Citation Nr: 0818924 Decision Date: 06/09/08 Archive Date: 06/18/08 DOCKET NO. 05-25 922 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona THE ISSUE Entitlement to service connection for peripheral neuropathy due to exposure to jet fuel. (The veteran's claim of entitlement to a rating in excess of 50 percent for post-traumatic stress disorder (PTSD) is the subject of a separate Board decision.) REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD Matthew W. Blackwelder, Associate Counsel INTRODUCTION The veteran had active military service from October 1966 to June 1969. This appeal comes to the Board of Veterans' Appeals (Board) from a January 2005 rating decision. FINDING OF FACT Medical and scientific evidence relates the veteran's peripheral neuropathy to exposure to jet fuel while in service. CONCLUSION OF LAW Criteria for service connection for peripheral neuropathy have been met. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION In seeking VA disability compensation, a veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110. "Service connection" basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. In the present case, the veteran has been diagnosed with peripheral neuropathy, which he believes is the result of his time in service while in the Republic of Vietnam. The veteran has advanced several theories as to the etiology of his peripheral neuropathy, including exposure to Agent Orange and as secondary to diabetes mellitus. However, both of those theories have been refuted by the medical evidence of record, denied by the agency of original jurisdiction, and not appealed by the veteran. Most recently, the veteran has advanced a third theory which is supported by the medical evidence. Specifically, he believes that exposure to JP-4 jet fuel and other cleaning solvents caused him to develop peripheral neuropathy. As this matter has not been previously considered (prior to the current appeal), the Board will adjudicate this claim on a de novo basis. The veteran testified at a hearing before the Board that he served as a rotary mechanic and as a door gunner. The veteran stated that he also went on a number of missions to determine whether helicopters were salvageable, which exposed him to numerous fuels and solvents. He also indicated that he would refuel aircraft and often used JP-4 cleaning solvent to clean his weapon as well as his helicopter (and, in so doing, wiped down the entire exterior of the helicopter with the JP-4). He stated that he would have the solvent on his hands for days and was often forced to eat without washing off the solvent. When asked when he first remembered having symptoms of peripheral neuropathy, the veteran indicated that he remembered going to the dispensary while in service for treatment of what he thought was a muscle spasm in his leg. Service medical records are silent for any complaints of symptoms that might be representative of peripheral neuropathy. Nevertheless, two soldiers who served with the veteran submitted letters in September 2006 indicating that they remembered the veteran complaining of numbness and tingling in his extremities while in service. The veteran's claims file is void of any medical treatment for peripheral neuropathy for many years following service, although the veteran testified that he did not hear about peripheral neuropathy for a number of years following service. Even when he first filed a claim (in 1989), the veteran simply noted problems with muscle control and motor reflexes. A treatment record from August 1992 noted tingling in the veteran's right lower extremity. The veteran was diagnosed with peripheral neuropathy in both upper and lower extremities in March 2000 when a nerve conduction study showed severe sensory motor neuropathy. In August 2004, the veteran's VA doctor submitted a letter indicating that she had treated the veteran for his peripheral neuropathy (as part of his general medical care) for the previous 4 years. The doctor noted that the veteran had described his exposure to JP-4 fuel both in refueling aircraft and in wiping both aircraft and equipment with the fuel as part of maintenance. The doctor noted that multiple medical studies on JP-4 fuel have shown that the inhalation of JP-4 can cause neurotoxicity, and specifically peripheral neuropathy, in aviation workers as confirmed by abnormal EMG tests. (It is noted that a March 2001 EMG showed that the veteran had severe advanced sensory motor neuropathy in both upper and lower extremities). The VA doctor concluded, after reviewing the veteran's history, that it was more likely than not that the veteran's peripheral neuropathy was caused by his military service, namely the exposure to jet fuel. The veteran submitted several studies that linked JP-4 exposure to the development of peripheral neuropathy. Specifically, in a public health statement regarding Jet Fuels JP-4 and JP-7, the Agency for Toxic Substances and Disease Registry indicated that nervous system effects have occurred in people who were exposed to vapor from jet fuels like JP-4 for short and long periods. A second study that involved neurological examinations of 29 aircraft factory workers who were exposed to jet fuel vapors revealed findings consistent with peripheral nervous system involvements, including peripheral neuropathy. The Board notes that, with regard to medical treatise evidence, the United States Court of Appeals for Veterans Claims (the Court) has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222, 228 (1999); see also Sacks v. West, 11 Vet. App. 314 (1998) and Wallin v. West, 11 Vet. App. 509 (1998). In the present case, the treatise evidence submitted by the veteran is accompanied by the opinion of a medical doctor; and it describes studies done on individuals who would have a similar exposure as the veteran to jet fuel. As such, they are considered to be useful evidence in support of the veteran's claim. The veteran underwent a VA examination in November 2004 at which the examiner confirmed the presence of peripheral neuropathy. The examiner agreed that exposure to cleaning solvents, such as n-hexane, could cause peripheral neuropathy (although he indicated that it was usually seen after an acute attack of inhalation with an encephalopathic picture which was not present in the veteran's case). He then stated that it was possible that the veteran's chemical exposure caused the peripheral neuropathy, noting that he was unable to come up with an alternative explanation. Nevertheless, he concluded that it was less likely than not that the exposure to the n-hexane or solvents caused the veteran's peripheral neuropathy. The evidence clearly demonstrates that the veteran has peripheral neuropathy; and two medical opinions have been presented by VA doctors. Each opinion suggests that it is at least possible that the veteran's peripheral neuropathy is the result of exposure to jet fuel. The first opinion was supported by medical studies that had connected exposure to jet fuel to the subsequent development of peripheral neuropathy; and the opinion concluded that it was more likely than not that the veteran's peripheral neuropathy was caused by exposure to jet fuel. Even the second opinion, which ultimately concluded that it was less likely than not that the veteran's peripheral neuropathy was caused by jet fuel exposure, noted that it was at least possible that the two were connected, and the examiner was unable to provide any alternative etiology as to what might have caused the peripheral neuropathy. Given that there are two equally credible opinions, one for and one against the veteran's claim, the evidence is at the very least in relative equipoise; and therefore, reasonable doubt must be resolved in the veteran's favor. See Gilbert v. Derwinski, 1 Vet. App. 49 (1991). Accordingly, the Board finds that the veteran's peripheral neuropathy was caused by his exposure to jet fuel while in service; and his claim is therefore granted. In light of this result, a detailed discussion of VA's various duties to notify and assist is unnecessary (because any potential failure of VA in fulfilling these duties is harmless error). ORDER Service connection for peripheral neuropathy is granted. ______________________________________________ THERESA M. CATINO Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs