Citation Nr: 21075586 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-56 939 DATE: December 20, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II (diabetes) to include as secondary to a non-Hodgkin's lymphoma known as Burkitt's Lymphoma is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1986 to April 1990. This matter is before the Board of Veterans' Appeals (Board) on appeal of a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the record. In June 2002, the Veteran's physicians diagnosed and treated the Veteran for Burkitt's lymphoma, a form of non-Hodgkin's lymphoma (NHL). He is now service connected for NHL although thankfully, the NHL is in remission. In April 2011, the Veteran was diagnosed with diabetes mellitus, type II (diabetes). The Veteran asserts that his NHL caused or aggravated the diabetes. 38 C.F.R. § 3.310. With apologies to the Veteran, 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 for service connection for diabetes. VA examinations must contain opinions and rationale that will allow the Board's decision to be a fully informed one. See D'Aries v. Peake, 22 Vet. App. 97, 104 (2008). The Veteran received two VA examinations. The October 2017 VA examiner only stated there was a nine-year period between the NHL diagnosis and the diabetes diagnosis. The examiner did not explain the significance of the time length when concluding NHL did not cause or aggravate the Veteran's diabetes. The August 2019 VA examiner noted diabetes can be a risk factor for cancer, but cancer does not increase the risk for diabetes. The Veteran's physician, Dr. D. Williams, however, submitted a January 2019 opinion concluding as likely as not that the NHL caused the Veteran's diabetes. This opinion suggested that the Veteran developed diabetes not from the NHL itself but from the chemotherapy administered to successfully treat NHL. (The Veteran's NHL has been in remission since the chemotherapy). Attached to the opinion are medical articles that discussed how certain cancer chemotherapy regimens may result in diabetes. The August 2019 VA examiner never discussed whether the chemotherapy regimen administered to the Veteran led to his diabetes. It is also unclear to the Board whether the Veteran's chemotherapy regimen is one of the regimens discussed in the submitted medical literature. Therefore, the Board has determined that the Veteran should receive a new VA examination to discuss this issue. Furthermore, the record raises other avenues regarding whether diabetes may be service connected. His service records establish the Veteran served at Camp Lejeune from September 1986 to November 1986. Thus, the Board finds the record reasonably raises the issue of whether the Veteran's diabetes is a result of the contaminated water at Camp Lejeune. 38 C.F.R. § 3.309 (f). The Board notes diabetes is not one of the diseases presumptively caused by the contaminated water at Camp Lejeune between August 1953 and December 1987, but the Veteran may still establish service connection with proof of direct causation. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran also attended training a chemical decontamination course in August 1988. He stated the training included participation in decontaminating other Marines in a training area. Thus, on remand, efforts should be made to determine whether the Veteran was exposed to chemicals that resulted in his diabetes. Ongoing medical records should also be obtained. The matters are REMANDED for the following action: 1. Ask the proper Federal custodians for information regarding any chemical exposure to the Veteran while he attended the NBC Monitor, Survey, and Decontamination School in August 1988. 2. Ask the Veteran to identify all outstanding treatment records relevant to his service connection for diabetes claim. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 3. After records development is completed, schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that diabetes had its onset during service or is otherwise related to an in-service injury, event, or disease, to include contaminated water at Camp Lejeune and/or exposure to chemicals while attending the decontamination course in August 1988. In offering the opinion, the examiner is instructed to provide an opinion as to whether the disability is related to the Veteran's active military service or otherwise attributable to the drinking water at Camp Lejeune regardless of whether the condition is a listed disease under 38 C.F.R. § 3.309 (f). The examiner should also address whether the Veteran's diabetes is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service connected Burkitt's lymphoma, to include as a result of the chemotherapy regimen used to treat the Burkitt's lymphoma. Both causation and aggravation should be discussed. In offering the opinion, the examiner is asked to consider the chemotherapy regimen consisted of 10 cycles of hyper-CVAD, Rituxan and Methotrexate, ara-c, plus Rituxan. The examiner is also asked to discuss the medical literature in the file regarding an association between diabetes and chemotherapy regimens. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Russell P. Veldenz, 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.