Case A26037113

M. SCHLICKENMAIER · 2026 · Case ID: A26037113

MIXED

Summary

The Veteran, a U.S. Marine Corps Veteran who served from April 1968 to March 1990, had his claim for service connection for diffuse large B-cell lymphoma and pulmonary fibrosis remanded for further development. The Veteran sought an earlier effective date for his lymphoma claim, contending it should relate back to his August 2, 2018, intent to file. The Board found that while the Veteran continuously prosecuted his claim, the PACT Act of 2022, enacted August 10, 2022, was the basis for the grant of service connection for lymphoma. Therefore, the earlier effective date was denied. The Board also remanded the claims for pulmonary fibrosis and a compensable rating for lymphoma. For the lymphoma residuals, the Board noted conflicting evidence regarding pancytopenia, pneumonitis, and peripheral neuropathy, requiring a VA opinion on the nature and severity of any residuals from treatment. For pulmonary fibrosis, the Board found VA opinions inadequate, as they did not address aggravation and applied an incorrect "proximate cause" standard instead of the "but-for" causation required for secondary service connection. The Board also noted the Veteran's private treatment record suggesting chemo-induced pulmonary fibrosis, but found it too speculative without further rationale. The case was remanded for new VA opinions on both the residuals of lymphoma and the secondary service connection of pulmonary fibrosis.

Rationale

PACT Act provided presumptive service connection for lymphoma.; Effective date of August 10, 2022, based on PACT Act enactment.; Conflicting evidence regarding residuals from chemotherapy and radiation treatment.; Remanded for VA opinion on residuals and severity.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260106-619809

Full Decision Text

Citation Nr: A26037113
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 260106-619809
DATE: April 21, 2026

ORDER

An effective date earlier than August 10, 2022, for the award of service connection for diffuse large B-cell lymphoma is denied.

REMANDED

Entitlement to a compensable disability rating for diffuse large B-cell lymphoma is remanded.

Entitlement to service connection for pulmonary fibrosis is remanded.

FINDINGS OF FACT

1. The Veteran served at the Royal Thai Air Force Base (RTAFB) Nam Phong, Thailand, from July 1973 to August 1973.

2. Based on the signing of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), a January 2023 rating decision granted service connection for diffuse large B-cell lymphoma associated with herbicide exposure at Nam Phong RTAFB, effective from August 10, 2022, which is the date the PACT Act went into effect.

3. Prior to enactment of the PACT Act, the RTAFB at Nam Phong is not among the recognized Thai Air Force Bases during the Vietnam Era where VA recognized exposure on a direct or facts-found basis

4. The evidence of record persuasively weighs against finding the Veteran had herbicide exposure on a facts-found basis.

5. The evidence of record persuasively weighs against finding that the Veteran's diffuse large B-cell lymphoma began during active service, manifested to a compensable level within one year of separation, or is otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for an effective date prior to August 10, 2022, for the award of service connection for diffuse large B-cell lymphoma have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.156; 3.400.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the U.S. Marine Corps from April 1968 to March 1990. His decorations include the Meritorious Mast, Sea Service Deployment Ribbon, and Armed Forces Expeditionary Medal. The appellant is his surviving spouse, who has been substituted for the Veteran for purposes of processing his claim to completion. See 38 U.S.C. § 5121A.

The original rating decision underlying the present appeal was issued in November 2019 by a Department of Veterans Affairs (VA) Regional Office (RO) that, in pertinent part, denied service connection for lymphoma. In September 2020, he filed a request for Higher-Level Review (VA Form 20-0996), which was denied in January 2022. The Veteran filed a supplemental claim (VA Form 20-0995) in April 2022 which was denied in July 2022. Subsequently, the Veteran filed another supplemental claim in August 2022. In January 2023, the agency of original jurisdiction (AOJ) granted service connection for lymphoma.

