RESTRICTIVE LUNG DISEASE INTERSTITIAL PULMONARY FIBROSIS

Summary

The veteran, who served in the Air Force from January 1989 to June 1989, appeals the denial of service connection for non-Hodgkin's lymphoma, hypothyroidism, and acquired psychiatric disorders (anxiety, depression, PTSD), while seeking service connection for shortness of breath as a residual of Hodgkin's lymphoma. The Board granted service connection for shortness of breath, finding competent and credible evidence established its relation to Hodgkin's disease treated during service, noting the veteran's testimony and medical records indicating decreased lung function consistent with radiation therapy. The Board found the presumption of soundness rebutted for shortness of breath, as the Hodgkin's disease was diagnosed during service. For non-Hodgkin's lymphoma, the Board denied service connection due to a lack of a pre-decisional nexus opinion, as the diagnosis was made after the AOJ decision and no duty to assist error was found. The Board also denied hypothyroidism and psychiatric disorders due to insufficient evidence of in-service incurrence and lack of a positive nexus opinion, noting that the diagnosis of anxiety occurred after the AOJ decision and the attorney's contention of secondary service connection was not remanded as it was raised late. The Board applied the benefit of the doubt doctrine only where the evidence was in equipoise, which was not the case for the denied claims.

Rationale

Competent and credible evidence establishes relation to Hodgkin's disease treated during service.; Veteran's testimony and medical records indicate shortness of breath consistent with radiation therapy.; Presumption of soundness rebutted as Hodgkin's disease diagnosed during service.

Full Decision Text

Citation Nr: A26037887
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 201010-115077
DATE: April 22, 2026

ORDER

Entitlement to service connection for shortness of breath, as a residual of in-service Hodgkin's lymphoma, is granted.

Entitlement to service connection for non-Hodgkin's lymphoma is denied.

Entitlement to service connection for hypothyroidism is denied.

Entitlement to service connection for acquired psychiatric disorder to include anxiety, depression, and posttraumatic stress disorder (PTSD) is denied.

FINDINGS OF FACT

1. The competent and credible evidence of record establishes that residuals of Hodgkin's lymphoma, to include shortness of breath, began in service. 

2. The evidence is persuasively against finding the Veteran's non-Hodgkin's lymphoma began during service, manifested to a compensable degree within one year of separation from service, or is otherwise related to service.

3. The evidence is persuasively against finding the Veteran's hypothyroidism began during service, manifested to a compensable degree within one year of separation from service, or is otherwise related to service.

4. The evidence is persuasively against finding the Veteran's acquired psychiatric disorder to include anxiety, depression, and PTSD, began during service, manifested to a compensable degree within one year of separation from service, or is otherwise related to service.

CONCLUSIONS OF LAW 

1. The criteria for service connection for residuals of Hodgkin's lymphoma, to include shortness of breath, have been satisfied. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for non-Hodgkin's lymphoma are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for service connection for hypothyroidism are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for acquired psychiatric disorder to include anxiety, depression, and PTSD are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had military service in the United States Air Force from January 1989 to June 1989.

In the October 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on May 31, 2024.

Therefore, the Board may only consider the evidence of record at the time of the May 2020 agency of original jurisdiction (AOJ) rating decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection on a direct basis requires (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability.  See Shedden v. Principi, 381 F.3d 1163, 116
.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection on a direct basis requires (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability.  See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service.  See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d).    

A veteran is presumed to be sound upon entrance into service except for disorders noted at entrance into service. 38 U.S.C. § 1111. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has distinguished between those cases in which the pre-existing condition is noted upon entry into service, and cases in which the pre-existence of the condition must otherwise be established. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004).  If a condition is not noted, the presumption of soundness applies, and the burden is on the VA to rebut that presumption by clear and unmistakable evidence both that (a) the condition pre-existed service and (b) the pre-existing condition was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b); Wagner, supra. 

Only those disorders that are noted on an examination report at the time of entrance into service are considered to have been "noted." 38 C.F.R. § 3.304 (b). To be "noted" within the meaning of the presumption of soundness statute, the condition must be recorded in the entrance examination report. 38 C.F.R. § 3.304 (b); Crowe v. Brown, 7 Vet. App. 238, 245 (1994). History of pre-service existence of a disease does not constitute a notation of such condition. Id. at 240. However, the disease need not be symptomatic at the time of the evaluation, so long as a diagnosis is provided. See Verdon v. Brown, 8 Vet. App. 529, 530 (1996).

