Citation Nr: 21010367 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 16-06 893 DATE: February 24, 2021 REMANDED Entitlement to a compensable evaluation for residuals of hairy cell leukemia on an extraschedular basis is remanded. REASONS FOR REMAND The Veteran served in the United States Army from October 1955 to October 1957. This matter is before the Board of Veterans’ Appeals Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2018, when it was remanded for further development, and again in March 2020, when it was remanded in order to be referred to the Director of Compensation. This matter returned to the Board in December 2020, at which time it was again remanded in order to obtain an addendum opinion and has since returned to the Board for further appellate review. Entitlement to a compensable evaluation for residuals of hairy cell leukemia on an extraschedular basis is remanded. In its March 2020 decision, the Board found the Veteran did not meet the criteria for a compensable schedular rating for residuals of hairy cell leukemia and remanded the claim to have the RO refer the Veteran’s claim on an extraschedular basis to the Director of Compensation Service (Director). The Director issued a decision in September 2020 denying an extraschedular rating for the Veteran. In its December 2020 decision, the Board remanded the Veteran’s claim for additional development. The Board instructed the RO to obtain the Veteran’s VA treatment records from September 2020 to the present, as well as to obtain an addendum medical opinion on whether symptoms, including weakness, shortness of breath, lightheadedness with exertion, headaches, exertion causing fatigue, and chest pain were at least as likely as not attributable, in whole or in part, to the Veteran’s residuals of hairy cell leukemia. An addendum opinion was provided in December 2020. The examiner reviewed the Veteran’s records and noted the Veteran had an appointment with hematology and oncology in September 2020. During the September 2020 appointment, the Veteran reported he continued to do well overall, with no complaints since his last appointment. The Veteran also reported his appetite and energy were good, and he denied having any weakness, shortness of breath, lightheadedness with exertion, headaches, exertion caused fatigue, and chest pain. The examiner noted the November 2019 examiner used lab results that were from May 2016, which the December 2020 examiner found to be unacceptable because the laboratory results were over three years old. The laboratory results from the September 2020 hematology/oncology appointment showed the Veteran’s platelet count was higher than the counts shown in the May 2016 lab results. The examiner went on to opine that the Veteran’s platelet count of 133, as well as the Veteran’s denial of weakness, shortness of breath, lightheadedness with exertion, headaches, exertion caused fatigue, and chest pain during his September 2020 appointment, shows there is no evidence of residuals of those symptoms, and therefore those symptoms “are less likely than not attributable, in whole or in part, to the Veteran’s residuals of hairy cell leukemia.” However, while the December 2020 examiner addressed the November 2019 VA examination and the September 2020 hematology/oncology notes, the examiner did not address the Veteran’s other reports of weakness, shortness of breath, lightheadedness, with exertion, headaches, easy fatigue, weakened immune system, easy bruising, and chest pain from both medical appointment notes as well as previous VA examinations. As these symptoms have been described during the appeal period, the Board finds the December 2020 examination to be inadequate because it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (indicating that a medical opinion based on an inaccurate factual premise has no probative value). Therefore, the Board must remand this matter in order to obtain an addendum opinion. Accordingly, this matter is REMANDED for the following action: 1. Obtain updated VA treatment records from December 2020 to the present. 2. Obtain an addendum opinion from the December 2020 examiner or another qualified examiner regarding the residuals of the Veteran’s hairy cell leukemia. If the examiner determines the Veteran should be given another examination (including via telehealth if an in-person examination is not possible) to answer the below question, one should be scheduled. The examiner is asked to opine on whether symptoms described during the period on appeal, including weakness, shortness of breath, lightheadedness with exertion, headaches, exertion causing fatigue, and chest pain are at least as likely as not attributable, in whole or in part, to the Veteran’s residuals of hairy cell leukemia. The examiner is to review all of the evidence of record, to include the following: (a.) September 20, 2013 VA hematology/oncology treatment note; (b.) December 2013 VA examination report; (c.) September 22, 2014 VA hematology/oncology note; (d.) February 2016 VA examination report; (e.) March 13, 2017 VA treatment note; (f.) November 2019 VA examination report; (g.) December 2020 VA examination report; and (h.) Any lay statements made by the Veteran. A complete rationale for all opinions must be provided. If the examiner cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be given due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Gabrielle Ongies, 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.