Subsequently, the appellant submitted a timely request for Higher-Level Review in July 2024, seeking an increased initial rating and earlier effective date. See May 2024 Notification Letter (advising that the appellant had until July 16, 2024 to file a request for a decision review before the Veteran's claim became final). In a January 2025 rating decision on Higher-Level Review, the AOJ denied an earlier effective date or higher rating.

Meanwhile, the AOJ issued a rating decision in April 2024 denying service connection for pulmonary fibrosis. In August 2024, the appellant filed a Supplemental Claim which was denied in January 2025.

In January 2026, the appellant timely appealed to the Board by filing a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)), disagreeing with the January 2025 rating decisions and requesting direct review of the evidence considered by the AOJ. 38 C.F.R. §§ 20.201, 20.202(b)(1).

Under the direct review option, the Board may only consider the evidence of record at the time of issuance of the January 2023 and January 2025 rating decisions. 38 C.F.R. § 20.301. The Board cannot consider evidence submitted after those decisions were promulgated.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the Veteran's claim. 38 C.F.R.
reement)), disagreeing with the January 2025 rating decisions and requesting direct review of the evidence considered by the AOJ. 38 C.F.R. §§ 20.201, 20.202(b)(1).

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the Veteran's claim. 38 C.F.R. § 20.300. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, she may file a Supplemental Claim (VA Form 20-0995) and submit or identify that evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

As to the claims for service connection for pulmonary fibrosis and entitlement to a compensable rating for lymphoma, the Board is remanding those claims to the AOJ for correction of pre-decisional duty to assist errors. The AOJ will consider any additional evidence that has been submitted when those claims are readjudicated.

1. Entitlement to an effective date earlier than August 10, 2022, for the award of service connection for diffuse large B-cell lymphoma

In a January 2023 rating decision, the RO granted service connection for lymphoma and assigned an effective date of August 10, 2022. The RO indicated that the assigned effective dates were based on the date of a change in law allowing VA to grant the claims. In that regard, the AOJ noted that when a claim for service connection is received within one year after a change in the law, and all of the requirements for a grant if benefits were met on the date of the change, the effective date was the date of the change in law. In essence, the RO granted the Veteran's claims pursuant to the PACT Act of 2022, which was signed into law on August 10, 2022.

On appeal, the appellant contends that an earlier effective date of August 2, 2018, is warranted. In her January 2026 notice of disagreement, she contended, in essence, that the effective date of the award should be the date that the Veteran filed his original claim inasmuch as the claims were continuously pursued until they were granted.

By way of background, the Board notes that the Veteran filed an intent to file a claim for compensation on August 2, 2018. While the claims file does not contain a copy of his actual intent to file form, it contains a notification letter to the Veteran from the AOJ indicating that the AOJ received his intent to file on August 2, 2018. The letter noted that if a completed application was received within one year from the receipt of his intent to file, VA might be able to compensate him from the date it received his intent to file.

In November 2018, the Veteran filed a formal application seeking service connection for lymphoma. While the AOJ initially denied the claims in a November 2019 rating decision, the Veteran filed a higher-level review (VA Form 20-0996) in September 2020, which was within one year of the November 2019 rating decision. Following denial on higher-level review in January 2022, the Veteran filed a supplemental claim (VA Form 20-0995) in April 2022 which was denied in July 2022. Subsequently, the Veteran filed another supplemental claim in August 2022. In January 2023, the AOJ granted service connection for lymphoma.

In light of the above, the Board finds that the Veteran continuously prosecuted his November 2018 claim for service connection until the time that it was granted in the January 2023 rating decision. Inasmuch as he filed an intent to file on August 2, 2018, which is within a year of his November 2018 application for service connection, his date of claim for effective date purposes is November 2018.

The next question presented for the Board's consideration is when entitlement to the benefits arose. The primary question for the Board, therefore, is whether entitlement to service connection for lymphoma can be established on a basis other than pursuant to the PACT Act; that is, on
connection for lymphoma.

