Citation Nr: 21022722 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-41 973 DATE: April 19, 2021 REMANDED Entitlement to a compensable rating for non-Hodgkin's lymphoma is remanded. Entitlement to a rating in excess of 20 percent from December 31, 2020 and 10 percent January 16, 2013 for left lower extremity sciatic nerve neuropathy, is remanded. Entitlement to a rating in excess of 20 percent from December 31, 2020 and 10 percent from January 16, 2013, for right lower extremity sciatic nerve neuropathy, is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to June 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston Salem, North Carolina. The Veteran testified before the undersigned Veterans Law Judge during a December 2018 hearing. A transcript of the hearing is associated with the Veteran’s claim file. This matter was previously before the Board in May 2019 and March 2020, wherein the Board remanded for additional development, to include obtaining additional treatment records and examinations. The matter has returned to the Board for adjudication. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). 1. Entitlement to a compensable rating for non-Hodgkin's lymphoma, to include separate disability ratings for residuals of non-Hodgkin's lymphoma Both the May 2019 and March 2020 Board decisions remanded the matter for additional treatment records and a VA examination as no clinician had addressed whether there were any residuals of the Veteran’s service-connected non-Hodgkin’s lymphoma, to include chronic pain syndrome; erectile dysfunction; peripheral vascular disease; an acquired psychiatric disorder, to include depression; peripheral artery disease, and carotid artery disease. The Veteran was afforded a VA examination in December 2020. There was an additional diagnosis of anemia related to the Veteran’s chemotherapy. Regarding the non-Hodgkin’s lymphoma, the VA examiner indicated that the Veteran had indolent and non-continuous phase of low grade non-Hodgkin’s lymphoma. The examiner also noted that the condition is in remission. She indicated that the location of the lymphoma was in the chest. Upon review of the Veteran’s claims file, his lymphoma that was diagnosed in 2004 was for lymphoma of the spleen. The Veteran was seen by Dr. J.Y. in May 2019 and it was noted that the Veteran had subacute onset of epigastric/abdominal pain. The physician indicated that a differential diagnosis also includes recurrence of non-Hodgkin’s lymphoma with GI manifestation since patient has been treated for this a few years ago. He stated that clinically, there was no obvious evidence of lymphadenopathy or hepatosplenomegaly on examination but, his night sweats are concerning, as is his anemia. The physician noted that he would refer the Veteran to GI for further evaluation. In June 2019, the Veteran was seen at Gastroenterology Associates and the problem/diagnosis list included non-Hodgkin’s lymphoma, unspecified, spleen, active and non-Hodgkin’s lymphoma (clinical), active. The Veteran’s private treatment records from Emerge Ortho document that in October 2019, the Veteran was seen for a follow-up for non-Hodgkin’s lymphoma (clinical). The most recent private treatment records are through October 2019 and therefore, based on the evidence in the record, it is unclear as to whether the Veteran’s non-Hodgkin’s lymphoma has recurred or whether it remains in remission. As such, the Board finds that a remand is necessary to obtain more recent private treatment records and a new examination is appropriate to determine the current state of the Veteran’s non-Hodgkin’s lymphoma. Furthermore, the Veteran indicated that his residuals from his non-Hodgkin’s lymphoma included carotid artery disease. The May 2019 and March 2020 Board decisions remanded the issue to determine whether there were any residuals related to the Veteran’s condition. The Veteran was examined in December 2020 for any residual conditions and the VA examiner noted that the Veteran had related residuals from his chemotherapy of chronic pain syndrome, peripheral vascular disease, peripheral neuropathy, heart disease, peripheral artery disease and carotid artery disease. A separate psychiatric examination found that the Veteran had depression related to his condition. Nevertheless, on examination there was no diagnosis related to carotid artery disease and it was only addressed in the medical opinion and not addressed on examination. Therefore, the Board will remand the issue to ask for clarification regarding the carotid artery disease. 2. Entitlement to a rating in excess of 20 percent from December 31, 2020 and 10 percent January 16, 2013 for left lower extremity sciatic nerve neuropathy 3. Entitlement to a rating in excess of 20 percent from December 31, 2020 and 10 percent from January 16, 2013 for right lower extremity sciatic nerve neuropathy 4. Entitlement to a TDIU During the course of the appeal, the Veteran was issued separate ratings for his left and right lower extremity sciatic nerve neuropathy as residuals related to his chemotherapy for his non-Hodgkin’s lymphoma. The Veteran also contends that he is entitled to a TDIU as he cannot secure or follow substantially gainful occupation due to his service-connected conditions. However, as the Board is remanding the case for an updated VA medical opinion regarding the status of his service-connected non-Hodgkin’s lymphoma, the Board will defer consideration of the appeal with regard to entitlement to the increased bilateral neuropathy ratings and TDIU. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The matters are REMANDED for the following action: 1. Obtain VA treatment records from November 2020 to present. All reasonable attempts should be made to obtain any identified records. 2. The Veteran should also be afforded the opportunity to identify and submit any outstanding private treatment records relevant to his claims on appeal, or in the alternative, provide a release so that VA can attempt to obtain these records. Specifically, the Veteran should either submit or provide a release for records from Dr. J.Y., from October 2019 to present, Duke University Medical Center after May 2006, Dr. Biehl, and Gastroenterology Associates. All the action taken in this regard should be documented. 3. After completion of the above, obtain an addendum opinion from the VA provider who issued the December 2020 examination for the service-connected non-Hodgkin’s lymphoma (or if no longer available, an appropriate replacement). The decision for an in-person examination of the Veteran is left to the discretion of the examiner. The record, including a copy of this remand, must be made available to the examiner, and an opinion as follows is requested: a.) The examiner is instructed to determine when the Veteran’s non-Hodgkin’s lymphoma was last active. The examiner must also discuss the duration of any active periods, to include any treatment for the disorder. b.) The examiner must address the findings of the December 2020 VA examination which found that the Veteran had indolent and non-contiguous phase of low grade non-Hodgkin’s lymphoma. The examiner must determine when the Veteran’s non-Hodgkin’s lymphoma began to be in the indolent and non-contiguous phase. Additionally, the examiner must explain the findings of the location of the Veteran’s lymphoma of the chest as noted in the December 2020 VA examination and lymphoma of the spleen as evidenced in July 2004. c) The examiner must also address whether the Veteran has a current diagnosis of carotid artery disease, or that a diagnosis was present at any point pertinent to the current claim (even if now asymptomatic or resolved) during the appellate period (from January 2013). (CONTINUED ON NEXT PAGE) The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, the examiner should so state and explain why an opinion cannot be provided without resorting to speculation. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Kim, 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.