LYMPHOMA

TANYA SMITH · 2026 · Case ID: 26004317

DENIED

Summary

The Veteran, a Navy Veteran who served from January 1969 to December 1972, appeals the denial of service connection for grade 2 follicular lymphoma and B-cell lymphoma, lethargy, and cold sensitivity in the bilateral upper and lower extremities. The Veteran contended that his lymphoma was due to toxic exposure risk activities (TERAs), including ionizing radiation and asbestos, and that his lethargy and cold sensitivity were secondary to the lymphoma. The Board reviewed multiple VA examinations and opinions from November 2024, December 2025, and January 2026. These opinions consistently found that the Veteran's lymphoma was less likely than not caused by his conceded TERAs, citing a lack of medical literature supporting an association between his specific lymphoma and low-level occupational exposure to asbestos or ionizing radiation. The Board also noted that the Veteran was not diagnosed with lymphoma until years after service and that his lay testimony, while competent to report symptoms, was insufficient to diagnose the complex medical condition. The Board found the VA opinions adequate and dispositive, denying service connection for the lymphoma. Consequently, the claims for lethargy and cold sensitivity, which were secondary to the lymphoma, were also denied due to the lack of a service-connected primary disability. The Board found the evidence was not in approximate balance, thus the benefit of the doubt doctrine did not apply.

Rationale

VA opinions found lymphoma less likely than not caused by ionizing radiation or asbestos exposure.; Lack of medical literature supporting association between lymphoma and low-level occupational exposure.; Veteran diagnosed years after service; no evidence of in-service onset or continuity of symptomatology.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-13 214

Full Decision Text

Citation Nr: 26004317
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 17-13 214
DATE: April 8, 2026

ORDER

Entitlement to service connection for grade 2 follicular lymphoma and B-cell lymphoma is denied.

Entitlement to service connection for lethargy is denied.

Entitlement to service connection for cold sensitivity in the bilateral upper and lower extremities is denied.

FINDINGS OF FACT

1. The Veteran's grade 2 follicular lymphoma and B-cell lymphoma are not etiologically related to service, to include his toxic exposure risk activities.

2. The Veteran is not service connected for grade 2 follicular lymphoma and B-cell lymphoma, the underlying disability for which the claim for lethargy is based upon.

3. The Veteran is not service connected for grade 2 follicular lymphoma and B-cell lymphoma, the underlying disability for which the claim for cold sensitivity in the bilateral upper and lower extremities is based upon.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for grade 2 follicular lymphoma and B-cell lymphoma have not been met. 38?U.S.C. §§ 1110, 5107; 38 C.F.R. §§?3.102, 3.303.

2. The criteria for entitlement to service connection for lethargy have not been met. 38?U.S.C. §§ 1110, 5107; 38 C.F.R. §§?3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for cold sensitivity in the bilateral upper and lower extremities have not been met. 38?U.S.C. §§ 1110, 5107; 38 C.F.R. §§?3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from January 1969 to

December 1972.

This matter originally came before the Board of Veterans' Appeals (Board) from a

December 2015 rating decision of the Department of Veterans Affairs (VA)

Regional Office (RO).

As indicated in the September 2021 and November 2025 Board remands, a Board hearing was conducted in August 2019, however, the transcript was unable to be produced. In November 2019 correspondence, the Veteran requested a new Board hearing. It was scheduled for August 2021, but the Veteran did not attend this hearing. As a result, the Veteran's hearing request was deemed withdrawn.

Service Connection

Generally, to establish service connection a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service."?Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009);?Shedden?v.?Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.?38?C.F.R. §?3.303(d).??????

Service connection may be granted on a?secondary?basis for a disability that is proximately due to or the result of a service-connected disease or injury.?38?C.F.R. §?3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.?Id.;?Allen v. Brown,?7?Vet. App.?439, 448-49 (1995).??

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits.?38?U.S.C. §?1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.?Jandreau?v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).??????

When there is an approximate balance of
App.?439, 448-49 (1995).??

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran.?38?U.S.C. §?5107(b); 38 C.F.R. §?3.102;?see?Gilbert v.?Derwinski,?1?Vet. App.?49, 53 (1990).???

1. Entitlement to service connection for grade 2 follicular lymphoma and B-cell lymphoma.

The Veteran contends his grade 2 follicular lymphoma and B-cell lymphoma (lymphoma) are due to his toxic exposure risk activities (TERAs). The April 2024 TERA Memorandum indicated that the Veteran was exposed to ionizing radiation and asbestos during service.