Both prior and subsequent to the enactment of the PACT Act, service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

A Veteran who served on active duty in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, is presumed to have been exposed to an herbicide agent, absent affirmative evidence to the contrary. See 38 C.F.R. § 3.307(a)(6)(iii). VA regulations further provide that service connection is warranted for certain diseases as presumptively due to herbicide exposure, to include ischemic heart disease. 38 C.F.R. § 3.309(e).

Prior to the enactment of the Pact Act, in a May 2010 bulletin, VA determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. A primary source of this information was the declassified Vietnam-era Department of Defense (DOD) document entitled, "Project CHECO Southeast Asia Report: Base Defense in Thailand." Although DOD indicated that the herbicide use was commercial in nature, rather than tactical (such as Agent Orange), VA determined that there was some evidence that herbicides of a tactical nature, or that of a greater strength commercial variant, were used.

In light of this information, VA determined that special consideration should be extended to those veterans whose duties placed them on or near the perimeters of Thailand military bases. This, in essence, allowed for presumptive service connection of diseases associated with herbicide exposure. The May 2010 bulletin identified seven bases in Thailand, including U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhili, Korat, and Don Muang RTAFB. Importantly, Nam Phong RTAFB was not included on the list of bases. VA indicated that herbicide exposure should be acknowledged on a facts found or direct basis if (1) a United States Air Force veteran served at one of the air bases as a security policeman, a security patrol dog handler, a member of a security police squadron, or otherwise served near the air base perimeter, as shown by his or her military occupational specialty (MOS), performance evaluations, or other credible evidence; (2) an Army veteran was a member of a military police unit that served at or near a base perimeter in Thailand; or (3) an Army veteran served on an air base in Thailand and provided perimeter security.

The Board acknowledges that, effective August 10, 2022, the PACT Act extended the presumption of exposure to such herbicide agents to veterans who had active service in Thailand "at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed." See Pub. Law 117-168, Title IV, § 403(a), 136 Stat. 1780 (amending 38 U.S.C. § 1116).

The Board must assess
3) an Army veteran served on an air base in Thailand and provided perimeter security.

The Board must assess the credibility and weight of all the evidence to determine its probative value, accounting for the evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran. 38 U.S.C. § 5107. An approximate balance of the evidence includes, but is not limited to, equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

The Veteran contends that entitlement to service connection for ischemic heart disease, to include as due to exposure to herbicide agents, arose prior to the enactment of the PACT Act. Specifically, he contends that he served at Nam Phong RTAFB where he was in fact (rather than presumptively) exposed to herbicide agents.

In various statements and undated photographs, the Veteran claimed that he had been exposed to herbicide agents while in Nam Phong because the base was being cleared with heavy equipment and herbicides. The Veteran also claimed that he had been housed in 10-man tents on the base while the clearing process took place. In support, the Veteran has submitted undated photographs of the base to demonstrate the areas devoid of plant life. The Veteran further reported that he worked close to the flightline while stationed at Nam Phong. He also indicated that he made trips to Udorn RTAFB with a liberty pass in which he passed through defoliated perimeters around Nam Phong and Udorn when entering and exiting each base.

As an initial matter, the AOJ made favorable findings in the November 2019 rating decision to the effect that he had diffuse large B-cell lymphoma as early as August 2018, and performed service in Nam Phong, Thailand in July 1973. The Board is bound by those favorable findings, and they are not in dispute. 38 C.F.R. § 3.104(c).

His DD Form 214 also shows that his MOS was avionic maintenance chief. The Veteran's military records also confirm he served in Nam Phong RTAFB during the requisite period.

The Board acknowledges that many of the Veteran's service treatment records are largely illegible; however, the service treatment records contain no complaints, treatments, or diagnoses that may be construed to be related to a later diagnosis of non-Hodgkin's lymphoma, and there is no documentation of any specific exposure that resulted in his current lymphoma. On his Report of Medical History at separation in December 1989, the Veteran responded no tumor, growth, cyst, or cancer. On clinical evaluation, no abnormalities were noted.

