Citation Nr: 18157004 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 16-53 195 DATE: December 11, 2018 ORDER Whether new and material evidence has been received to reopen a claim of service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis due to exposure to Coolanol is granted. Whether new and material evidence has been received to reopen the claim of service connection for left finger numbness due to exposure to Coolanol is granted. Whether new and material evidence has been received to reopen a claim of entitlement to service connection for right finger numbness due to exposure to Coolanol is granted. Whether new and material evidence has been received to reopen a claim of service connection for left lower extremity demyelinating neuropathy due to exposure to Coolanol is granted. Whether new and material evidence has been received to reopen a claim of service connection for right lower extremity demyelinating neuropathy due to exposure to Coolanol is granted. Entitlement to service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis due to exposure to Coolanol is denied. Entitlement to service connection for left finger numbness due to exposure to Coolanol is denied. Entitlement to service connection for right finger numbness due to exposure to Coolanol is denied. Entitlement to service connection for left lower extremity demyelinating neuropathy due to exposure to Coolanol is denied. Entitlement to service connection for right lower extremity demyelinating neuropathy due to exposure to Coolanol is denied. FINDINGS OF FACT 1. Evidence received since a final February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning relates to an unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis, due to exposure to Coolanol. 2. Evidence received since a final February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning relates to an unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for left finger numbness due to exposure to Coolanol. 3. Evidence received since a final February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning relates to an unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for right finger numbness due to exposure to Coolanol. 4. Evidence received since a final February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning relates to an unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for left lower extremity demyelinating neuropathy due to exposure to Coolanol. 5. Evidence received since a final February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning relates to an unestablished fact and raises a reasonable possibility of substantiating the claim of service connection for right lower extremity demyelinating neuropathy due to exposure to Coolanol. 6. The preponderance of the evidence is against finding that the Veteran has monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis due to a disease or injury in service, to include specific in-service exposure to Coolanol. 7. The preponderance of the evidence is against finding that the Veteran has left finger numbness due to a disease or injury in service, to include specific in-service exposure to Coolanol. 8. The preponderance of the evidence is against finding that the Veteran has right finger numbness due to a disease or injury in service, to include specific in-service exposure to Coolanol. 9. The preponderance of the evidence is against finding that the Veteran has left lower extremity demyelinating neuropathy due to a disease or injury in service, to include specific in-service exposure to Coolanol. 10. The preponderance of the evidence is against finding that the Veteran has right lower extremity demyelinating neuropathy due to a disease or injury in service, to include specific in-service exposure to Coolanol. CONCLUSIONS OF LAW 1. The unappealed February 1993 rating decision that denied service connection for residuals of Coolanol exposure/poisoning is final. 38 U.S.C. § 7105 (c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. The additional evidence received since February 1993 regarding the claim of service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis, due to exposure to Coolanol is new and material and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 3. The additional evidence received since February 1993 regarding the claim of service connection for left finger numbness due to exposure to Coolanol is new and material and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 4. The additional evidence received since February 1993 regarding the claim of service connection for right finger numbness due to exposure to Coolanol is new and material and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 5. The additional evidence received since February 1993 regarding the claim of service connection for left lower extremity demyelinating neuropathy due to exposure to Coolanol is new and material and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 6. The additional evidence received since February 1993 regarding the claim of service connection for right lower extremity demyelinating neuropathy due to exposure to Coolanol is new and material and, therefore, the claim is reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 7. The criteria for service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis, due to exposure to Coolanol are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 8. The criteria for service connection for left finger numbness, due to exposure to Coolanol are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for service connection for right finger numbness, due to exposure to Coolanol are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for service connection for left lower extremity demyelinating neuropathy due to exposure to Coolanol are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 11. The criteria for service connection for right lower extremity demyelinating neuropathy due to exposure to Coolanol are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1984 to September 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2015 rating decisions of the Department of Veterans Affairs (VA), Regional Office (RO), in Sioux Falls, South Dakota. The Board notes that in February 1993, the RO denied the claim of service connection for residuals of Coolanol exposure/poisoning. The Veteran again seeks service connection for residuals of such exposure. As he did not appeal the February 1993 decision, in order for VA to review the merits of the claims, new and material evidence must be received. