Citation Nr: 9915488 Decision Date: 06/03/99 Archive Date: 06/15/99 DOCKET NO. 97-17 384 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. Schlosser, Associate Counsel INTRODUCTION The veteran had active military service from October 1976 to August 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 1996 rating action in which the RO denied, among other things, service connection for the cause of the veteran's death. By a July 23, 1996, letter, the RO also informed the appellant that a claim for accrued benefits, death pension, and dependency and indemnity compensation under 38 U.S.C.A. § 1318(b) (West 1991) had been denied. The denial of service connection for the cause of the veteran's death was the only issue thereafter appealed. 38 C.F.R. §§ 20.200, 20.302(c) (1998) (an appeal is initiated by a notice of disagreement and is completed only by filing a substantive appeal after issuance of a statement of the case or supplemental statement of the case which addresses the issues that the appellant desires to appeal). FINDINGS OF FACT 1. The veteran was exposed to benzene or benzene-like compounds in service while performing her duties as an aircraft maintenance specialist. 2. The veteran was diagnosed with acute myeloid leukemia in 1991. 3. It is likely that prolonged exposure to benzene or benzene-like compounds in service led to the development of acute myeloid leukemia. 4. Complications from acute myeloid leukemia contributed significantly to the veteran's death. CONCLUSION OF LAW Service connection is warranted for the cause of the veteran's death. 38 U.S.C.A. §§ 1101, 1110, 1112, 1310 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.102, 3.312 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background The death certificate reveals that the veteran died on May [redacted] 1996. The immediate cause of death was listed as respiratory arrest. The primary causes of death, in sequential order, were listed as multi-organ system failure, graft versus host disease, and umbilical cord blood transplant for leukemia. An autopsy was performed. At the time of the veteran's death, she was hospitalized at the Duke Medical Center in Durham, North Carolina. The hospital summary and clinical records of the terminal period of hospitalization reflect a primary diagnosis of acute myeloid leukemia with multiple secondary diagnoses. The veteran's service medical records are negative for any diagnosis of acute myeloid leukemia. The veteran's occupational specialty in service was aircraft maintenance specialist. Post-service treatment records show that the veteran was seen at Seymour Johnson Air Force Base in June 1991 after experiencing pounding in her chest along with some mild chest pain for the previous few weeks. Subsequent evaluation at the Southeastern Medical Oncology Center resulted in a diagnosis of pancytopenia, probably secondary to pre-leukemia or frank leukemia. The veteran underwent chemotherapy and the leukemia was noted to be in remission in October 1991. In August 1992, the veteran filed a claim for entitlement to service connection for acute myelogenous leukemia. She contended that she served as an F-4 crew chief in service and was exposed to numerous carcinogens including F-4E and F-4F radar transmissions, various fuels, greases, oils, cleaning compounds, ECM transmissions, aircraft cleaning soap, and asbestos gloves. On VA examination in September 1992, diagnoses included acute myelogenous leukemia, history of total body radiation, chemotherapy, bone marrow transplant, multiple bone marrow biopsies and aspirations, and history of exposure to radar, jet fuel, oil and asbestos gloves. In a May 1993 letter to the veteran, the RO requested information from the veteran about her alleged exposure to carcinogens in service. In a June 1993 letter, the veteran outlined her in-service duties which exposed her to the carcinogens previously identified in her claim for service connection. She stated that her occupational history in service included work on both flightline and phase inspection maintenance from 1976 to 1981. Her duties included, but were not limited to the following: washing aircraft with PD-680 which contained petroleum distillates, NAPTHA; treating minor corrosion using lacquer paints which contained toluene, methylene chloride, acetone, NAPTHA; launching, recovering and operating aircraft while radar was in operation; removing and replacing panels, doors, radomes; removing, replacing, lubricating and servicing landing gear and components, wheel and tire assemblies, and brake assemblies, using MIL-C-83360 containing antimonytrioxide and inorganic lead compounds; servicing and draining liquid oxygen, and removing and installing liquid oxygen converters with asbestos gloves for protection; lubricating aircraft flight controls, parts and assemblies, and aircraft engines with various oils and lubricants including, but not limited to VV-L-800, molybdenum grease and leak tek; servicing and draining hydraulic systems, pneudraulic systems, nitrogen systems, and pneumatic systems; removing and installing system components; servicing aircraft with JP-4 fuel which contained petroleum distillates (NAPTHA), benzene and toluene; removing and installing external JP-4 fuel tanks and fuel filters; inspecting and repairing JP-4 fuel leaks; inspecting, removing, and replacing engines and engine components; and removing and installing nickel-cadmium aircraft batteries. The veteran further stated that her post-service occupational history consisted of office work and educational pursuits without any