Citation Nr: 18160031 Decision Date: 12/20/18 Archive Date: 12/20/18 DOCKET NO. 17-04 390 DATE: December 20, 2018 ORDER Service connection for allergic rhinitis is granted. Service connection for non-Hodgkin’s lymphoma (NHL) is granted. FINDINGS OF FACT 1. The Veteran’s allergic rhinitis first manifested in service and was incurred in service. 2. The evidence is at least in equipoise as to whether the Veteran’s NHL is related to in-service chemical exposure and other carcinogenic agents. CONCLUSIONS OF LAW 1. The criteria for service connection for allergic rhinitis are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for service connection for non-Hodgkin’s lymphoma are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from July 1974 to July 1998, to include service in the Gulf War. This case comes before the Board of Veterans’ Appeals (Board) on appeal from April 2010 and January 2012 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The record reflects that after the RO last reviewed this matter in a December 2016 Statement of the Case, additional relevant evidence was added to the claims file. However, as the Board is granting the Veteran’s appeal, there is no prejudice in the Board considering this evidence in the first instance. Allergic Rhinitis The Board notes that the Veteran has already been awarded service connection for sinusitis. He also seeks service connection for allergic rhinitis. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Upon review of all the evidence of record, the Board finds that service connection for allergic rhinitis is warranted. Service treatment records include a June 1997 note where the Veteran complained of sinus problems. He was diagnosed with chronic sinusitis. It was also noted that the Veteran underwent sinus surgery. In a September 1995 note, a notation of “allergic vs. non-allergic rhinitis” was indicated. In May 1996, the Veteran complained of ongoing sinus problems and indicated that they occurred occasionally with weather changes. In a November 1997 Narrative Summary, conducted less than one year prior to service separation, the Veteran requested waiver for flying class II duties because of his use of beclomethasone for the “control of mild seasonal allergic rhinitis.” An October 1997 Medical Examination-Flying Personnel report noted “allergic rhinitis.” Post-service private treatment records from Dr. Y. L. include a June 2007 note where the Veteran was seen for nasal congestion, sinus congestion, and sinus pressure. At that time, the Veteran reported having nasal congestion that began 25 years earlier, i.e., in approximately 1982 (during service). The onset of symptoms was noted to be gradual and was associated with a sinus infection and allergies. Dr. Y. L. assessed the Veteran with both chronic sinusitis and allergic rhinitis. The evidence also includes a June 2010 statement from Dr. Y. L. where it was noted that the Veteran had been treated for chronic allergic rhinitis and chronic sinusitis. Dr. Y. L. opined that the Veteran’s disorders were more likely than not related to service. In support of this opinion, Dr. Y. L. noted that service records showed multiple treatments for allergic rhinitis and sinusitis for the duration of his military career. The Veteran was also afforded a VA general medical examination in March 2011. The examiner diagnosed the Veteran with allergic rhinitis, but opined that it was not related to service. In support of this opinion, the examiner stated that there was no in-service treatment for allergic rhinitis. The Board finds the March 2011 VA medical opinion to lack probative value as it is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value). In this regard, although the examiner indicated that there was no evidence of treatment for allergic rhinitis, service treatment records reflect that, in November 1997, the Veteran requested waiver for flying class II duties because of his use of beclomethasone for the “control of mild seasonal allergic rhinitis.” As such, the March 2011 medical opinion lacks probative value. The remaining evidence of record, to include a May 2017 VA examination report, does not address the etiology of the Veteran’s allergic rhinitis. Accordingly, the Board finds that the Veteran’s allergic rhinitis first manifested in service and was incurred in service. Therefore, service connection for allergic rhinitis is granted. 38 C.F.R. §§ 3.102. Non-Hodgkin’s Lymphoma (NHL) The Veteran essentially maintains that his NHL first manifested in service as evidenced by persistent microscopic hematuria and exposure to chemicals in service while serving in the Gulf War. In an August 1984 in-service emergency care note, it was indicated that the Veteran was “exposed to aircraft cleaning compound” with resulting tightening of chest and irritation to eyes. The Veteran was also light-headed at the time. Service treatment records also show a diagnosis of persistent microscopic hematuria in January 1995. In a follow-up note, it was indicated that the Veteran had a 10-year history of hematuria. In a June 1991 urology note, the Veteran was noted to have a history of hematuria since 1985. IVP (intravenous pyelogram) conducted in June 1991 was within normal limits. The Board notes that an IVP is an x-ray exam to evaluate the kidneys, ureters, and bladder. The evidence includes a March 2011 VA general medical examination report. During the examination, the Veteran reported exposure to smoke from oil fires and depleted uranium shells. It was also noted that the Veteran had hematuria since 1985 and had undergone several work-ups in service, which were negative. However, he had a cystoscopy in March 2008, and was diagnosed with NHL during a bladder biopsy. The examiner then opined that the Veteran’s NHL was not related to service as the Veteran was not diagnosed with or treated for the condition in service. The examiner did not explain, however, whether the Veteran’s hematuria was a manifestation of the NHL. The Veteran has submitted two private medical opinions from Dr. E. H. (a urologist) and Dr. J. S. (an oncologist and hematologist). These opinions will be discussed in concert as they essentially include similar facts and opinions. In this regard, both doctors indicated that the Veteran was exposed to hazardous chemical compounds and carcinogenic agents (such as from smoke and burning oil fires) during service in the Gulf War. The doctors indicated that these compounds had a weakening effect upon the immune system and that these compounds “significantly increases the risk for bladder cancer.” Dr. J. S. also opined that the Veteran’s history of longstanding microscopic hematuria was “directly related” to his diagnosis of diffuse large B-cell lymphoma of the bladder. The Veteran had several workups in his 20 years in service for a history of hematuria and bladder problems. Dr. J. S. indicated that patients with unexplained microscopic hematuria “should be suspected of having bladder cancer.” Dr. J. S. also specifically noted that there was a “strong possibility” that the Veteran’s immune system was weakened by the in-service exposure to chemical compounds and contributed to the large B-cell NHL, which is an otherwise rare tumor. Moreover, it was noted that, in most cases, it took many years after the chemical exposure for a person to develop bladder cancer and often the person had no symptoms until it reached an advanced state, as was the case with this Veteran. Both doctors indicated that the Veteran’s aggressive form of NHL was “extremely rare to be found in the bladder.” It was further noted that the Veteran’s diagnosis was ultimately found in 2008 via bladder biopsy. The Board finds these private medical opinions (which weigh in favor of the Veteran’s claim) to be highly probative as to the issue at hand. Both doctors had treated the Veteran and had reviewed service treatment records. Further, the doctors discussed, in detail, the Veteran’s in-service conditions and provided opinions supported by well-reasoned rationales. The Board also notes that, although the Veteran had several workups in his 20 years of service due to recurring microscopic hematuria, it does not appear that a bladder biopsy (which was ultimately used to diagnose the bladder cancer in 2008) was ever performed during service. For these reasons, and resolving any reasonable doubt in the Veteran’s favor, the Board finds that service connection for non-Hodgkin’s Lymphoma is warranted. 38 C.F.R. §§ 3.102. E. BLOWERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel