Citation Nr: 18150635 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-47 801 DATE: November 15, 2018 ORDER Entitlement to service connection for B-Cell lymphoma, claimed as Non-Hodgkin's lymphoma is granted. FINDING OF FACT The probative medical evidence of record is at least in equipoise as to whether the Veteran’s current B-Cell lymphoma, claimed as Non-Hodgkins lymphoma was caused by her exposure to toxins emitted by burn pits during her period of active service in Iraq and Kuwait. CONCLUSION OF LAW The criteria for entitlment to service connection for Non-Hodgkin’s lymphoma are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from June 2002 to August 2002, and again from March 2005 to May 2008, including service in Operation Iraqi Freedom. 1. Entitlement to service connection for B-Cell lymphoma, claimed as Non-Hodgkins Lymphoma. The Veteran claims entitlement to service connection for Non-Hodgkins Lymphoma (lymphoma). Specifically, the Veteran contends that her current lymphoma was caused by exposure to burn pits during her period of active duty service at Continuing Operations Base Speicher in Iraq, and Camp Arifjan in Kuwait. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. In order to prevail on the issue of service connection there must be competent evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When a disease is first diagnosed after service, service connection is warranted for that condition if the competent evidence shows it was incurred in service. 38 C.F.R. § 3.303(d). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The Veteran has a current diagnosis of lymphoma. In a July 2013 VA hematologic and lymphatic conditions examination, the Veteran’s April 2013 diagnosis of lymphoma was affirmed. The Veteran was exposed to burn pit toxins during her active service in Iraq. In an October 2013 medical opinion, the examiner stated that the Veteran’s lymphoma is not related to service or exposure to environmental hazards during active service. The examiner reasoned that the Veteran’s specific B-Cell lymphoma occurs predominately in women in third and fourth decade of life. The opinion also stated, “[a]ccording to studies done by the Institute of Medicine, the available medical studies are of insufficient quality, validity, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association between any cancer and deployment to the Gulf War region.” Additionally, in August 2016, a VA addendum opinion also found that the Veteran’s current lymphoma was not related to service or exposure to environmental hazards. The August 2016 opinion stated that medical literature suggested that etiology of the Veteran’s B-Cell lymphoma was not exposure to environmental toxins but rather recurrent gene alteration and immune deregulation. The VA clinician stated that no causal relationship had been established between exposure to dioxins and lymphoma. The Board finds these opinions to significant probative evidence against the Veteran’s claim for service connection. However, the Veteran has submitted a November 2014 private medical opinion and November 2016 addendum opinion stating a direct relationship between the Veteran’s exposure to dioxins emitted from burn pits and her current lymphoma. The medical opinion was authored after an interview with the Veteran, and a review of her service treatment records and prior medical history. The addendum November 2016 addendum opinion states: Even without invoking the benefit of the doubt for this Veteran, it is at least as likely as not that [the Veteran’s] primary mediastinal B-Cell lymphoma was caused by exposure to toxicants in burn pits, including TCDD and dioxin-like compounds, Benzene, which are already well established as causing B-cell lymphoma. This opinion is based upon widely acknowledged facts and scientific research, my intimate knowledge of both military deployment health issues, environmental and occupational medicine including environmental toxicology and a thorough review of the IOM reports, VA regulations and DOD documents relevant to this case. The Board finds the November 2014 medical opinion and November 2016 addendum opinion to be significant probative evidence in favor of the Veteran’s claim for service connection. Considering the above discussed examinations and medical opinions, The Board finds that the probative medical evidence of record is in equipoise. A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. Entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence. When the evidence is in “relative equipoise, the law dictates that the Veteran prevails.” Gilbert v. Derwinski, 1 Vet. App. 49 (1990). (Continued on the next page)   Accordingly, the Boards finds that entitlement to service connection for B-Cell lymphoma, claimed as Non-Hodgkins Lymphoma is warranted. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Riordan, Associate Counsel