Citation Nr: 18161106 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-51 231 DATE: December 28, 2018 ORDER Service connection for the cause of the Veteran's death is granted. FINDINGS OF FACT 1. The Veteran had active service between October 1964 and October 1968, including service in the Republic of Vietnam between April 1966 and November 1967; he is presumed to have been exposed to herbicide agents while in service. 2. The Veteran died in December 2011 at the age of 65. The death certificate identified the immediate cause of death as acute myelogenous leukemia (AML); no other significant contributing conditions were identified. 3. At the time of his death, the Veteran was not service connected for any disabilities. 4. The Veteran’s AML is etiologically related to active service. CONCLUSION OF LAW Resolving reasonable doubt in the appellant’s favor, the cause of the Veteran’s death is presumed to have been incurred in service. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1310, 5103(a), 5103A (2012); 38 C.F.R. §§ 3.102, 3.312 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION To establish service connection for the cause of a veteran’s death, the evidence must show that a disability incurred in or aggravated by active service either caused or contributed substantially or materially to cause death. For a service-connected disability to be the cause of death, it must singly or with some other condition be the immediate cause or underlying cause, or be etiologically related. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death, but, rather, a causal connection must be shown. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. There are primary causes of death which, by their very nature, are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, but, even in such cases, there is for consideration whether there may be a reasonable basis for holding that a service-connected condition was of such severity as to have a material influence in accelerating death. 38 C.F.R. § 3.312(c)(4). In such a situation, however, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature. In adjudicating a claim, the Board determines whether the weight of the evidence supports the claim, or, whether the weight of the “positive” evidence in favor of the claim is in relative balance with the weight of the “negative” evidence against the claim. 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. As noted above, the Veteran died in December 2011 at the age of 65. His immediate cause of death was listed as AML. No other significant conditions were found to contribute to his death. A review of the medical evidence shows that the Veteran had a past medical history of recurrent AML, depression, gout, hypertension, and benign prostatic hyperplasia (BPH). At the time of death, he was not service connected for any disabilities. Accordingly, service-connected disabilities did not cause the Veteran’s death. Turning to the issue of whether the Veteran’s death is related to service, a review of personnel and service treatment records (STRs) reveals that his military occupational specialty was working as a liquid fuel system specialist and that he served in the Republic of Vietnam from April 1966 to November 1967. However, the records do not show treatment or diagnoses related to AML, or any symptoms reasonably related thereto. Indeed, his skin and lymphatic systems were found to be clinically normal and his serology was card-micro negative in his May 1968 separation examination. Furthermore, he reported that he did not have skin diseases or a growth, tumor, cyst, or cancer in an associated Report of Medical History. The appellant’s primary contention is that the Veteran developed AML as a result of in-service exposure to Agent Orange. As noted above, the STRs and personnel records confirm his service in the Republic of Vietnam. Accordingly, exposure to herbicides, including Agent Orange, is presumed. Moreover, AML is considered to be a chronic B-cell leukemia and thus is presumed to have been caused by his in-service herbicide exposure. Therefore, AML is presumed to be service connected. 38 C.F.R. § 3.309(e). The record does not establish a diagnosis of AML until more than 40 years after his separation from service. However, in a November 2018 private medical opinion, the clinician opined that it was more likely than not that the Veteran’s AML was related to his exposures to dioxin and benzene through his service in Vietnam. The clinician observed that in his MOS as a liquid fuel system specialist, the Veteran was responsible for requisitioning, receiving, storing, and dispensing petroleum fuel, and opined that he was exposed to benzene, as benzene was a component of all petroleum fuels. The clinician additionally stated that, through his Vietnam service, the Veteran must be considered to have been exposed to Agent Orange. The clinician further noted that there was no period of time following exposure to toxins such as benzene and those in Agent Orange, including dioxin, where there was no risk of leukemogenesis. The clinician finally related that dioxin has been epidemiologically linked as a cause of AML. Based on the above, service connection for cause of death is warranted. As described above, the Veteran worked as a liquid fuel specialist, served in Vietnam, and was presumptively exposed to herbicide agents, including Agent Orange. Furthermore, the Board notes that there is no medical opinion of record that contradicts the nexus opinion provided by the private clinician. Therefore, resolving reasonable doubt in the appellant’s favor, the Veteran’s AML is causally related to service and the appellant’s claim of service connection for the cause of the Veteran’s death is granted. Finally, the appellant has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Spigelman, Associate Counsel