Citation Nr: 21026423 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 16-31 513 DATE: May 3, 2021 ORDER 1. Entitlement to service connection for right upper extremity neuropathy as secondary to service-connected for follicular center cell lymphoma is granted. 2. Entitlement to service connection for left upper extremity neuropathy as secondary to service-connected for follicular center cell lymphoma is granted. FINDINGS OF FACT 1. The Veteran is currently service-connected for follicular center cell lymphoma (Non-Hodgkins lymphoma) due to contaminated ground water exposure at Camp Lejeune during active service. 2. The evidence as at least in equipoise as to whether the Veteran's bilateral upper extremity neuropathy is secondary to his service-connected follicular center cell lymphoma. CONCLUSIONS OF LAW 1. The criteria for service connection for right upper extremity neuropathy as secondary to service-connected follicular center cell lymphoma are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 2. The criteria for service connection for left upper extremity neuropathy as secondary to service-connected follicular center cell lymphoma are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from August 1979 to July 1983. This matter returns to the Board of Veterans' Appeals (Board) after a December 2018 Board decision remanding upper and lower extremity neuropathy. The Board finds substantial compliance with the December 2018 remand directives and therefore provides this decision on the merits under the legacy appeal framework. Service Connection Service connection generally requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a causal relationship, or nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; see Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability which is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 1 Vet. App. 439 (1995). To establish secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) competent evidence establishing a medical relationship between the service-connected disability and the current disability for which compensation is sought. See Wallin v. West, 11 Vet. App. 509 (1998). The necessary medical relationship may be shown by evidence that the nonservice-connected disability is proximately due to or the result of a service-connected disability, or that the nonservice-connected disease or injury is aggravated (increased in severity due)to a service-connected disability. 38 C.F.R. § 3.310(b). Service Connection for Left and Right Upper Extremity Neuropathy The Veteran contends that his bilateral upper extremity neuropathy is secondary to his service-connected follicular cell carcinoma (non-Hodgkins lymphoma). See June 2016 Form 9. The Veteran is currently diagnosed with mononeuropathy of the upper limbs. See October 2019 VA examination; October 2013 Private Treatment Record. Therefore, the Veteran has a current diagnosed disability for direct and secondary service connection. The Veteran is service connected for follicular cell carcinoma (non-Hodgkins lymphoma) due to contaminated water at Camp Lejeune during his active service from 1979 to 1983. Therefore, the second element of secondary service connection is met. The probative evidence of record contains two positive nexus opinions establishing a medical relationship between his service-connected follicular cell carcinoma (non-Hodgkins lymphoma) and his neuropathy of the upper limbs. The Veteran submitted a December 2013 private medical opinion by Dr. Ahmet Z. Burakgazi that stated that the Veteran's nerve disorders could be aggravated and/or amplified by the existence of non-Hodgkins lymphoma. Subsequently, the Veteran was afforded a VA examination in August 2014 which agreed with the private examination opinion. The August 2014 examiner stated that neurological disorders identified by the Veteran's private physician are at least as likely as not proximately due to or caused by the Veteran's service-connected follicular cell (non-Hodgkins) lymphoma. The Veteran has subsequently undergone various VA examinations in September 2015 and October 2019 with an addendum opinion in August 2020 based on the October 2019 examination. The September 2015 is was found inadequate for being counter to the evidence of record. The August 2020 addendum opinion is given little probative weight because it does not address all the evidence of record, relying heavily on a single nerve conduction examination and lack of supporting service treatment records; moreover, it does not address the Veteran's theory of secondary service connection. Therefore, after resolving any reasonable doubt in favor of the Veteran, the Board finds that the evidence is at least in equipoise to establish a medical relationship between the Veteran's service-connected follicular cell carcinoma (non-Hodgkins lymphoma) and his right and left (bilateral) upper extremity neuropathy. For foregoing reasons, the Board finds the preponderance of the evidence is in favor of the Veteran's claim and grants service connection for right and left upper extremity neuropathy on a secondary basis, subject to the laws and regulations governing the payment of VA monetary benefits, including consideration by the RO of potential pyramiding under 38 C.F.R. § 4.14. D. C. JOHNSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Boushehri, Darjush M. 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.