Citation Nr: 18159069 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 18-21 350 DATE: December 19, 2018 ORDER Entitlement to service connection for right lower extremity peripheral neuropathy with weakness and right knee flexion contracture is granted. Eligibility for financial assistance in the purchase of an automobile or other conveyance and/or automobile adaptive equipment is granted. Eligibility for assistance in acquiring specially adapted housing is granted. FINDINGS OF FACT 1. The Veteran’s right lower extremity peripheral neuropathy with weakness and right knee flexion contracture is at least as likely as not proximately due to his service-connected non-Hodgkin’s lymphoma and treatment thereof. 2. Following implementation of this decision, the Veteran will be in receipt of service connection benefits for non-Hodgkin’s lymphoma and right lower extremity peripheral neuropathy with weakness and right knee flexion contracture, which results in permanent loss of use of the right foot. 3. The Veteran’s service-connected non-Hodgkin’s lymphoma and associated right lower extremity peripheral neuropathy with weakness and right knee flexion contracture has resulted in the effective loss of use of both lower extremities, such as to preclude locomotion without the aid of a wheelchair. CONCLUSIONS OF LAW 1. The criteria for secondary service connection for right lower extremity peripheral neuropathy with weakness and right knee flexion contracture are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 2. The criteria for establishing eligibility for financial assistance in the purchase of an automobile or other conveyance with necessary adaptive equipment are met. 38 U.S.C. §§ 3901, 3902, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.808. 3. The criteria for eligibility for assistance in acquiring specially adapted housing are met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from May 1967 to March 1970. Among other awards, he received a combat action ribbon and purple heart for this period of service. 1. Entitlement to service connection for a disability manifesting in right lower extremity weakness. The Veteran asserts that his right lower extremity weakness is a result of his extended hospital stay of between three and four months after he developed ventricular tachycardia due to his service-connected lymphoma. Additionally, on his VA Form 9, the Veteran reported that according to the Mayo Clinic, peripheral neuropathy is linked to bone marrow disorders such as lymphoma, and further reported that he received 17 rounds of chemotherapy between 2008 and 2009 which left him extremely weak and bedridden for a majority of this period. A June 2018 “administrative note” written by the Veteran’s primary care physician is of record. The physician wrote that since treatment for T-cell lymphoma with arterial insufficiency in the right leg, the Veteran has been confined to a wheelchair, noting that the Veteran had suffered right leg weakness and a flexion contracture which does not allow him to fully extend his leg. The physician concluded that these impairments are related to the Veteran’s service-connected conditions of lymphoma and atherosclerotic heart disease. The Veteran was provided with a VA peripheral nerves examination in February 2018, where he was again found to have peripheral neuropathy. The examiner noted that the Veteran had developed a progressive peripheral neuropathy in the right leg with sensory loss and muscle weakness since his diagnosis of lymphoma. The examiner opined that the etiology of the peripheral neuropathy is unknown, but that there would be no etiology for this that could be ascribed to his heart condition. In an earlier May 2017 VA addendum medical opinion, the reviewing physician found that there was, at that time, no current diagnosis associated with the Veteran’s right leg muscle weakness, but stated that the Veteran’s right leg weakness is at least as likely as not due to his extended hospital stay following his development of ventricular tachycardia due to service-connected lymphoma. In considering the totality of the record, the weight of the evidence is found to have at least reached the point of equipoise so as to allow for resolution of all reasonable doubt in the Veteran’s favor in finding that his right lower extremity peripheral neuropathy with weakness and right knee flexion contracture is proximately due to his service-connected non-Hodgkin’s lymphoma. According to the National Institute of Neurological Disorders and Stroke, certain cancers and tumors can irritate or press on nerve fibers, and chemotherapy drugs used to treat cancer cause polyneuropathy in an estimated 30-40 percent of users. Peripheral Neuropathy Fact Sheet, National Institute of Neurological Disorders and Stroke, https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet (last modified Aug. 16, 2018). The Veteran has been shown to have developed right lower extremity peripheral neuropathy following his numerous rounds of chemotherapy, and there is no medical opinion weighing against a finding that the neuropathy is due to his non-Hodgkin’s lymphoma or the treatment thereof with chemotherapy. Further considering the opinions from the May 2017 VA examiner and the Veteran’s primary care physician that the Veteran’s right lower extremity weakness and right knee flexion contracture are also at least as likely as not related to his lymphoma, an award of the benefits sought is found warranted. 