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380, 1383-1384 (Fed. Cir. 1996). Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303 (b), 3.307, 3.309(a). Although a decision is final, a claim will be reopened if new and material evidence is received. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New and material evidence can be neither cumulative, nor redundant, of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. “New” evidence means existing evidence not previously submitted to VA. “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an un-established fact necessary to substantiate the claim. See 38 C.F.R. § 3.156 (a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). If the claim is reopened, it will be reviewed on a de novo basis. 38 U.S.C. §§ 5108, 7105; Evans v. Brown, 9 Vet. App. 273, 282-83 (1996); Manio v. Derwinski, 1 Vet. App. 140 (1991). 1. Whether new and material evidence has been received to reopen the claims of service connection for monoclonal gammopathy; left and right finger numbness; and left and right lower extremity demyelinating neuropathy; each as due to exposure to Coolanol. The Veteran asserts that he has developed residuals of exposure to Coolanol 25-R (a heat transfer fluid) manifested by monoclonal gammopathy, left and right finger numbness, and left and right lower extremity demyelinating neuropathy, as a result of his period of active service. Initially, the Board notes that exposure to Coolanol during the Veteran’s period of active service has been conceded by VA. By rating action dated in February 1993, the RO, in pertinent part, denied service connection for residuals of Coolanol exposure/poisoning. The Veteran did not timely perfect an appeal of that decision and new and material evidence was not received within one year of issuance. Thus, the February 1993 decision became final. See 38 U.S.C. § 7105 (d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. The Veteran filed a new claim for service connection in February 2015, and by rating actions dated in August 2015, the RO again denied service connection. The evidence of record at the time of the February 1993 rating decision included the Veteran’s service treatment records that did not show any diagnosis of or symptoms associated with Coolanol exposure, nor did they show any treatment for symptoms associated with monoclonal gammopathy, finger numbness, or lower extremity neuropathy. A VA examination report dated in December 1992 had shown that the Veteran reported that while working on a B-1 Bomber, he had been exposed to Coolanol which dripped from the plane onto his hands and head. He added that the warning label had indicated that it substance was carcinogenic. He described being sick with headache and nausea for several days following this incident. He was said to have recovered without incident and had no residuals. The diagnosis included a history of exposure to Coolanol with no residuals. As there was no residual disability from the exposure to Coolanol, the RO denied service connection in the February 1993 decision. Subsequent to the February 1993 rating decision, the evidence of record has included VA and private outpatient treatment records (Mayo Clinic, Regional Health Physicians, RMC Neurology and Rehabilitation, and Eccarius Eye Clinic) that show intermittent treatment for symptoms associated with monoclonal gammopathy, left and right finger numbness, and left and right lower extremity demyelinating neuropathy. The private medical records confirm that the Veteran has tested positive for the IgM lambda monoclonal protein that is potentially etiologically related to his asserted symptoms. The additional evidence also includes a treatise that shows the active ingredients and potential hazards of exposure to Coolanol. The additional evidence also includes VA examination reports dated in August 2015 and October 2016 addressing the etiology of the asserted current disabilities. The Board finds that the foregoing medical opinions constitute new and material evidence, as they were not previously of record when the prior decision was made and address whether the Veteran’s asserted disabilities are the result of exposure to Coolanol during the Veteran’s period of active service. Accordingly, the claims of service connection are reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 2. Entitlement to service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis; left and right finger numbness; and left and right lower extremity demyelinating neuropathy; each as due to exposure to Coolanol. Having reopened the Veteran’s claims, the Board must now consider whether entitlement to service connection is warranted on the merits. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. In this regard, as indicated above, the VA and private outpatient treatment records show intermittent treatment for symptoms associated with monoclonal gammopathy, left and right finger numbness, and left and right lower extremity demyelinating neuropathy. The private medical records confirm that the Veteran has tested positive for the IgM lambda monoclonal protein that is potentially etiologically related to his asserted symptoms. The August 2015 VA examination report concludes that it is less likely as not that the Veteran’s current diagnoses of elevated IgM monoclonal protein and peripheral neuropathy are secondary to exposure to Coolanol (a phenol compound) during active service. The VA examiner explained that (1) there is very little medical literature support for causation of elevated IgM para-protein secondary to phenol exposure; (2) researchers have found that the rate of elevated IgM monoclonal protein in the blood increases with age; that the condition is more common in men than women, and twice as common in African-Americans than Caucasians; and the occurrence in first degree relatives was higher suggesting a genetic factor; and (3) the model for the mechanisms that contribute to the development and progression of monoclonal gammopathy of undetermined significance (this term not used by Mayo Clinic) include: obesity, exposure to