump in 2003, but then stated that it “could have been related to other factors” without a discussion of what those “other factors” were and whether any were present when the Veteran was in service. Finally, the Board finds the examiner’s use of the words “theoretically” and “could have” render this opinion too speculative to be of any probative value. See, Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from March 2018 to the Present. 2. After, and only after, completion of step one above, schedule the Veteran for an examination by an appropriate clinician who has not previously examined the Veteran to determine the nature and etiology of his Castleman’s disease. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including a painful lump in his left groin that was found to be a lymph node inferior to his inguinal ligament. The examiner must list and discuss all of the Veteran’s risk factors for developing Castleman’s disease. The examiner’s attention is invited to the July 2003 private treatment record in which a painful lump was found to be a lymph node inferior to the Veteran’s left inguinal ligament. The examiner’s attention is invited to the February 2006 VA treatment record which notes the Veteran stated that his “left groin mass” has remained stable in size since he first noticed it. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 3. After completing the requested actions, and any additional development deemed warranted, readjudicate the claims in light of all pertinent evidence and legal authority. If the benefits sought remain denied, furnish to the Veteran a Supplemental Statement of the Case and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. P. Keeley, Associate Counsel