In November 2018, the Veteran submitted a statement dated January 24, 2017, from another servicemember who wrote, "I am convinced that we used, and that we were sprayed with, herbicides while we served at the Royal Thai Airbase in Nam Phong, Thailand (the "Rosegarden") in Thailand 1972." This servicemember went on to describe his service in Vietnam, Guam, Okinawa, Thailan, Taiwan, and the Philippines. He indicated that he never heard the term "Agent Orange" in service but asserted he saw three or four barrels with a thin orange stripe on the middle that had the word herbicide. He went on to describe spraying this throughout the base.

The RO contacted the Joint Services Records Research Center ("JSRRC"), which issued an April 2019 Memorandum that sufficient information required to verify herbicide exposure did not exist. See Administrative Decision, dated April 23, 2019.

A June 2022 Records Research Response in the record reflects a professional researcher from the
2." This servicemember went on to describe his service in Vietnam, Guam, Okinawa, Thailan, Taiwan, and the Philippines. He indicated that he never heard the term "Agent Orange" in service but asserted he saw three or four barrels with a thin orange stripe on the middle that had the word herbicide. He went on to describe spraying this throughout the base.

A June 2022 Records Research Response in the record reflects a professional researcher from the Veterans Benefits Administration, Compensation Service, Military Records Research Center, completed comprehensive research on the Veteran's claimed exposure event, claiming that from July 7, 1973 to September 30, 1973, while assigned to the Marine Fighter Attack Squadron 115 (VMFA-115) Marine Aircraft Group 15 (MAG-15) 1st Marine Aircraft Wing (MAW) at Nam Phong, Thailand the Veteran was exposed to Agent Orange. The custodian indicated that they partnered with the Air Force Historical Research Agency (AFHRA), custodian of Air Force unit records, who was unable to confirm the exposure event claimed by the Veteran. In conclusion, no evidence was located to support documentation of the claimed exposure event.

Post-service, the Veteran's medical records show that he was diagnosed with non-Hodgkins diffuse large B-cell lymphoma as early as August 2018, decades after service. Private and VA treatment records indicate that the Veteran received chemotherapy and radiation treatment for his lymphoma following his diagnosis.

Following review of the record, and the applicable law and regulations, the Board finds that the evidence persuasively weighs against the appellant's claims.

In this case, it is not established that he was exposed to herbicides. There is no evidence that the Veteran has specialized training or background to identify such chemicals at the time, and his recollections are not considered competent evidence of exposure to herbicide agents in line with the applicable regulation. Moreover, pre-PACT Act, herbicide exposure has not been conceded for all veterans who served at all RTAFBs and Nam Phong RTAFB is not on the list of bases where the presumption applies. Further, even if it was established that herbicides were used at the base the Veteran's MOS does not establish that he worked near the perimeter of the base, and the Veteran has not submitted additional credible evidence that he was exposed to herbicides.

The Board acknowledges the statement from the Veteran's fellow servicemember. However, the Board is unable to corroborate the places, types, and circumstances of that Veteran's service.

The Veteran also testified that he went to Udorn RTAFB on a liberty pass, a base at which the presumption of herbicide exposure is provided to veterans who served along the perimeter. However, even if he visited Udorn RTAFB, the Board finds that he is not presumed to have been exposed to herbicides at Udorn RTAFB, as his MOS and his lay statements do not establish that he had a duty at the perimeter of Udorn RTAFB.

There is no evidence that the Veteran sought treatment for the lymphoma in service, or that it was diagnosed within a year of service discharge. Rather, it was diagnosed several decades after service. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The claims file does not contain any credible and probative evidence (including medical opinions, medical treatises, or treatment records) that suggests that his lymphoma is otherwise related to service. As the Veteran's service treatment records fail to suggest the presence of lymphoma during service, and as the condition was not shown within a year of discharge from service, he is also not entitled to service connection pursuant to the presumptive provisions of 38 C.F.R. §§ 3.307 and 3.309(a).

