Citation Nr: 21066894 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 16-55 955 DATE: November 2, 2021 REMANDED Entitlement to service connection for non-Hodgkin's lymphoma, also claimed as mycosis fungoides is remanded. Entitlement to service connection for chronic migraines is remanded. REASONS FOR REMAND The Veteran served on active duty with the Air Force from October 1973 to October 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a video Board hearing in July 2021. A transcript of the proceeding has been associated with the claims file. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to decide on the claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); Duenas v. Principi, 18 Vet. App. 512 (2004); Robinette v. Brown, 8 Vet. App. 69 (1995); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). For the below noted reasons, the Board finds that addendum medical opinions are necessary. 1. Entitlement to service connection for non-Hodgkin's lymphoma, also claimed as mycosis fungoides is remanded. The Veteran contends that his diagnosis of non-Hodgkin's lymphoma was incurred in service. Alternatively, the Veteran contends that his non-Hodgkin's lymphoma is due to exposure to ionizing radiation and/or exposure to herbicides during service. See July 2021 Hearing Transcript. Considering the Veteran's military occupational specialty as an aerospace control and warning systems craftsman and superintendent and his assertions, the Board finds that further development is necessary to determine whether the Veteran was exposed to radiation while on active duty. Accordingly, VA should develop the Veteran's claim as directed under 38 C.F.R. § 3.311. Also, the Veteran contends that the radar equipment he worked on in 1974 and 1975 with the 607th Tactical Control Squadron based at Luke Air Force Base was returned from Vietnam, and he believes he may have been exposed to herbicide agents including Agent Orange. Accordingly, the VA should develop the claim to verify possible exposure to herbicides, Further, the Veteran was afforded a VA examination in September 2015 for his claimed non-Hodgkin's lymphoma. However, the Board finds that opinion inadequate as the examiner based his negative opinion on the absence of documentation of the condition in the Veteran's service treatment records. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (stating that the absence of documented treatment cannot, alone, serve as a basis for finding that lay evidence lacks credibility). Also, during the July 2021 Board hearing, the Veteran testified that he had skin problems throughout active duty, but doctors only diagnosed it as a rash or eczema. He also testified that he continued to have rashes all over his body after his separation from service. Accordingly, an addendum opinion is necessary for the examiner to discuss and consider the Veteran's testimony regarding his rashes in-service and thereafter. 2. Entitlement to service connection for chronic migraines is remanded. The Veteran contends that he experienced headaches on active duty and continued to experience headaches after separation from service. Alternatively, the Veteran contends that his migraines are due to exposure to ionizing radiation and/or exposure to herbicides during service. See July 2021 Hearing Transcript. As noted above, further development is needed in regard to the Veteran's contentions regarding exposure to ionizing radiation and herbicides during active service. Additionally, the Board finds that an addendum VA medical opinion is necessary although the Veteran was afforded a VA examination for his migraines in September 2015. The VA examiner's negative opinion is based on the absence of documentation in the Veteran's service treatment records of symptoms or diagnoses similar to the migraines and headaches the Veteran presently reports. Id. During the July 2021 Board hearing, the Veteran testified that he experienced headaches quite often during active duty and he visited site medics who gave him Motrin to treat his headaches. He also testified that his headaches continued after separation from service and his physician told him that his headaches may be attributed to his exposure to radiation from the radar equipment. Accordingly, an addendum opinion is necessary for the examiner to discuss and consider the Veteran's testimony regarding his headaches in-service and thereafter. The matters are REMANDED for the following actions: 1. Conduct all necessary development to request any available records concerning the Veteran's claimed exposure to radiation and develop the claim in accordance with 38 C.F.R. § 3.311. The Veteran testified that he was exposed to ionizing radiation while completing his duties as an aerospace control and warning systems craftsman and superintendent. 2. Attempt to verify the Veteran's asserted in-service exposure to herbicide agents, specifically his contention that the radar equipment he worked on in 1974 and 1975 with the 607th Tactical Control Squadron based at Luke Air Force Base was returned from Vietnam, and he believes he may have been exposed to herbicide agents including Agent Orange. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's non-Hodgkin's lymphoma (also claimed as mycosis fungoides) is at least as likely as not related to the skin problems he experienced during active service. The Veteran's service treatment records note treatment for skin problems in February 1776, July 1994, February 1995, and March 1995. When rendering an opinion, the examiner must consider and discuss the Veteran's July 2021 Board hearing testimony where he stated that he had skin problems throughout active service and continued to experience skin problems after his separation from service. Any opinion expressed should be accompanied by a complete rationale. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's migraines and headaches are at least as likely as not related to the headaches he experienced in service. The examiner is also asked to consider whether his migraines and headaches at least as likely as not that the (1) began during active service, (2) manifested within one year after discharge from service, or (3) were noted during service with continuity of the same symptomatology since service? The Veteran's service treatment records note complaints of headaches in December 1977, September 1981, September 1991, and June 1992. When rendering an opinion, the examiner must consider and discuss the Veteran's July 2021 Board testimony where he stated that he experienced headaches throughout service and sought treatment with site medics who gave him Motrin. He also testified that he continued to experience headaches after his separation from service. Any opinion expressed should be accompanied by a complete rationale. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hartford, 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.