Service connection may also be granted on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995).

Entitlement to service connection for residuals of Hodgkin's lymphoma, to include shortness of breath.

The Veteran contends that service connection is warranted for loss of lung function, specifically shortness of breath, as a residuals of radiation for Hodgkin's lymphoma. See March 2020 VA Form 21-526EZ. 

Service treatment records (STRs) note the Veteran experienced dyspnea during a half mile march. See April 1989 STRs. STRs also note a lung examination showed mild decreased breath sounds. See April 1989 STRs. The Veteran reported experiencing shortness of breath during service. See May 1989 Report of Medical History. STRs show that the Veteran was treated for Hodgkin's disease with chemotherapy and radiotherapy. See May 1989 Medical Board Report. A medical board determined that the Veteran's Hodgkin's disease existed prior to service and was not permanently aggravated by service. See May 1989 Medical Board Report.

In July 1995, the Veteran submitted a statement stating he experienced difficulty breathing while running with his flight (unit). See July 1995 Statement. He also stated that he felt like he was choking. He also experienced night sweats and a low grade fever for 2 weeks before he went to the base hospital where an X-ray revealed a mass in his chest. The Veteran stated he had surgery to remove the mass and was diagnosed with Hodgkin's lymphoma and underwent radiation and chemotherapy. The Veteran stated the treatment for Hodgkin's lymphoma caused his lungs to
 Report. A medical board determined that the Veteran's Hodgkin's disease existed prior to service and was not permanently aggravated by service. See May 1989 Medical Board Report.

In July 1995, the Veteran submitted a statement stating he experienced difficulty breathing while running with his flight (unit). See July 1995 Statement. He also stated that he felt like he was choking. He also experienced night sweats and a low grade fever for 2 weeks before he went to the base hospital where an X-ray revealed a mass in his chest. The Veteran stated he had surgery to remove the mass and was diagnosed with Hodgkin's lymphoma and underwent radiation and chemotherapy. The Veteran stated the treatment for Hodgkin's lymphoma caused his lungs to shrink to half of the normal size, which causes him to be short of breath. Id.

During the Board hearing on May 31, 2024, the Veteran agreed with his representative that the chemotherapy treatment for Hodgkin's lymphoma caused fibrotic lung disease. See May 31, 2024, Board Hearing transcript. The Veteran also testified that before entering service, he ran regularly and had no issues with lung function. He also testified that he had no issues running and doing physical training during basic training. The Veteran testified that while at Sheppard Air Force Base for technical school, he experienced difficulty when quickly trotting with his flight. The Veteran testified he felt this was odd as he was a runner and did not have issues in the past. The Veteran testified that he went to the base hospital where an X-ray was performed revealing a mass in his chest. He testified that he received chemotherapy and radiation treatment while on active duty. 

Further, the Veteran adopted his representative's statement that it took some time to be diagnosed with lung disease. He testified that after his treatment, he was no longer able to breathe "much" when going up and down flights of stairs. The Veteran stated he was advised that his lungs would be damaged from the radiation treatment and that he would not have the capacity of a normal human his age. He testified that after speaking with his doctor, he knows his lung function is not going to improve but will advance. The Veteran stated his doctor gave him Albuterol, but that now he is on Wixela. The Veteran testified that he is "progressing and getting worse." The Veteran also testified that he has woken up many nights feeling as though he can't breathe.

Following the Board hearing, the Veteran's representative submitted VA outpatient records noting that the Veteran was healthy "except for minimal decrease in his overall lung function which is consistent with the radiation therapy that he received." See December 1991 VA outpatient records. He also submitted a March 2021 Heart Condition Disability Benefits Questionnaire (DBQ). The VA examiner noted the Veteran's current symptoms as lightheadedness, shortness of breath, and dyspnea on exertion. The Veteran reported that his heart valve conditions made it more difficult to perform the duties of his job and that he becomes short of breath and that he must sit down to catch his breath. On the physical examination, the VA examiner noted bilateral fine wheezes throughout the lung field.

