Citation Nr: 20032267 Decision Date: 05/07/20 Archive Date: 05/07/20 DOCKET NO. 10-37 102 DATE: May 7, 2020 THE ISSUES 1. Entitlement to service connection for Hodgkin's lymphoma, to include as due to chemical or environmental hazard exposure. 2. Entitlement to service connection for a blood clot disorder of the left leg, to include as secondary to Hodgkin's lymphoma. REMANDED 1. Entitlement to service connection for Hodgkin’s lymphoma, to include as due to chemical or environmental hazard exposure is remanded. 2. Entitlement to service connection for a blood clot disorder of the left leg, to include as secondary to Hodgkin’s lymphoma is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1992 to May 1996. This case comes before the Board of Veterans' Appeals (the Board) from an October 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran appeared at a hearing before the undersigned Veterans Law Judge in June 2016. A transcript of the hearing has been associated with the Veteran's claims file. This case was previously before the Board in December 2014. At that time, the Board remanded the claim for additional development. When the claim returned to the Board in March 2016, the Board remanded it to provide the Veteran with a hearing that had been requested after the initial remand. After the hearing was held, the case returned to the Board in September 2017, and was remanded to obtain additional evidence. In a January 2018 decision, the Board denied the Veteran above claims. The Veteran appealed the January 2018 Board decision as to these determinations to the United States Court of Appeals for Veterans Claims (Court), and in a September 2019 Memorandum Decision, the Court vacated the Board's decision and remanded these matters back to the Board for development consistent with the Memorandum Decision. 1. Entitlement to service connection for Hodgkin’s lymphoma, to include as due to chemical or environmental hazard exposure is remanded. 2. Entitlement to service connection for a blood clot disorder of the left leg, to include as secondary to Hodgkin’s lymphoma is remanded. The Veteran has claimed service connection for Hodgkin's lymphoma and a clot disorder of the left leg. The Veteran has specifically alleged that the Hodgkin's lymphoma is due to his service and possible exposure to environmental hazards in Southwest Asia, and that his clotting disorder was secondary to his Hodgkin's lymphoma. Alternatively, the Veteran contends that his Hodgkin’s lymphoma was due to a Havrix vaccine he claims he received while in service. See June 2016 Board hearing. In its January 2018 decision, the Board denied the Veteran’s claims for service connection based largely on an October 2017 VA examination in which the VA examiner indicated that because of the considerable uncertainty surrounding the Veteran’s particular exposures during service, she was unable to state whether the Veteran’s Hodgkin’s lymphoma was caused by Southwest Asia service without resorting to speculation. The VA examiner also concluded that the Veteran’s blood clot was caused by the chemotherapeutic treatment for Hodgkin’s lymphoma. However, in the September 2019 Memorandum Decision, the Court found that the Board failed to adequately address the Veteran’s explicitly raised contention that his disabilities were due to his purported in-service hepatitis A vaccination, Havrix. Additionally, the Court found that the October 2017 VA examination did not adequately address the Veteran’s contention that Havrix was the potential cause of his Hodgkin’s lymphoma. The Court found that “the [October 2017 VA] opinion did not provide the Board with sufficient information to allow to resolve an explicit theory of service connection advanced by the [V]eteran. The Board, therefore, did not adequately explain why it deemed the October 2017 opinion adequate to decide the claims with respect to the Havrix vaccine theory.” While the Court did not find that the Veteran’s contentions created an obligation for VA to provide a medical opinion, it did find that the Board erred by not addressing whether obtaining such an opinion was necessary under the analysis of McLendon v. Nicholson, 20 Vet. App. 79 (2006). Under the VCAA, VA is obliged to provide an opinion when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d) (2014). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F.3d 1381 (Fed.Cir. 2003). The Board, therefore, finds VA has a duty to obtain a new medical opinion under the low threshold of McLendon, 20 Vet. App. 79, 83 (2006). As the October 2017 VA medical opinion is inadequate in addressing the Veteran’s theory that his Hodgkin’s lymphoma is caused by his purported in-service Havrix vaccination, the Board finds that a remand is necessary to obtain an addendum opinion which explicitly addresses this theory of entitlement. The issue of entitlement to service connection for a blood clot disorder is also inextricably intertwined with the pending claim of entitlement to service connection for a Hodgkin’s lymphoma. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). The October 2017 VA medical opinion noted that the Veteran's Hodgkin’s lymphoma caused the diagnosed blood clot disorder. Thus, the claim of entitlement to service connection for a blood clot disorder depends on the outcome of the pending claim of entitlement to service connection for Hodgkin’s lymphoma. Thus, remand is necessary for adjudication of the underlying claim. The matters are REMANDED for the following action: 1. Obtain any outstanding VA medical treatment records regarding the Veteran's Hodgkin's lymphoma. 2. After the above development has taken place, forward the Veteran's claims file to the October 2017 VA examiner, or a suitable substitute, to address the etiology of his Hodgkin's lymphoma. If it is determined that a new VA examination is necessary, one should be conducted (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner is asked to address the following: Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran's Hodgkin's lymphoma is related to his purported in-service Havrix vaccination. In formulating the opinion, the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against. Any opinions offered should include the underlying reasons for the conclusions. If the examiner is unable to offer any of the requested opinions, it is essential that the he or she offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2011). 4. Thereafter, readjudicate the issues on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable time period in which to respond. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. E. Geary, Associate 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.