Citation Nr: 21011845 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-44 007 DATE: March 2, 2021 REMANDED Entitlement to service connection for rheumatoid arthritis (RA) is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from January 1966 to December 1968, to include service in the Republic of Vietnam. Unfortunately, the Veteran died in November 2015 during the pendency of this appeal. The Veteran’s surviving spouse has been substituted as the appellant in this appeal by the Agency of Original Jurisdiction (AOJ) by way of a November 2018 decision. The Board remanded this matter in February 2019 and July 2020 for further evidentiary development. The case has returned to the Board for appellate review. Entitlement to service connection for RA is remanded. The Veteran sought service connection for his RA as he believed that this disability was related to his military service. Specifically, the Veteran contended that his RA had worsened as a result of the treatment and management of his service-connected non-Hodgkin’s lymphoma (NHL). The Board notes that a March 2013 statement from the Veteran’s private physician indicated that the Veteran was treated for RA and had been taking immunosuppressive therapy prior to his diagnosis of NHL. He reported that immunosuppressive therapy was contraindicated due to NHL. He noted that exposure to Agent Orange and development of lymphoma directly impacted the treatment for RA. He reported that he anticipated a progression of the Veteran’s RA. No particular rationale was provided to support this indication. The Veteran was afforded VA examinations in November 2013 and January 2020. The February 2019 Board remand found the November 2013 VA examination inadequate for rating purposes as the examiner failed to provide an adequate rationale for the conclusion reached. The January 2020 examiner provided negative nexus opinions for both direct and secondary service connection and provided the rationale that RA is not related to Agent Orange and there is no cause and effect relationship between NHL causing RA. However, the examiner did not discuss the contention of aggravation of the Veteran’s RA as a result of the treatment and management of his service-connected NHL. In light of the inadequacy of the opinion for rating purposes, a remand is necessary in order to obtain another VA opinion discussing the nature and etiology of the Veteran’s RA disability as it related to his treatment for NHL. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Reonal v. Brown, 5 Vet. App. 548 (1993). The matters are REMANDED for the following action: 1. Obtain a VA opinion from a clinician of appropriate expertise to ascertain the nature and etiology of the Veteran’s RA. The claims file should be made available to and be reviewed by the examiner in conjunction with the entry of pertinent findings. The examiner should address the following: (a.) Whether is it at least as likely as not (50 percent or greater likelihood) that the Veteran’s RA disability had its onset in service or is otherwise related to active service, Agent Orange exposure, and/or due to treatment for the Veteran’s non-Hodgkin’s lymphoma. This should include a discussion of whether the Veteran’s RA was proximately due to, the result of, or aggravated (made worse) by the treatment for non-Hodgkin’s lymphoma. (b.) The clinician should provide a detailed rationale for the opinion, including a discussion of the evidence of record and medical principles which led to the conclusions reached, to include the relation between treatment for non-Hodgkins lymphoma and RA. If an opinion cannot be provided without resort to speculation, the examiner should explain why it is not possible to provide an opinion; 2. After the development requested has been completed, the AOJ should review the expanded record to ensure complete compliance with the directives of this REMAND. If any report is deficient in any manner, implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Frazier, Associate Attorney 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.