The Veteran's representative also submitted a March 2021 VA opinion providing a negative nexus opinion as to whether it was as likely as not that the Veteran's enlarged heart was incurred in or was caused by the heart abnormality on the Medical Evaluation Board examination during service. He also submitted private medical records documenting the Veteran having shortness of breath on exertion that had been going on for years since he had chemotherapy and radiation treatment. See May 2019 private medical records. Private medical records indicate the Veteran was diagnosed with shortness of breath and prescribed Albuterol. See July 2023 private medical records. Of particular note, one of the private records from July 2019 found that the Veteran's chronic fibrotic lung disease resulted from post radiation treatment for his non-Hodgkin's lymphoma in 1989. See July 2019 private treatment records. Additionally, private medical records note that the Veteran experienced shortness of breath since 1989. See June 2020 private medical records. 

Regarding the presumption of soundness, shortness of breath, Hodgkin's disease, or other respiratory or hematologic conditions were not noted at entrance to active duty in 1988. However, the Board cannot also say that there is otherwise clear and unmistakable evidence that the Veteran's shortness of breath preexisted service. Clear and unmistakable evidence means that the evidence "cannot be misinterpreted and misunderstood, i.e. it is undebatable." Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Clear and unmistakable evidence is an onerous standard. Laposky v. Brown, 4 Vet. App. 331, 
 private medical records. 

Regarding the presumption of soundness, shortness of breath, Hodgkin's disease, or other respiratory or hematologic conditions were not noted at entrance to active duty in 1988. However, the Board cannot also say that there is otherwise clear and unmistakable evidence that the Veteran's shortness of breath preexisted service. Clear and unmistakable evidence means that the evidence "cannot be misinterpreted and misunderstood, i.e. it is undebatable." Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Clear and unmistakable evidence is an onerous standard. Laposky v. Brown, 4 Vet. App. 331, 334 (1993). Notwithstanding the May 1989 Medical Board report, which determined that the Hodgkin's disease preexisted service, there are no actual clinical findings showing abnormal blood work or other symptoms prior to service. Accordingly, the Board finds that the condition did not preexist service, and as such, the claim converts to one for service connection.

The Veteran is competent to report on the observable symptoms of loss of lung function. See 38 C.F.R. § 3.159 (a)(2). Specifically, as a lay person he is able to report that he experiences shortness of breath, dyspnea, difficulty breathing, and choking. As a result, the Board also finds the Veteran's statements credible. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995). His claims are consistent. As a result, the Veteran's lay assertions are deemed highly probative evidence in establishing that the Veteran's loss of lung function onset in service. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994). Importantly, dyspnea and mild decreased breath sounds were noted during the Veteran's military service. See April 1989 STRs. Also significant is the VA outpatient record note indicating that the Veteran was healthy "except for minimal decrease in his overall lung function which is consistent with the radiation therapy that he received." See December 1991 VA outpatient records.  

Based on the foregoing, the Board finds that the competent and credible evidence supports that the Veteran's loss of lung function is related to the Hodgkin's disease first diagnosed during service. As such, entitlement to service connection for loss of lung function, as a residual of Hodgkin's disease, on a direct basis is warranted. The appeal is granted.

Entitlement to service connection for non-Hodgkin's lymphoma.

The Veteran alleged his non-Hodgkin's lymphoma is due to his time in service. See March 2020 VA Form 21-526EZ. Review of the record shows that during service, in May 1989, the Veteran was diagnosed with stage 3B Hodgkin's disease with a large mediastinal mass. See January 1992 STRs. The Veteran was treated with 6 cycles of Adriamycin Bleomycin Vinblastine Dacarbazine (ABVD) followed by consolidation radiation therapy. See December 1991 STRs. After treatment, the Veteran was deemed physically fit for military service and removed from the temporary disability retired list. See March 1992 STRs.

The Veteran submitted a statement stating that he was diagnosed with Hodgkin's lymphoma. See July 1995 Statement.

A Board hearing was held on May 31, 2024. The Veteran testified that he experienced difficulty when quickly trotting with his flight. He also testified to having night sweats, not feeling well, and deciding to go to the base hospital to get checked out. The Veteran stated he passed out before making it into the hospital. The Veteran testified he was shown an X-ray showing a mass in his chest. He stated he received chemotherapy and radiation treatments while serving in the military. 

