Citation Nr: 22012220 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 18-44 975 DATE: March 2, 2022 REMANDED Entitlement to a compensable disability rating for non-Hodgkin's lymphoma (NHL), to include residuals, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1986 until September 1986. This claim comes to the Board of Veterans' Appeals (Board) on appeal from a July 2017 Department of Veterans Affairs (VA) regional office (RO) rating decision. The Veteran participated in a hearing before the undersigned in March 2021; a transcript is associated with the claims file. In August 2021, the Board remanded the matter to obtain a VA examination regarding the nature and severity of his NHL residuals including headaches, lightheadedness, and fatiguability. Entitlement to a compensable disability rating for NHL residuals is remanded. To review, the August 2021 Board decision found that while the Veteran's NHL was in remission, and therefore ineligible for the only rating available under Diagnostic Code 7715, there were several residuals related to his NHL, including headaches, lightheadedness, and fatiguability. Because Diagnostic Code 7715 allows NHL to be rated upon residuals during inactive disease, remand was required to obtain information on how severe these residuals were. In response, an October 2021 VA examination was obtained. Therein, the examiner noted that the Veteran's NHL was in treatment phase but also in remission. The examiner explained that the Veteran is "still with periods of fatigue and taking vitamin E for it." In a separate October 2021 opinion, the examiner described the Veteran's headaches, lightheadedness, and fatigability to be of a "moderate level of severity with low vitamin D." No further description of the Veteran's residuals was given. Unfortunately, remand is again required. First, the Board finds that the October 2021 examination report contains internal inconsistencies, namely, whether or not the Veteran's NHL is in remission or in treatment phase. The former is eligible for the sole rating under Diagnostic Code 7715, while the latter is eligible to be rated under residuals. Clarification must be sought on remand. Furthermore, if the Veteran was to be rated under his NHL residuals, the Board is without the medical information necessary to make an informed decision on this claim as the October 2021 VA examination was vague and non-specific. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). At this juncture, the Board finds that his symptoms of fatigue and lightheadedness are most closely analogous to those relating to chronic fatigue syndrome, Diagnostic Code 6354, and his symptoms of headaches are most closely analogous to those relating to migraine headaches, Diagnostic Code 8100. Diagnostic Code 6354 includes debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms. A 10 percent disability rating is warranted for signs and symptoms that wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year or the symptoms are controlled by continuous medication. A 20 percent disability rating is warranted for signs and symptoms which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level or; which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year. A 40 percent disability rating is warranted for signs and symptoms that are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level or; which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year. A 60 percent disability rating is warranted for signs and symptoms that are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level or; which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year. A maximum 100 percent disability rating is warranted for signs and symptoms that are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care. A Note to Diagnostic Code 6354 provides that, for the purpose of rating chronic fatigue syndrome, the condition will be considered incapacitating only while it requires bed rest and treatment by a physician. Diagnostic Code 8100, governing headaches, provides for a 10 percent rating for characteristic prostrating attacks occurring an average of once every two months over the several months. A 30 percent rating is warranted for characteristic prostrating attacks occurring on an average of once a month over the last several months. A maximum 50 percent rating is warranted for very frequent completely prostrating attacks productive of severe economic inadaptability. After reviewing the above diagnostic codes, the Board finds that the October 2021 VA examiner's statement describing these residuals of being of a "moderate level of severity with low vitamin D" does not inform the Board nearly enough to make a decision on the merits. On remand, the relevant VA examinations for each residual should be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination(s) with a qualified examiner(s) to determine the current nature and severity of all NHL residuals found to be present, to include headaches, lightheadedness, and fatiguability. The Board reminds the examiner(s) that his symptoms of fatigue and lightheadedness are most closely analogous to those relating to chronic fatigue syndrome, Diagnostic Code 6354, and his symptoms of headaches are most closely analogous to those relating to migraine headaches, Diagnostic Code 8100. The record and a copy of this remand must be made available to and reviewed by the examiner(s). The examination(s) must include all physical and diagnostic testing deemed necessary by the examiner(s) in conjunction with this request and must address the level of severity, and the functional effects, of each residual of NHL found to be present at any point during the appeal period. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.