Citation Nr: 21028937 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 15-17 003 DATE: May 12, 2021 REMANDED Entitlement to service connection for a respiratory condition, including as secondary to service-connected non-Hodgkins lymphoma is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1968 to February 1970. This matter comes before the Board from a December 2014 rating decision. The Veteran appeared before the undersigned Veterans Law Judge at a Board hearing in February 2018. The transcript is in the record. The matter was previously remanded by the Board in July 2018. An April 2020 Board decision denied the claim. The Veteran appealed the Court of Appeals for Veterans Claims (CAVC). A joint motion for remand (JMR) was issued in December 2020, returning the matter to the Board for further adjudication. 1. Entitlement to service connection for a respiratory condition, including as secondary to service-connected non-Hodgkins lymphoma is remanded. In essence, the parties to the JMR agreed that the report of a November 2019 VA examination failed to adequately address the question of whether medications that the Veteran took to treat his non-Hodgkin's lymphoma had aggravated his respiratory disorder. Reference made to a portion of the Veteran's February 2018 hearing testimony in which the Veteran stated he developed a chronic cough after his chemotherapy treatment and the cough continues to the present. Although the VA examiner acknowledged that approximately 13 percent of patients treated with Ritaxan (the chemotherapy drug with which the Veteran was treated), and that the most likely cause of the Veteran's cough was his history of smoking, the parties found that the question of aggravation was not sufficiently addressed. As the lay evidence indicates that the timing of the onset of the Veteran's chronic cough corresponds to the beginning of his lymphoma treatment with Ritaxan, and there is medical evidence of record, including a statement from Dr. L.M., which indicates patients treated with Ritaxan develop coughs and minor lung damage, a remand is necessary to address whether in the Veteran's specific case it is as likely as not that his cough developed as a result of his treatment for lymphoma, including Ritaxan. Additionally, in an April 2021 brief from the Veteran's representative, it is argued that the Veteran's respiratory condition is directly related to his exposure to herbicide agents in Vietnam. It has already been conceded that the Veteran is presumed exposed to herbicide agents. No VA examiner has addressed whether direct exposure to herbicide agents may have caused, or contributed to, the Veteran's development of a respiratory condition. This theory should also be addressed on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any respiratory condition, including chronic cough. After reviewing the claims file and examining the Veteran, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran's respiratory condition, including chronic cough: (a.) had its onset in service or is otherwise etiologically related to active service. The Veteran's exposure to herbicide agents should be addressed, as well as the theory that this exposure has caused or contributed to the development of his respiratory condition, including chronic cough. (b.) was proximately due to the Veteran's service-connected non-Hodgkin's lymphoma, including treatments for the lymphoma. The Veteran's treatment with Ritaxan should specifically be addressed, as well as the Veteran's lay statements regarding the development of his chronic cough after he began treatment with Ritaxan and that he did not have a chronic cough prior to this treatment. The medical literature cited by the November 2019 VA examiner should be addressed, as should the statement from Dr. L.M. about the correlation between Ritaxan and minor lung damage. (c.) underwent any incremental increase in disability, regardless of its permanence, due to service-connected non-Hodgkin's lymphoma, including treatments for the lymphoma. Even if smoking is found to have been primary cause of his respiratory disorder, the examiner must address the argument that the Veteran's use of Ritaxan aggravated his respiratory disorder. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rekowski 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.