Following the Board hearing, the Veteran's representative submitted a March 2021 Heart Condition Disability Benefits Questionnaire (DBQ).  The Veteran stated his heart problems were due to chemotherapy and radiation from his Hodgkin's lymphoma. The VA examiner noted that the Veteran had damage to all valves in his heart from the chemotherapy and radiation for the treatment of Hodgkin's lymphoma as well as pulmonary hypertension. The VA examiner did not make notes or observations regarding non-Hodgkin's lymphoma. The Veteran's representative also submitted a March 2021 VA opinion providing a negative nexus opinion as to whether it was as likely as not that the Veteran's enlarged heart was incurred in or was caused by the heart abnormality on the Medical Evaluation Board examination during service. 

Following the hearing, the Veteran's representative also submitted private medical records showing a diagnosis of non-Hodgkin's lymphoma. See May 2019, July 2023 private medical records. Of particular
 The VA examiner noted that the Veteran had damage to all valves in his heart from the chemotherapy and radiation for the treatment of Hodgkin's lymphoma as well as pulmonary hypertension. The VA examiner did not make notes or observations regarding non-Hodgkin's lymphoma. The Veteran's representative also submitted a March 2021 VA opinion providing a negative nexus opinion as to whether it was as likely as not that the Veteran's enlarged heart was incurred in or was caused by the heart abnormality on the Medical Evaluation Board examination during service. 

Following the hearing, the Veteran's representative also submitted private medical records showing a diagnosis of non-Hodgkin's lymphoma. See May 2019, July 2023 private medical records. Of particular note, one of the private records from July 2019 found that the Veteran's chronic fibrotic lung disease resulted from post radiation treatment for his "non-Hodgkin's lymphoma" in 1989. See July 2019 private treatment records.

Review of the record shows that there is not a nexus opinion on whether the Veteran's non-Hodgkin's lymphoma is due to his military service. While the records showing a current diagnosis of non-Hodgkin's lymphoma would ordinarily raise the question of nexus, in this case the Veteran's diagnosis of non-Hodgkin's lymphoma was not provided until after the rating decision on appeal. As such, there is no pre-decisional duty to assist error permitting remand for such nexus opinion. 38 C.F.R. §§ 3.159(c), 20.802(a).

While the Veteran believes the non-Hodgkin's lymphoma is related to an in-service injury, event, or disease or is due to a service-connected disability, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; the Veteran is not considered competent (meaning medically qualified by training or experience) to provide such a medical opinion. Jandreau, 492 F.3d at 1377, 1377 n.4 (Fed. Cir. 2007). The Board hearing transcript also contains the Veteran's attorney's contention that "nodular sclerosing Hodgkin's disease... [t]hey now refer to it as non-Hodgkin's lymphoma. It's all one-in the same, all the same issue that started while he was in service." However, the record does not reflect that the Veteran's attorney has similar medical training or experience to offer this opinion and cited no medical treatises or other literature to support this contention.

Accordingly, the criteria for service connection are not met, and the appeal must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

[Note: The Veteran is not prejudiced by this decision as he may submit new and relevant evidence with a Supplemental Claim, along with any other relevant evidence not available for the Board to consider in the current docket.]

Entitlement to service connection for hypothyroidism as a residual of treatment for Hodgkin's lymphoma.

The Veteran contends that service connection is warranted for hypothyroidism as a residual of radiation treatment for Hodgkin's lymphoma. See March 2020 VA Form 21-526EZ. 

Review of the record does not show that hypothyroidism was diagnosed in service. The Board recognizes the Veteran's testimony at his May 2024 Board hearing that hypothyroidism was not diagnosed until after service, because while he felt sluggish and fatigued, it took some time to determine that it was the result of thyroid abnormalities. However, the record still does not relate any diagnosis of hypothyroidism to service, to include the inservice treatment for Hodgkin's lymphoma. 