2. Eligibility for financial assistance in the purchase of an automobile or other conveyance and/or automobile adaptive equipment. Financial assistance may be provided to an “eligible person” in acquiring an automobile or other conveyance and adaptive equipment, or automotive adaptive equipment only. 38 U.S.C. § 3902(a)(b). Eligibility for assistance in the purchase of a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis; or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38 C.F.R. § 3.808. Following implementation of this Board decision, the Veteran will be in receipt of VA service connection benefits for a number of disabilities including but not limited to angioimmunoblastic T-cell lymphoma, non-small cell lung cancer, and right lower extremity peripheral neuropathy with weakness and right knee flexion contracture. At the February 2018 VA peripheral nerves examination, the examiner noted that the Veteran could transfer from his wheelchair to the examination table using his arms for assistance, but could not stand or ambulate. The examiner noted that the Veteran was in a wheelchair due to his right leg peripheral neuropathy, and opined that due to the peripheral neuropathy, the functioning of the right leg is so diminished that amputation with prosthesis would equally well serve the Veteran. The evidence, therefore, demonstrates that the Veteran has been wheelchair-bound since 2009, and has effectively lost the use of his right foot due to his service-connected disability. Thus, he meets the criteria for eligibility for financial assistance in the purchase of one automobile or other conveyance and necessary adaptive equipment. See 38 C.F.R. § 3.808. 3. Eligibility for assistance in acquiring specially adapted housing. Specially adapted housing is available to a veteran who has permanent and total service-connected disability due to: (1) amyotrophic lateral sclerosis rated as 100 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8017; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or (4) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbows. Specially adapted housing is also available to a veteran with a permanent and total disability that precludes locomotion without the aid of braces, crutches, canes, or a wheelchair due to: (5) the loss, or loss of use, of both lower extremities; (6) the loss or loss of use of one lower extremity, together with residuals of organic disease or injury which so affect the functions of balance and propulsion; or, (7) the loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion. 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(a), (b), (d). The phrase “preclude locomotion” is defined as the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion, although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). The Veteran is in receipt of 100 percent disability ratings for a number of disabilities, including a static 100 percent evaluation for his service-connected angioimmunoblastic T-cell lymphoma with residual ischemic colitis. Following implementation of the present Board decision, the Veteran will be in receipt of service connection for disability directly affecting his right lower extremity. The evidence of record shows the Veteran to be wheelchair-bound. In an October 2017 letter from his primary care physician, the doctor wrote that the Veteran has been confined to a wheelchair since his treatment for T-cell lymphoma with arterial insufficiency in the right leg. As noted above, the February 2018 VA examiner opined that the Veteran used a wheelchair because of his right leg peripheral neuropathy and that the functioning of the right leg is so diminished that amputation with prosthesis would equally-well serve the Veteran. While the VA treatment records document that the Veteran has a nonservice-connected left leg above the knee amputation, the Board nevertheless finds that the Veteran qualifies for eligibility for assistance in acquiring specially adapted housing based on the effective loss of use of both lower extremities. The treatment records indicate that the Veteran had been ambulatory and able to utilize a left leg prosthesis in the past, but that he became unable to ambulate in 2009 while undergoing several rounds of chemotherapy. A VA physical therapy consult note from October 2017 states that the Oncology department at VA had told the Veteran never to use a prosthetic device again due to the high possibility of infection. His service-connected lymphoma, therefore, effectively resulted in the loss of use of his left lower extremity for locomotion and balance, as well. (Continued on the next page)   The Veteran is, thus, found to have permanent and total service-connected disability which has resulted in him losing the use of both lower extremities, such as to preclude locomotion without the use of a wheelchair. This meets the criteria for eligibility for assistance in acquiring specially adapted housing; a grant of the claim is therefore warranted. L. CHU Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Solomon, Counsel