Citation Nr: 21074695 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 18-48 102 DATE: December 16, 2021 ORDER Entitlement to service connection for non-Hodgkins lymphoma is denied. REMANDED Entitlement to service connection for Hodgkins lymphoma is remanded. FINDING OF FACT The Veteran has not had a diagnosis of non-Hodgkins lymphoma during the period on appeal. CONCLUSION OF LAW The criteria for service connection for non-Hodgkins lymphoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from July 1977 to August 1980. The Board sincerely thanks the Veteran for his service to our country. This matter comes before the Board of Veterans' Appeals (Board) from a March 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). It was previously before the Board in July 2020 when it was remanded for medical opinions. In February 2020, the Veteran testified at a Travel Board before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. 1. Entitlement to service connection for non-Hodgkins lymphoma The Veteran contends that he has a diagnosis of non-Hodgkins lymphoma, which he asserts is related to radiation exposure in service. See June 2016 VA Form 21-526EZ, Fully Developed Claim. In his June 2016 claim for service connection for non-Hodgkin's lymphoma, the Veteran stated what while he was assigned to AIMD in Rota, Spain, as a Seaman Apprentice, he was assisting with non-destructive investigation (NDI) monitoring radiation on aircraft superstructure and was responsible to establish a safety perimeter. The Veteran reported using a Geiger counter to monitor gamma radiation and was supplied with film badges to monitor personal radiation exposure. In a January 1992 Statement in Support of Claim, the Veteran stated he performed x rays on aircraft super structures in Spain from 1977 to 1980. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of non-Hodgkins lymphoma and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The April 2021 VA clinician reviewed the Veteran's treatment records and noted some treatment records showed a history of non-Hodgkins lymphoma. The clinician concluded the Veteran has a diagnosis of Hodgkins lymphoma but not non-Hodgkins lymphoma based on pathology reports. The examination report shows that the Veteran reported that he was diagnosed with Hodgkins lymphoma in 1981 and underwent radiation therapy. He further reported a relapse in 1987 for which he underwent radiation therapy and chemotherapy. Further, a September 1991 hematology/oncology treatment note provides a diagnosis of Hodgkins disease. Treatment records close in time to the Veteran's 1981 diagnosis all refer to his Hodgkins lymphoma diagnosis (see, e.g., October 1983, November 1983, September 1991 treatment records), and not to a diagnosis or biopsy confirming non-Hodgkins lymphoma. The Board gives more probative weight to the April 2021 VA examiner's findings than to the VA treatment records as the examiner had the benefit of review of the medical history and laboratory findings. While the Veteran believes he has a current diagnosis of non-Hodgkins lymphoma, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The claim for non-Hodgkins lymphoma must be denied. REASONS FOR REMAND 1. Entitlement to service connection for Hodgkins lymphoma is remanded. It appears VA has not yet requested records from the VA Medical Center in Long Beach, California prior to December 1982, likely because the Veteran indicated that he began treatment in December 1982 when he filed his original claim. However, VA treatment records from that facility dated in August 1984 reflect that he was "diagnosed by Pathology as a Stage 1A by right cervical lymph node in 11/81" which suggests that there are relevant VA records outstanding from the period prior to December 1982. Further, a supplemental opinion is needed as the examiner did not address the Veteran's report of a swollen gland in his neck during service and after service that was removed following his 1981 diagnosis as part of his treatment for Hodgkins lymphoma. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete VA clinical records (any not already of record) of all VA treatment prior to December 1982, including records of treatment at the VA Medical Center in Long Beach, California in 1980, 1981 and 1982. 2. After the development in paragraph 1, above, is deemed to be complete, please refer the claim to the appropriate clinician for a medical opinion as to the nature and etiology of the Veteran's Hodgkins lymphoma. The Veteran's claims-file must be made available to and reviewed by the clinician. Based on review of the record, the clinician is requested to provide the following opinions: (a.) Whether it is at least as likely as not (a 50 percent or higher degree of probability) that the Veteran's Hodgkin's disease, diagnosed in November 1981 manifested within 1 year of his separation from service in August 1980 in light of the Veteran's statements that he observed he had a swollen area/gland in his neck in service and following service and that a needle biopsy of that area resulted in his 1981 diagnosis of Hodgkins disease. Please explain. (b.) Whether it is at least as likely as not (a 50 percent or higher degree of probability) that the Veteran's lymphoma is related to his military service in light of the Veteran's statements that he observed he had a swollen area/gland in his neck in service and following service and that a needle biopsy of that area resulted in his 1981 diagnosis of Hodgkins disease. Please explain. (c.) Is the Veteran's report of a swollen gland in service consistent or inconsistent with the way Hodgkins disease is known to manifest/develop? Why? ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination (or telehealth interview, etc., if an in-person examination is not feasible) to determine the nature and etiology of the disorder on appeal. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in-service and post-service symptom experiences. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O. Halpern 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.