known exposure to carcinogens. Thereafter, the RO undertook significant efforts to ascertain whether the veteran had been exposed to radiation in service. The RO requested information about possible radiation exposure the veteran may have experienced in service from the United States Air Force Occupational Health Laboratory, the Defense Nuclear Agency, the Navy Dosimetry Center, the USA Ionizing Radiation Dosimetry Center, and the Reynolds Electrical &Engineering Co., Inc. These requests were met with negative results. In February 1995, the veteran submitted a January 1995 letter from her treating oncologist, Lance Loomer, M.D., at the Southeastern Medical Oncology Center. Dr. Loomer indicated that, if the veteran was indeed exposed to benzene or benzene-like compounds, it was definitely possible that her leukemia arose from such exposure. Dr. Loomer went on to state that the lag time in developing leukemia after exposure peaked at approximately eight years and then plateaued at a 3-4% probability. He indicated that it was consequently rare to develop leukemia immediately, and that it would be much more common to develop leukemia years later as in the case of the veteran. The veteran also submitted abstracts from several articles which reportedly linked exposure to certain carcinogens, including benzene compounds, to the development of leukemia. Following the death of the veteran in May 1996, the appellant submitted a document from the veteran's service medical records which showed treatment in service for a chemical burn of the right upper extremity while using PD-680 during a cleaning operation in 1977. II. Analysis Initially, the Board finds that the appellant's claim for service connection for the cause of the veteran's death is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is not inherently implausible, especially given the veteran's previously submitted statements regarding in-service chemical exposure, the opinion by Dr. Loomer, and the abstracts of certain medical articles. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). In order to establish service connection for a disability, there must be objective evidence that establishes that such disability either began in or was aggravated by service. 38 U.S.C.A. § 1110. A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or disease incurred in service. Watson v. Brown, 4 Vet.App. 309, 314 (1993). The death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The service-connected disability will be considered as the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312 (1998). For a service- connected disability to be considered the principal or primary cause of death, it must singly, or with some other condition, be the immediate or underlying cause, or be etiologically related thereto. 38 C.F.R. § 3.312(b) (1998). In determining whether a service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. 38 C.F.R. § 3.312(c) (1998). The veteran's occupational specialty in service was aircraft maintenance specialist. Prior to her death, the veteran alleged that she had been exposed to multiple carcinogens, including benzene compounds, during her duties as an aircraft maintenance specialist. Based on her occupational specialty in service, and the expertise regarding fuels, solvents, and the like implicit in such a specialty, the Board finds that the veteran's reference to exposure to certain chemicals, including benzene, to be both credible and competent evidence of such exposure. There is evidence of record which confirms that the veteran was diagnosed with acute myeloid leukemia in 1991, ten years after her discharge from service. As noted above, there is also a private medical opinion from the veteran's treating oncologist, as well as evidence contained in two referenced treatises which strongly suggests a relationship between exposure to benzene compounds and subsequent development of acute myeloid leukemia. This increased risk is supported by information contained in two medical treatises. Cecil Textbook of Medicine, (James B. Wyngaarden, M.D., Lloyd H. Smith, Jr., M.D., and J. Claude Bennett, M.D., eds., 19th ed. 1992), provides, in part, that heavy occupational exposure to benzene frequently results in marrow hypoplasia, which sometimes evolves into acute leukemia. Similarly, Harrison's Principles of Internal Medicine, (Anthony S. Fauci, M.D., Joseph B. Martin, M.D., Eugene Braunwald, M.D., Dennis L. Kasper, M.D., Kurt J. Isselbacher, M.D., Stephen L. Hause, M.D., Jean D. Wilson, M.D., and Dan L. Longo, M.D., eds., 14th ed. 1998), notes that benzene used as a solvent has been related to an increased incidence of acute myeloid leukemia. The Board finds that the evidence, both positive and negative, is at least in relevant equipoise. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability or any other point, such doubt will be resolved in favor of the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Under such circumstances, the Board concludes that the evidence supports a grant of service connection for the cause of the veteran's death. 38 C.F.R. §§ 3.102, 3.303 (1998). It is clear from review of the veteran's death certificate that complications from the veteran's acute myeloid leukemia were a significant contributing cause of her death. Pursuant to the provisions of 38 U.S.C.A. § 5107(b) (West 1991) and 38 C.F.R. § 3.312(c) (1998), service connection for the cause of the veteran's death is granted. ORDER Service connection for the cause of the veteran's death is granted. MARK F. HALSEY Member, Board of Veterans' Appeals