The appeal concerning the propriety of the reduction in the rating of B-cell lymphoma from 100 percent to noncompensable, effective March 1, 2017, is remanded.

Citation Nr: 26001438 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 17-66 390 DATE: January 30, 2026 REMANDED The appeal concerning the propriety of the reduction in the rating of B-cell lymphoma from 100 percent to noncompensable, effective March 1, 2017, is remanded. REASONS FOR REMAND Unfortunately, the Veteran in January 2021 died during the pendency of this appeal. Given such, prior to discussing the appeal at hand, the Board would be remiss if it did not recognize the Veteran's outstanding service. The Veteran had honorable active service with the United States Army from May 1970 to November 1971 with service in the Republic of Vietnam. He received the National Defense Service Medal, Vietnam Service Meal, and Combat Infantryman Badge, as well other awards. He was clearly a credit to the Army and to his family, and his service to his country is greatly appreciated. The appellant is the Veteran's surviving spouse and has been deemed an eligible claimant for substitution by the Agency of Original Jurisdiction (AOJ). See April 2023, AOJ letter. In a May 2024 decision, the Board, in pertinent part, denied the appellant's appeal of the reduction in rating of B-cell lymphoma from 100 percent to 0 percent effective March 1, 2017, finding that the reduction was proper. See May 2024, Board decision. The Veteran appealed this Board's denial to the United States Court of Appeals for Veterans Claims (Court). In May 2025, the Court issued an order granting an April 2025 Joint Motion for Partial Remand (JMPR), vacating and remanding this issue. See April 2025, JMPR. The Board subsequently remanded the issue in September 2025. 1. The appeal concerning the propriety of the reduction in the rating of B-cell lymphoma from 100 percent to noncompensable, effective March 1, 2017, is remanded. The Board remanded this appeal for a medical opinion in September 2025. The AOJ obtained an opinion in October 2025. See October 2025, VA-VES opinion. Unfortunately, this opinion is not adequate to decide the claim. Specifically, the examiner was asked to determine whether it was at least as likely as not whether there was local recurrence or metastasis of the Veteran's B-cell lymphoma at the time of the July 2016 VA Hematologic and Lymphatic Conditions examination. The examiner was asked to discuss (1) the appellant's argument that the Veteran's oncologist had explained the Veteran was not cancer-free, (2) the August 2014 VA treatment record noting that systemic involvement could not be ruled out at that time, and (3) the April 2016 VA treatment note noting MRI results with a concern for neoplasm, with pancreatic adenocarcinoma being highly differential. The examiner concluded that a study showing that 88 percent of people experienced complete remission after initial treatment, 93 percent in those with a solitary lesion "generally disprove[d]" that there had been any local recurrence or metastasis. While these statistics may provide the basis for treatment decisions, they are not specific to the Veteran's situation or condition at the time of the reduction. The examiner further concluded that "having a few single cells [of remaining cancer] in the body" could be "destroyed by the body's immune system." However, he did not provide any citation or explanation for this conclusion or evidence of how it related to the Veteran's specific situation. Finally, the examiner stated that the Veteran's above-referenced MRI findings were pancreatic adenocarcinoma. However, a review of the medical records shows that the Veteran's pancreatic MRI findings were ultimately determined to be chronic pancreatitis, which is inconsistent with the examiner's statement. This raises the question of whether the examiner fully reviewed all relevant medical records in forming his opinion. In light of the examiner's inaccurate statements regarding the Veteran's medical history and generalized and conclusory opinion, the Board finds that the October 2025 VA-VES opinion is not adequate to decide the claim. This claim must be remanded for an addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following actions: 1. Send the Veteran's claims file to an appropriate examiner other than the October 2025 examiner, preferably an oncologist, for an addendum opinion. The examiner must review the entire claims file in conjunction with the examination. 2. The examiner must opine whether it is at least as likely as not that there was local recurrence or metastasis of the Veteran's B-cell lymphoma at the time of the July 2016 examination. a) The examiner must specifically discuss the following: (1.) The appellant's argument that the Veteran's oncologist explained that the Veteran was not cancer-free "because B-cell lymphoma is a malignancy borne by the blood and by the lymphatic system and carries itself throughout the body and remains present in the body, even though the main points of collection in the right arm's lymph nodes have been excised. The probability of at least some 'metastasis' that is, the unavoidable spreading of B-cell lymphoma cancer cells, is great-in fact-almost certain." See Third Party Correspondence received December 5, 2016. (2.) The August 5, 2014, VA TR, noting "[e]xplained in details the natural course of cutaneous marginal zone B-cell lymphoma ... We also discussed that at this time, we cannot rule out systemic involvement and how systemic B-cell lymphoma has a worse prognosis than its cutaneous form." See Kansas City VA Medical Center (VAMC) records, received November 2017 in CAPRI. (3.) The April 13, 2016, VA TR, noting "[f]rom most recent onc notes: 'I reviewed the abdominal magnetic resonance imaging findings (MRI), outlined above. Although there is a decrease in the size of the uncinate lesion, there is still concern for a neoplasm. Pancreatic adenocarcinoma is highly differential given the location and longstanding history of smoking.'"). See Kansas City VA Medical Center (VAMC) records, received November 2017 in CAPRI. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiner must provide a comprehensive rationale for each opinion provided. Any opinion expressed by the VA examiner must "contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. 2. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. (Continued on the next page) ? (1.) If any development is incomplete, appropriate corrective action must be implemented. (2.) If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moore, 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.