Citation Nr: 20004889 Decision Date: 01/23/20 Archive Date: 01/21/20 DOCKET NO. 18-55 428 DATE: January 23, 2020 ORDER Entitlement to service connection for lower intestinal lymphoma is denied. Entitlement to special monthly compensation based on aid and attendance is denied. FINDINGS OF FACT 1. The evidence is insufficient to show that the Veteran’s lower intestinal lymphoma had its onset in service or is otherwise related to service. 2. The evidence is insufficient to show that the Veteran needed regular aid and attendance due to his service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for lower intestinal lymphoma have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for special monthly compensation based on the need for aid and attendance have not been met. 38 U.S.C. § 1114(l); 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from February 1951 to February 1954. 1. Entitlement to service connection for lower intestinal lymphoma. To establish service connection for a disability, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Private treatment records indicate the Veteran was treated for diffuse large C cell non-Hodgkins lymphoma. See December 2018 Correspondence. The issue that remains disputed is whether the Veteran’s condition had its onset in service or is otherwise related to service. The preponderance of the evidence is against the claim. The Veteran’s service treatment records were unavailable, and the Veteran’s contemporaneous medical records were limited. The Agency of Original Jurisdiction (AOJ) contacted the Veteran in July 2019 and requested that he complete a private medical record release to allow VA to obtain his outstanding medical records. There is no record of response from the Veteran. As such any pertinent information that would have been expected from this development is not available and the claim must be decided on the evidence of record. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In a November 2019 VA medical opinion, the examiner opined that the Veteran’s large B-cell lymphoma less likely than not incurred in service. The examiner reasoned that the Veteran did not have any immunosuppressive symptoms or diseases in service per his memory and recall. The Veteran was not diagnosed with large B cell lymphoma until 63 years after separation and there is no medical evidence indicating that the Veteran developed B-cell lymphoma while in active service. The examiner also noted that B-cell lymphoma is the most common type of non-Hodgkin lymphoma. The Board finds the VA examiner’s opinion adequate and probative to the question at hand. The examiner possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the VA examiner provided a detailed rationale for the opinions, which was based on an examination and interview of the Veteran, a review of the service treatment records, post-service treatment records, and the lay statements of the Veteran. The opinion considered an accurate history, was definitive and supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Significantly, the Veteran has not presented or identified any contrary medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). The only evidence suggesting a relationship between the Veteran’s lymphoma and service are his statements, and the Veteran is not competent to provide an opinion on issues requiring medical expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In sum, the evidence is insufficient to show that the Veteran’s lower intestinal lymphoma is related to service. As the preponderance of the evidence is against the Veteran’s claim, the doctrine of reasonable doubt does not apply. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to special monthly compensation based on aid and attendance Special monthly compensation (SMC) is warranted if, because of a service-connected disability, a veteran is permanently bedridden or so helpless as to need regular aid and attendance of another person. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.352(a). The need for aid and attendance means helplessness or being so nearly helpless as to require the regular assistance of another person. In order to establish entitlement to an increased compensation based on the need for regular aid and attendance, a veteran must have an anatomical loss or loss of use of both feet, one hand and one foot, blindness in both eyes of 5/200 or less or have a factual need for regular aid and attendance of another person. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.351(b), (c). Determinations as to need for aid and assistance must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to such conditions as: inability of the appellant to dress or undress himself or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; inability of the appellant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment. 38 C.F.R. § 3.352(a). Performance of the necessary aid and attendance service by a relative of the beneficiary or other member of his household will not prevent the granting of the additional allowance. 38 C.F.R. § 3.352(c). VA must consider the enumerated factors under 38 C.F.R. § 3.352(a); that eligibility requires at least one of the enumerated factors to be present; and that, because the regulation provides that the “particular personal function” which a veteran is unable to perform should be considered in connection with his condition as a whole, the “particular personal function” must be one of the enumerated factors. Turco v. Brown, 9 Vet. App. 222 (1996). The Board finds that the evidence is insufficient to show that the Veteran needed aid an attendance due to his service-connected conditions. The Veteran is service connected for hearing loss and tinnitus. His February 2018 VA examination indicates the Veteran is need of daily assistance due to his tremors, weakness, and abdominal pain. As these symptoms are not related to a service-connected disability, entitlement to SMC based on need of aid and attendance is not warranted. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Williams, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.