Because the Veteran's claim is granted based upon the provisions of the PACT Act, specifically exposure to herbicide agents in Thailand "at any United States or Royal Thai base," the appropriate effective date is no earlier than August 10, 2022, the date entitlement arose under Public Law 117-168 (PACT Act). (Emphasis added).

The Board concludes that, although the Veteran had the above disability prior to August 10, 2022, the applicable law at the time provides that the changes in Public Law 117-168 (PACT Act) specifically implements the effective date of no earlier than August 10, 2022. As noted above, the effective date of the award for compensation based on an original claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(b)(2). In the present case, the date entitlement arose is August 10, 2022, the date that the applicable law changed.

Accordingly, the appellant's claim for an earlier effective date is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b).

REASONS FOR REMAND

1. Entitlement to a compensable disability rating for diffuse large B-cell lymphoma is remanded.

The Veteran's non-Hodgkin's diffuse large B-cell lymphoma is rated under Diagnostic Code 7715. 38 C.F.R. § 4.117. Under Diagnostic Code 7715, a 100 percent rating, which is the highest and only rating available under the schedule, is warranted when there is active disease, during treatment phase, or with indolent and non-contiguous phase of low-grade non-Hodgkin's lymphoma.

At the time of his death, the Veteran's cancer was in remission, and therefore ineligible for the only rating available under Diagnostic Code 7715, as that requires "an active disease, during treatment phase, or with indolent and non-contiguous phase." However, a Note to Diagnostic Code 7715 states that if there has been no recurrence, rate on residuals under the appropriate diagnostic code(s).

Here, private medical records reflect complaints and findings of pancytopenia, pneumonitis, and peripheral neuropathy during and following completion of chemotherapy treatment for the service-connected lymphoma. See September 2018 UT Health treatment record; December 2018 UT Health treatment record; February 2021 Pulmonary Medicine progress Note. This evidence suggests that there may have been several residuals related to the Veteran's lymphoma prior to his death.

On the other hand, in a November 2022 VA examination report, an examiner noted that the Veteran's lymphoma was in remission and did not have anemia or any other pertinent physical findings, complications, conditions, signs and/or symptoms related to his lymphoma. On specific questioning as to whether there were any additional diagnoses warranted for residuals, the examiner simply wrote "N/A."

In light of the conflicting evidence, the AOJ committed a pre-decisional duty to assist error when it failed to obtain a clarifying opinion to determine any residuals from the treatment of the Veteran's lymphoma.

Since Diagnostic Code 7715 allows non-Hodgkin's lymphoma to be rated on its residuals, remand is required to afford the appellant a VA medical opinion with respect to the nature and severity of any residual disability, to include as a result of the chemotherapy and radiation treatment, any other treatment received for his non-Hodgkin's diffuse B-cell lymphoma.

2. Entitlement to service connection for pulmonary fibrosis is remanded.

The appellant also seeks to establish service connection for the Veteran's pulmonary fibrosis.

Initially, the AOJ made a favorable finding in the January 2025 rating decision to the effect that the Veteran was diagnosed with pulmonary fibrosis. The Board is bound by those favorable findings, and they are not in dispute. 38 C.F.R. § 3.104(c).

In April 2024, a VA examiner opined that the Veteran's pulmonary fibrosis was less likely than not caused by the ischemic heart disease, aortic valve stenosis, hypertension, and lymphoma as these are not known risk factors or have known pathophysiological relationships with development of idiopathic pulmonary fibrosis. The examiner indicated that the Veteran had a 40-year history of smoking, which is a known risk factor for development of pulmonary fibrosis.

The examiner further opined that the claimed disability was less likely than not (likelihood is
was diagnosed with pulmonary fibrosis. The Board is bound by those favorable findings, and they are not in dispute. 38 C.F.R. § 3.104(c).

The examiner further opined that the claimed disability was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. As to the rationale, the examiner indicated there was no known, established pathophysiologic relationship between Agent Orange exposure and development of idiopathic pulmonary fibrosis.

