Citation Nr: 20002895 Decision Date: 01/13/20 Archive Date: 01/13/20 DOCKET NO. 18-28 062A DATE: January 13, 2020 ORDER Entitlement to service connection for the cause of the Veteran’s death is granted. FINDINGS OF FACT 1. The Veteran’s death certificate lists his cause of death as multiple myeloma, thrombocytopenia, and anemia. 2. Resolving all doubt in the Veteran’s favor, multiple myeloma is related to his military service. CONCLUSION OF LAW The criteria for service connection for the cause of the Veteran’s death have been met. 38 U.S.C. §§ 101, 1110, 1131, 1310, 5107; 38 C.F.R. §§ 3.1, 3.5, 3.50, 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty service from August 1979 to August 1999, to include service in the Persian Gulf. The Veteran died in May 2016. The appellant is the Veteran’s surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Board remanded the case for additional development and it now returns for appellate review. The Board notes that additional evidence has been associated with the record since the Veteran’s September 2019 Supplemental Statement of the Case without a waiver. However, as the Board is granting service connection for the Veteran’s claim, no waiver is needed. Entitlement to service connection for the cause of the Veteran’s death. The appellant seeks benefits based on service connection for the cause of the Veteran’s death. She contends that the Veteran’s death is related to his exposure to toxins while serving in the Gulf War. For the reasons that follow, the Board finds that service connection for the cause of the Veteran’s death is warranted. VA benefits are payable to the surviving spouse of a veteran if the veteran died from a service-connected disability. 38 U.S.C. § 1310; 38 C.F.R. § 3.5. 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. 38 C.F.R. § 3.312. A service-connected disability will be considered as the principal 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. Id. § 3.312(b). A service-connected disability will be considered a contributory cause of death where it contributed substantially or materially to cause death; it combined to cause death; or it aided or lent assistance to the production of death. Id. § 3.312(c). 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 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. VA’s regulatory framework contains provisions relating to veterans who served in the Persian Gulf War, see 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1); however, the Board is granting this benefit based on a direct theory of entitlement, and further discussion of those regulations is not needed. In this case, prior to his death, the Veteran was not service connected for any disabilities. The death certificate recorded the Veteran’s primary causes of death as multiple myeloma, thrombocytopenia, and anemia. The appellant argues that the Veteran’s death in 2016 was due to multiple myeloma is related to his exposure to toxins while serving in the Gulf War. She further contends that independent medical research supports a potential link between multiple myeloma and Persian Gulf War veterans. See May 2018 argument from appellant’s attorney-representative, including the article from American Society for Microbiology entitled RNAs in the Sera of Persian Gulf War Veterans Have Segments Homologous to Chromosome 22q11.2. The Veteran’s post service treatment records, which consists of treatment records dating from December 2013, reflects oncology treatment for multiple myeloma to the time of his death. The Veteran’s service treatment records are silent for complaints, treatment, or diagnosis related to multiple myeloma. However, the Board notes that the Veteran’s military personnel records reveal that his military occupational specialty (MOS) was a systems organizational maintenance technician and weapons systems integrator. The Veteran also had service in the Persian Gulf as a member of the Red Sea Multinational Battle Force who engaged in Operation Desert Shield and Desert Storm during the period of August 1990 to March 1991. Therefore, the Board concedes that it is likely that the Veteran was exposed to hazardous chemicals/toxins, to include trichloroethylene (TCE) and benzene, due to his military occupation and service in the Persian Gulf. Consequently, the remaining inquiry is whether the Veteran’s cause of death is related to his military service. In this regard, in accordance with the June 2019 Board remand, VA obtained an opinion addressing the cause of the Veteran’s death. At such time, the examiner opined that claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner explained that the Veteran’s service treatment records were silent for any hematologic or immunological abnormalities. The examiner noted that the Veteran served aboard a ship during the Persian Gulf War, but there was no established medical nexus for his multiple myeloma, thrombocytopenia and anemia proximately due to or caused by his Persian Gulf War service. The examiner referenced the article submitted by the appellant’s representative and concluded that it was insufficient evidence to establish a nexus. In this regard, the examiner explained that the study tested for polyribonucleotide (RNAs) with Gulf War Veterans and compared the findings to a non-military reference group with no Gulf War exposure. The examiner further explained that, in the discussion section of the paper, the authors postulate that the presence of unique RNAs may be found in individual chronic multifactorial diseases, including multiple myeloma, and may be used as diagnostic markers. However, the examiner concluded that, there was no established medical nexus for the cause of the Veteran’s death, including his service in the Persian Gulf War. In November 2019, the appellant submitted a private opinion from Dr. C.K. Dr. C.K. opined that it was at least as likely as not that the Veteran’s multiple myeloma was a direct result of his military service and exposure to chemicals/toxins, to include TCE and benzene. As rationale, Dr. C.K. explained that the Veteran’s MOS exposed him to solvents including TCE and benzene, and the routine use of the solvents was confirmed by the archived military technical manuals associated with his MOS during that era. Dr. C.K. noted that TCE and benzene were recognized as Group I human carcinogens. According to the Agency for Toxic Substances and Disease Registry (ATSDR), benzene and TCE are each “equipoise and above” for causing multiple myeloma. Dr. C.K. also stated that several epidemiologic meta-analyses confirm the link between benzene and TCE exposure and multiple myeloma. The Veteran had the single personal association risk fact of being an African American. He had no family history of multiple myeloma or related hematologic cancers and was not exposed to radiation, and the Veteran’s diagnosis at age 47 was 23 years younger than the average age of 70 for multiple myeloma. He was not exposed to the carcinogens prior to or following his military service. Therefore, based on the entire review of the Veteran’s records, Dr. C.K. concluded that the Veteran’s multiple myeloma was due to his military service. After a careful review of the record, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran’s multiple myeloma was a direct result of his military service. In this regard, both the VA examiner and Dr. C.K. are competent medical professionals, and considered the totality of the evidence as well as medical principles in rendering their opinions. Therefore, the Board resolves all doubt in the appellant’s favor and finds that service connection for the Veteran’s cause of death is warranted. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brennae L. Brooks, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.