The Board notes that although the Veteran also claimed he was exposed to herbicides on the USS Richard B. Anderson when it had just returned from Vietnam, VA has not been able to verify the Veteran's contentions, even after requesting records such as deck logs and the command history. In October 2024 correspondence, VA found that herbicide exposure could not be conceded as the evidence of record does not show the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019.

As stated in the November 2025 Board remand, June 2024 opinions from the Director of Policy and Health Outcomes of Military Exposures and Director of

Compensation Service found that it is unlikely that the Veteran's B-cell lymphoma

(grade 2 follicular lymphoma) was caused by exposure to ionizing radiation during

military service.

The Veteran was afforded VA examinations and medical opinions for his lymphoma in November 2024, December 2025, and January 2026. The November 2024 examiner opined the Veteran's lymphoma was less likely than not caused by exposure to ionizing radiation. She explained that the Veteran was not diagnosed with grade 2 follicular lymphoma or B cell lymphoma until several years after separation and that she could not find evidence to collaborate a causative relationship between his lymphoma and ionizing radiation exposure.

The Board remanded this claim in November 2025 to obtain an addendum opinion that addressed the Veteran's in-service asbestos exposure and considered the total potential exposure through all applicable deployments and the synergistic, combined effect of all his TERAs, in light of the examination requirements under the PACT Act (38 U.S.C. § 1168).

In December 2025, two addendum opinions were obtained, both of which were returned to the VA examiner for clarification that was ultimately provided in the January 2026 addendum opinion. The examiner, after detailing the Veteran's medical history and citing medical literature, opined that his lymphoma was less likely than not caused by his conceded TERAs after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERAs of the Veteran. The examiner stated he was unable to find medical literature that shows the Veteran's lymphoma is caused by asbestos or ionizing radiation exposure. He explained that the medical literature cited in his opinion shows "there is no increased risk of NHL or other HL-CAs associated with asbestos exposure," and does not show "an association of lymphoma risk with low level occupational exposure to ionizing radiation, either external or internal, within the current standards."

The Board finds that the November 2024, December 2025, and January 2026 VA opinions, when combined, are adequate and dispositive of the nexus questions presented in this case because they are based on a review of the file, including the Veteran's lay statements, and supported by a rationale based on sound medical principles and medical literature.

The only other opinion in this matter comes from the Veteran. The Board recognizes that there are instances in which a layperson may be competent to offer testimony on medical matters, such as describing symptoms observable to the naked eye or even diagnosing simple conditions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds, however, that the questions posed by this claim are of such complexity as to require that individuals who provide competent medical evidence on this matter possess a level of expertise that a lay person simply does not possess. Additionally, the December 2025 and January 2026 VA examiner specifically acknowledged the Veteran's statements, ultimately reiterating that although competent to report his symptoms, the Veteran is not capable of diagnosing the medical condition related to those symptoms. Accordingly, service connection is not warranted.

There is also no persuasive medical evidence or persuasive credible lay evidence that the Veteran's claimed disorder manifested to a compensable degree within a year of his separation from service or had its onset in service and continued ever since service. The Board notes the Veteran was not diagnosed with lymphoma until several years after service. Therefore, service connection based on presumptive service connection for a chronic disease or based on a theory of continuity of symptomatology is not warranted.

The benefit of the doubt rule does not apply as the evidence is not in "approximate balance" or "nearly equal." 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Therefore, entitlement to service connection for grade 2 follicular lymphoma and B-cell lymphoma is denied.

2. Entitlement to service connection for lethargy.

3. Entitlement to service connection for cold sensitivity in the bilateral upper and lower extremities.

The Veteran contends his lethargy and cold sensitivity in the bilateral upper and lower extremities are secondary to his grade 2 follicular lymphoma and B-cell lymphoma. The Board notes the Veteran has not claimed any other theory of entitlement.

Considering service connection for grade 2 follicular lymphoma and B-cell lymphoma, the Veteran's claimed primary disability, was denied above, service connection for lethargy and cold sensitivity in the bilateral upper and lower extremities is not warranted on a secondary basis.

The claims file does not contain any evidence, to include medical opinions, that indicates the Veteran's lethargy or cold sensitivity in the bilateral upper and lower extremities had onset in service or is otherwise related to service.

The benefit of the doubt rule does not apply as the evidence is not in "approximate balance" or "nearly equal." 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Therefore, entitlement to service connection for lethargy and cold sensitivity in the bilateral upper and lower extremities is denied.

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Papacalos, Angelic

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.

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