The AOJ obtained another VA medical opinion in September 2024. At the time, the examiner opined that the Veteran's pulmonary fibrosis was less likely than not proximately due to or the result of the Veteran's service-connected lymphoma. The examiner explained that the pathophysiologies of the two conditions are unrelated.

In November 2024, the AOJ obtained yet another VA medical opinion. The examiner opined that there was no causative relationship between lymphoma and pulmonary fibrosis. The examiner expressed that "for a complete and thorough evaluation of any claimed condition, ALL salient evidence, including all risk factors specific to this Veteran's case must be considered." He further stated that "Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) states that a medical rationale based solely on general medical literature without discussing the facts pertaining to a Veteran's specific individual circumstances is inadequate" and that there "must be a citation of CASE-SPECIFIC evidence." The examiner went on to state that smoking is a universally recognized risk factor for development of idiopathic pulmonary fibrosis and, specific to his case, and consistent with this etiology, he had a 40 pack-year history of tobacco abuse. Therefore, it was less likely than not that the Veteran's pulmonary fibrosis was proximately due to or the result of lymphoma.

The Board finds that these opinions are inadequate for adjudication purposes. In this regard, the opinions did not address the aggravation aspect of secondary service connection. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion as to secondary service connection is inadequate when it fails to adequately address the question of secondary aggravation). Also, by requiring the nonservice-connected disabilities to be "proximately related," the examiner appears to have applied a stricter standard than is required to establish service connection on a secondary basis. In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the United States Court of Appeals for the Federal Circuit Court held that 38 U.S.C. § 1110 employs only "but-for" (rather than proximate) causation in direct and secondary service connection claims. Therefore, a service-connected disability need only be a contributing cause, not the contributing cause, in order to establish secondary service connection.

The Board acknowledges that the Veteran submitted an October 2023 private treatment record that indicated that pulmonary fibrosis was "felt that to be due to chemo" and that he had exposures in the military and "this may be service related." The Board finds the opinion too speculative for an award of service connection, inasmuch as it attributes the condition to two different etiologies without any meaningful additional rationale to support the conclusion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion that contains only data and conclusions without any supporting analysis is accorded no weight); see also Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2009) (a medical opinion is speculative when it uses equivocal language without any other rationale or supporting data).

The matters are REMANDED for the following action:

1. Arrange to provide the record on appeal to a qualified VA examiner for purposes of determining all non-Hodgkin's diffuse large B-cell lymphoma residuals to be present, including disability resulting from the Veteran's chemotherapy, radiation
-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion that contains only data and conclusions without any supporting analysis is accorded no weight); see also Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2009) (a medical opinion is speculative when it uses equivocal language without any other rationale or supporting data).

The matters are REMANDED for the following action:

1. Arrange to provide the record on appeal to a qualified VA examiner for purposes of determining all non-Hodgkin's diffuse large B-cell lymphoma residuals to be present, including disability resulting from the Veteran's chemotherapy, radiation, and any other treatment received for the lymphoma. In doing so, the examiner should directly address the findings of pancytopenia, pneumonitis, and peripheral neuropathy reflected in the treatment records during and following completion of chemotherapy treatment. To the extent feasible, the examiner must address the level of severity, and the functional effects, of each residual of non-Hodgkin's diffuse B-cell lymphoma residuals found to be present at any point during the appeal period.

A complete medical rationale for all opinions expressed must be provided.

2. Arrange to provide the record on appeal to a qualified VA examiner for purposes of assessing the etiology of the Veteran's pulmonary fibrosis. The examiner should review the record.

After reviewing the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether the likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's pulmonary fibrosis (a) was caused or (b) has been aggravated (i.e., any incremental increase in disability above the degree of disability existing before the increase, regardless of permanence) by his service-connected lymphoma.

In this regard, the examiner is advised that proximate cause is not required. Rather, the examiner's opinion should address whether the non-service-connected disability would have been less severe but-for the service-connected lymphoma, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

A complete medical rationale for all opinions expressed must be provided.

M. Schlickenmaier

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Kettler, 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.

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