pesticides, radiation exposure, and personal history of autoimmune diseases, inflammatory conditions and infection. It was also indicated that there was a genetic predisposition. The October 2016 VA examination report shows that the examiner provided a detailed history of the Veteran’s asserted disabilities. Following physical examination, the examiner concluded that it was less likely than not that the claimed conditions were secondary to Coolanol exposure during active service. The examiner explained as follows: (1) Coolanol 25-R is a heat transfer fluid, and that a Material Safety Data Sheet (MSDS) indicates low toxic risk. MSDS effects of over-exposure were said to include slight irritation, but none were reported. (2) The Veteran was exposed per his report to taking five to six samples of Coolanol 25-R every other week for three and a half years. His exposure was minimal, he did not report any skin rashes related to any irritating effects of handling these samples. The medical records are silent for any skin rash from his exposure to Coolanol, and he did not report skin rash on examination. (3) The Veteran did report one episode of exposure to his hands and head, after which he showered two to three hours later. Washing with soap and water are the recommended guidelines in the MSDS. The Veteran had limited exposure (two to three hours) and, at most, would have had skin irritation, but none was reported or documented in the medical records. (4) The Veteran was exposed for three and a half years between 1984 to 1992, however, he has reported that his symptoms of neuropathy began in the preceding five years. The likelihood of an association over the span of 24 years was low as he did not have daily contact with the chemical. (5) The Veteran stated he never worked with nor was exposed to jet fuel or jet fuel additives. (6) The chemicals/mineral BHT (2,6-DI-TERT-BUTYL-P-CRESOL), beryllium silicate, and hydrogen chloride would have had to be ingested or inhaled (in sufficient amount) to cause harm. Harmful effects of these chemicals through inhalation do not include neuropathy. The Veteran did not report any episodes of ingestion or inhalation of Coolanol. (7) The Mayo clinic findings of mild length-dependent mixed demyelinating and axonal peripheral neuropathy, likely IgM related, and the IgM monoclonal protein had MAG antibodies; the MAG antibodies are a response of one’s own body (immune system) and does not indicate any association to Coolanol or the primary chemicals in Coolanol. (8) The medical records are silent for sequela, or further medical evaluation of Veteran’s exposure to Coolanol. He was seen once in October 1998 for a reported headache. Coolanol exposure is noted as an irritant on the MSDS and no skin irritation was noted at that medical evaluation. The Board concludes that, while the Veteran has current diagnoses of the asserted disabilities; and, his exposure to Coolanol during his period of active service has been conceded, the preponderance of the evidence weighs against finding that the diagnoses began during service or are otherwise related to in-service injury or disease, to include Coolanol exposure. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Board finds probative the August 2015 and October 2016 opinions of the VA examiners as they are definitive, based upon a complete review of the Veteran’s claims file, and supported by detailed rationale. Thus, the opinions are found to carry significant probative weight. The Veteran has not provided any competent medical evidence to rebut the opinions against the claim or otherwise diminish their probative weight. While the private medical records show current disability, they do not provide a link to active service, including Coolanol exposure. The Board recognizes the competent assertions of the Veteran. Lay evidence is competent regarding features or symptoms of injury or disease when the features or symptoms are within the personal knowledge and observations of the witness. See Buchanan v. Nicholson, 451 F.3d 1331,1336 (Fed. Cir. 2006); Jandreau, 492 F.3d at 1377; Davidson, 581 F.3d. at 1313. The lay evidence is certainly competent as to the events and symptoms of which there was personal knowledge; and in this regard the Board finds these accounts credible. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, it is the province of trained health care professionals to enter conclusions that require medical expertise, such as opinions as to causation. Jones v. Brown, 7 Vet. App. 134, 137 (1994). Moreover, with regard to direct service connection through chronicity, no chronic disease is shown during service, and it is not until several years following separation from service that the medical evidence shows treatment for the asserted symptoms. With regard to the treatises submitted by the Veteran showing the active ingredients and hazards of exposure to Coolanol, such 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); Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). Here, the treatises were not accompanied by evidence definitively proving the in-service Coolanol exposure was linked specifically to the development of the asserted symptoms. Thus, the treatise is insufficient to establish a medical nexus opinion for causation. Given the medical evidence against the claim, for the Board to conclude that the Veteran’s monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis; left and right finger numbness; and left and right lower extremity demyelinating neuropathy were incurred as a result of service (or exposure to Coolanol during service) would be speculation, and the law provides that service connection may not be based on a resort to speculation or remote possibility. 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. 30, 33 (1993). Accordingly, the Veteran’s claims of entitlement to service connection for monoclonal gammopathy leading to double vision, dizziness, cranial neuropathy, and amyloidosis; left and right finger numbness; and left and right lower extremity demyelinating neuropathy must be denied. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit-of-the-doubt doctrine is not helpful to a claimant where, as here, the preponderance of the evidence is against the claims. 38 U.S.C. § 5107 (b). L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Orfanoudis, Counsel