Also, during the Board hearing, the Veteran's attorney contended that records showing a current diagnosis of hypothyroidism would be provided, and that the rating decision on appeal which found that there was no current diagnosis was incorrect. While the records showing a current diagnosis of hypothyroidism were submitted, and would ordinarily raise the question of nexus, in this case the Veteran's diagnosis of hypothyroidism, or those records, was not provided until after the rating decision on appeal. The rating decision on appeal noted that while the Veteran indicated medical records on his application for benefits, he did not respond to VA's requests in developing for this evidence. Review of the record shows that VA attempted to obtain signed VA Forms 21-4142 from the Veteran
 during the Board hearing, the Veteran's attorney contended that records showing a current diagnosis of hypothyroidism would be provided, and that the rating decision on appeal which found that there was no current diagnosis was incorrect. While the records showing a current diagnosis of hypothyroidism were submitted, and would ordinarily raise the question of nexus, in this case the Veteran's diagnosis of hypothyroidism, or those records, was not provided until after the rating decision on appeal. The rating decision on appeal noted that while the Veteran indicated medical records on his application for benefits, he did not respond to VA's requests in developing for this evidence. Review of the record shows that VA attempted to obtain signed VA Forms 21-4142 from the Veteran for these records in March 2020, but the Veteran did not submit a VA Form 21-4142 or the actual records prior to the May 2020 rating decision on appeal. As such, there is no pre-decisional duty to assist error permitting remand for such nexus opinion. 38 C.F.R. §§ 3.159(c), 20.802(a).

While the Veteran believes the hypothyroidism is related to an in-service injury, event, or disease, such a medical opinion requires medical expertise, and that determination cannot simply be made by lay observation alone; the Veteran is not considered competent (meaning medically qualified by training or experience) to provide such a medical opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). 

Accordingly, the criteria for service connection are not met, and the appeal must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch, 21 F.4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Entitlement to service connection for acquired psychiatric disorder to include anxiety, depression, and PTSD.

The Veteran contends that service connection is warranted for acquired psychiatric disorder to include anxiety, depression, and PTSD due to his military service. See March 2020 VA Form 21-526EZ. 

STRs do not show complaints or treatment for acquired psychiatric disorder to include anxiety, depression, and PTSD.

During the May 2024 Board hearing, the Veteran adopted his representative's statement that the Veteran's shortness of breath is the cause of his anxiety. See May 31, 2024, Board Hearing transcript. The Veteran testified that he has been prescribed Xanax to take whenever he feels panic attacks coming on. In sum, the Veteran has alleged that the treatment for Hodgkin's lymphoma caused a loss of lung function, which in turn caused or led to him developing anxiety. 

Within 90 days after the Board hearing, the Veteran provided private medical treatment records showing a diagnosis of anxiety. See May 2019 private records. 

While there is a diagnosis of anxiety and the first prong for service connection is satisfied, there is no evidence of an in-service incurrence of an acquired psychiatric disorder to include anxiety, depression, and PTSD. Furthermore, there is not a positive nexus opinion linking the Veteran's acquired psychiatric disorder to include anxiety, depression, and PTSD to his military service. Without both of these elements, direct service connection cannot be granted. See Shedden, 381 F.3d at 1167. 

At the May 2024 Board hearing, the Veteran's representative asserted that the Veteran's acquired psychiatric disorder to include anxiety, depression, and PTSD is secondary to a service-connected disability. See May 2024 Board Hearing transcript. As this theory of entitlement was first raised after the May 2020 rating decision on appeal and is not related to a statutory or regulatory duty such as development related to the PACT Act, the Board is not permitted to remand to obtain an opinion. 38 C.F.R. § 20.802(a). However, the Board is obligated to address the contentions and will do so below. See Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009) (Board is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record). 

Per the decision above, service connection is in effect for shortness of breath as a residual of treatment for Hodgkin's lymphoma during service. The evidence also establishes a current diagnosis of anxiety. Having satisfied the first and second prongs of secondary service connection, the inquiry turns to whether the
 is obligated to address the contentions and will do so below. See Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009) (Board is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record). 

Per the decision above, service connection is in effect for shortness of breath as a residual of treatment for Hodgkin's lymphoma during service. The evidence also establishes a current diagnosis of anxiety. Having satisfied the first and second prongs of secondary service connection, the inquiry turns to whether the anxiety was either proximately caused by or proximately aggravated by a service-connected disability, to include shortness of breath. Allen, 7 Vet. App. at 448.

The record does not contain an opinion providing a positive nexus. While the record showing a current diagnosis of anxiety would ordinarily raise the question of nexus, because the diagnosis was not provided until after the May 2020 rating decision on appeal, there is no pre-decisional duty to assist error requiring remand, and no other basis to remand. 38 C.F.R. §§ 3.159(c), 20.802(a). Without a nexus opinion connecting the Veteran's anxiety to his service-connected residuals of Hodgkin's lymphoma, to include shortness of breath, the elements of secondary service connection are not met, and the appeal must be denied.

In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch, 21 F.4th 776; 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

J. Kirby

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bryan, L.

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.