Citation Nr: 21042426 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-03 337 DATE: July 13, 2021 REMANDED Service connection for anaplastic large cell non-Hodgkin's lymphoma. REASONS FOR REMAND The Veteran served on active duty for training (ACDUTRA) from May 1998 to November 1998 and on active duty from January 2003 to May 2004. The case is on appeal from a May 2013 rating decision. In April 2019, the Board remanded this claim. While the Veteran requested a Board hearing on his January 2016 VA Form 9, the Board in April 2019 determined that this request was considered withdrawn. Service connection for anaplastic large cell non-Hodgkin's lymphoma. The Board finds that remand is warranted, pursuant to VA's duty to assist, to afford the Veteran a VA examination and to obtain outstanding VA treatment records. Evidence of record indicated that the Veteran was diagnosed with anaplastic large cell non-Hodgkin's lymphoma in May 2008 and that at that time he had a three month history of a neck mass. See, e.g., July 2011 Dr. C.F. Letter ("[The Veteran] was diagnosed of stage IB anaplastic large cell non-Hodgkin['s] lymphoma on May 9, 2008"); May 2008 Ben Taub General Hospital Discharge Summary (noting "a 3-month of history of an enlarging left base of the neck mass"). Dr. C.F.'s July 2011 letter additionally noted that the Veteran "underwent allogeneic hematopoietic stem cell transplantation on August of 2010" and that "[a]t this time, it is impossible to determine if [the Veteran] is cured of his recurrent lymphoma." See also August 2011 Dr. J.C. Letter ("[The Veteran's] lymphoma is difficult to treat, on the most part not curable, and often relapses"). The Veteran has, essentially, contended that while his lymphoma was diagnosed after service, it was due to in-service exposures to various substances. In this regard, in a July 2011 statement the Veteran stated: Upon doing research of my illness (cancer), I have come to conclude that Anaplastic Large Cell Lymphoma can come at 5 to 10 y[ea]rs after coming in contact with anything from chemicals, radioactive products or waste, radiation from antennas, exposure to contaminants and so on. I then further proce[e]ded to ask questions to doctors and they too confirmed these findings...I strongly believe that there is re[a]sonable chance that I got sick while in the Army. Then years later it came. After all since I joined the Army I worked with chemicals. Then after doing an MOS change I started patrolling areas that showed warning as having radio activity ([b]unkers while being an MP). We also worked, patrolled areas where aircraft w[]ere and radar antennas working. So technically speaking, the Army does have those pos[s]ibilities of exposure of something to have caused my cancer. In addition, in a May 2014 statement accompanying his notice of disagreement (NOD) the Veteran stated: From the research I conducted it shows that the possibility of me getting diagnosed with cancer can happen anywhere from 4 to 10 years after a potential exposure. Potential exposure meaning of any substances, chemicals, solvents, fumes, diesel, gasses, etc. Although the military says I never was exposed to radiation (which I feel I wasn't), I believe that the possibility of exposure to something else can exist. Throughout my military career I was exposed to gun powder gasses, oils, solvents, chemicals, fuel, and bug sprays along with many other types of substances used by the military. And from the internet research I looked up it shows that there is a possibility that those items can result in lymphomas within the 4 to 10 year span. I also did talk to a research doctor that agrees with my statement. But at the moment I have not been able to locate him. They went on to elaborate and used chemicals as an example that frequent exposure to chemicals and solvents used for cleaning weapons could have triggered the lymphoma. It was mentioned that practically it can be anything that triggered the lymphoma to happen during my years of enlistment. But the symptoms did not show till 2008. He also noted that from the time I completed my enlistment (2004) I fall within the bracket of the 4 to 10 years. Furthermore he stated that because there is no record of ever being sick during my enlistment, it does not rule out the possibility of getting diagnosed later related to military substances. He also concluded that the military is aware of the potential after effects of the products they use in the military such as the chemicals and the after effects of the gasses released from diesel engines and fire arms etc. And last, he brought up that those items are noted in many reference manuals and are known to cause cancer from frequent exposure. As noted, the Veteran has been diagnosed with lymphoma. His July 2011 and May 2014 statements, essentially, included his reports of being exposed to various substances during his active service. His May 2014 statement, essentially, included his report of being told by a doctor that there was a possibility that his in-service exposure to various substances can result in lymphomas within four to ten years of exposure. The Veteran is competent to report being exposed to various substances during his active service and also to report what a doctor told him. See 38 C.F.R. § 3.159(a)(2) (defining competent lay evidence). The Veteran has not been afforded a VA examination as part of this claim. Based on the evidence of record, to include that outlined above, the Board finds that the requirements for VA to afford the Veteran a VA examination and obtain a direct service connection opinion have been met. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Specifically, the Veteran's competent May 2014 statement as to what a doctor told him is sufficient to meet the "low threshold" to indicate that the Veteran's claimed lymphoma "may be associated" with his active service. As such, remand is warranted to afford the Veteran a VA examination and obtain an opinion, as outlined further in the remand directives below. In addition, outstanding VA treatment records also should be obtained. In this regard, the current VA treatment records are limited to a single day of mental health records from August 2011. The Veteran, however, has reported receiving treatment related to his claimed lymphoma during this appeal. See e.g., June 2011 VA Form 21-526 (listing VA treatment from April 2008 to the present at the Houston and San Antonio VA Medical Centers (VAMCs)); June 2013 Veteran Statement (noting specific dates of treatment at the Houston and San Antonio VAMCs in 2009-2011). Pursuant to VA's duty to assist, on remand all outstanding VA treatment records from the Houston and San Antonio VAMCs should be obtained. See 38 U.S.C. § 5103A(c)(1)(B); 38 C.F.R. § 3.159(c)(3). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records from the Houston and San Antonio VAMCs. 2. Afford the Veteran a VA examination with respect to his anaplastic large cell non-Hodgkin's lymphoma claim. The examiner must provide an opinion addressing the following: Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that anaplastic large cell non-Hodgkin's lymphoma had its onset during service or is otherwise related to service. The examiner's attention is invited to: (a.) The Veteran's contention that, essentially, while his lymphoma was diagnosed after service, it was due to in-service exposures to various substances. The Veteran outlined this contention in July 2011 and May 2014 statements, which were extensively quoted in the body of the Board remand. (b.) The Veteran's report of, essentially, being told by a doctor that there was a possibility that his in-service exposure to various substances can result in lymphomas within four to ten years of exposure. See May 2014 Veteran Statement. The Board notes that the Veteran's last period of active service ended in May 2004 and that evidence referenced his anaplastic large cell non-Hodgkin's lymphoma as being diagnosed in May 2008. See, e.g., July 2011 Dr. C.F. Letter. For all opinions provided, the examiner must include the underlying reasons for any conclusions reached. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoopengardner, 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.