Citation Nr: 1105289 Decision Date: 02/08/11 Archive Date: 02/18/11 DOCKET NO. 05-18 466 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to service connection for idiopathic thrombocytopenia purpura (ITP), also claimed as bruising and low platelet count. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B. Berry, Associate Counsel INTRODUCTION The Veteran served in the Air Force Reserve from May 1972 to November 1998, with active duty from May 1972 to November 1972, August 1990 to June 1991 and October 1993. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision dated in February 2004 by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In June 2006, the Veteran testified during a hearing before the undersigned Veterans Law Judge at the Roanoke, Virginia RO. A transcript of the hearing is of record. In March 2009, the Board remanded this matter to the RO for a VA examination and opinion. After accomplishing the requested action to the extent possible, the RO continued the denial of the claim (as reflected in the August 2010 supplemental statement of the case (SSOC)) and returned this matter to the Board for further appellate consideration. In August 2010, the Veteran submitted additional evidence with a waiver of initial RO consideration. The additional evidence includes statements by the Veteran, a list of blood platelet counts and two articles. The Board accepts the additional evidence for inclusion into the record on appeal. See 38 C.F.R. § 20.800 (2010). FINDINGS OF FACT The evidence of record is at least in equipoise that the Veteran's current idiopathic thrombocytopenia purpura is related to active military service. CONCLUSION OF LAW Idiopathic thrombocytopenic purpura was incurred during active military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2010). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Veterans Claims Assistance Act As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the United States Department of Veterans Affairs (VA) has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2010). In this case, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and will not be further discussed. II. Merits of the Claim for Service Connection The Veteran filed a claim for idiopathic thrombocytopenia purpura (ITP), bruising and low blood platelet count in July 2002. The Veteran contends that he has a disability manifested by abnormal blood chemistry and bruises due to exposure to jet fuel while on active duty. Service connection may be granted to a veteran for a disability resulting from a disease or injury incurred in or aggravated by military service. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2010). For the showing of chronic disease in service, there must be a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, evidence of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may be granted for a disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection may be presumed for certain chronic diseases that are manifested to a compensable degree within one year after separation from service. 38 U.S.C.A. §§ 1101, 1112 (West 2002); 38 C.F.R. §§ 3.307, 3.309(a) (2010). To establish service connection for a claimed disorder, there must be (1) medical evidence of current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Pond v. West, 12 Vet. App. 341, 346 (1999); Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997). Such determination is based on an analysis of all the evidence of record and evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1, 8 (1999). In order for the Veteran to be entitled to service connection, the medical evidence must show a diagnosis of the claimed disability. The Board observes that the Veteran complained of bruising and he was found to have a low platelet count in 1998. A February 1998 private treatment record documents that the Veteran was diagnosed with idiopathic thrombocytopenic purpura (ITP). The private treatment records show that treatment for ITP ended in August 1998. A July 1999 private treatment record provides a diagnosis of chronic ITP. Although there is evidence that the condition has resolved and his platelet count has been normal since 1998, the Veteran requires on-going follow up from a private physician. See letters from private physicians dated in May 2006 and June 2009. Therefore, resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran has a current diagnosis of ITP. A review of the Veteran's service records show that during active duty the Veteran's military occupational specialty was flight engineer technician. In addition, between August 1990 and June 1991, the Veteran served on active duty in the Southwest Asia Theater of operations during the Persian Gulf War. In a case where a veteran is seeking service connection for any disability, due consideration must be given to the places, types, and circumstances of the veteran's service. 38 U.S.C.A. § 1154(a) (West 2002). As a flight engineer technician it is likely that the Veteran was exposed to jet fuel. Furthermore, the Veteran likely was exposed to other chemicals while serving in the Southwest Asia Theater of operations during the Persian Gulf War. Furthermore, the medical evidence of record shows that the Veteran's ITP was related to jet fuel and other chemicals during military service. In this regard, a June 2009 opinion from the Veteran's treating physician provided the opinion that the Veteran's ITP is as likely as not related to the exposure of numerous chemicals during service. A May 2006 letter from a private physician also indicates that it is likely the Veteran's ITP is related to exposure to jet fuel. He noted that the Veteran had a long history of exposure to jet fuel and at the time of his presentation he was still exposed to jet fuel through his weekend reserve service duties, which had followed almost constant exposure during his active duty service in Southwest Asia during the Gulf War. The physician noted that the time course of his recovery is compatible with an exposure that when he was removed from contact resulted in clinical improvement. Furthermore, a VA examiner in April 2010 provided the opinion that the Veteran's ITP was as likely as not related to jet fuel and other chemicals during his service. The Board also finds it persuasive that there is no medical evidence of record indicating the Veteran's ITP is not related to exposure to chemicals during military service. Based on the foregoing, the evidence of record reveals that the Veteran has a current disorder of ITP that is related to in- service exposure to chemicals, including jet fuel. Accordingly, the evidence is at least in equipoise with respect to whether the Veteran's current ITP was incurred during active military service. Therefore, the claim of entitlement to service connection for ITP is warranted. (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection idiopathic thrombocytopenia purpura is granted. ____________________________________________ MARK W. GREENSTREET Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs