Citation Nr: 20009646 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 16-32 353 DATE: February 6, 2020 ORDER Entitlement to service connection for polycythemia vera is granted. FINDING OF FACT The Veteran’s polycythemia vera is etiologically related to his active service, to include as due to exposure to toxic chemicals therein. CONCLUSION OF LAW The criteria for entitlement to service connection for polycythemia vera have been met. 38 U.S.C. §§ 1110, 1131, 1155, 5107; 38 C.F.R. §§ 3.159; 3.303; 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Coast Guard from November 1968 to November 1972, December 1972 to March 1980, April 1980 to December 1982, January 1983 to November 1985, and November 1985 to December 1988. This appeal comes to the Board of Veterans’ Appeals (Board) from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In October 2018, the Board denied service connection for polycythemia vera. However, the Veteran subsequently appealed the Board’s October 2018 decision to the Court of Appeals for Veterans Claims (Court). In July 2019, the Court granted the Joint Motion for Remand (JMR), vacating and remanding the October 2018 Board decision that denied the issue of service connection for polycythemia vera. Entitlement to service connection for polycythemia vera. 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). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A disorder diagnosed after discharge may be service connected if all the evidence establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d). For certain chronic diseases, including leukemia or a malignant tumor, service connection can be presumed without showing evidence of such disease having been incurred during a period of service, if the disease has manifested to a degree of ten percent or more within one year from the date of separation. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). If there is no manifestation within one year of service, service connection for a recognized chronic disease can still be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. Continuity of symptomatology requires that the chronic disease have manifested in service. 38 C.F.R. § 3.303(b). In service manifestation means a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings. In determining whether service connection is warranted for a disorder, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran asserts that his current diagnosis of polycythemia vera was caused by exposure to toxic chemicals during active service, to include trichloroethylene (TCE), tetrachloroethylene (PCE), and benzene. Specifically, the Veteran contends that as an electrician in the Coast Guard, he came into contact with chemicals and solvents during his watches in the engine room, which also caused him to come into contact with diesel fuel frequently. Also, as an electrician, the Veteran came into contact with cleaning solvents in a confined area on frequent occasions. He contends that these exposures caused the polycythemia vera. See June 2014 NOD. Military personnel records show that the Veteran served aboard the USS Ironwood from April 1970 to October 1971. His military occupational specialty was an electrician. Based on the circumstances of the Veteran’s military service, the Board concedes that the Veteran was exposed to hazardous chemicals. Service treatment records are silent for symptoms, treatment, or a diagnosis of a blood disorder. At enlistment in October 1968, a normal physical evaluation was indicated. No complaints of a blood disorder were referenced in the report of medical history with the same date. In March 1970, a report of medical examination indicated that the Veteran was qualified for overseas service. A physical examination in December 1977 noted high bloods levels. Additional examinations in March 1980, May 1980, September 1985, and July 1988 specifically referenced blood level findings. For men, higher than normal hemoglobin levels are generally defined as more than 17.5 grams (g) of hemoglobin (Hgb or Hb) per deciliter (dL) of blood. In service, the Veteran’s hemoglobin levels ranged from 15.0-16.6. No mention of a blood disorder was indicated on his separation examination in 1988. Post-service treatment records show a current diagnosis of polycythemia vera. In September 1999, the Veteran was evaluated for an elevated white blood count. Laboratory results showed a hemoglobin level of 17.7. In January 2000, an oncology note referenced a suspicion of polycythemia vera. The examination report noted that a routine physical examination the previous summer revealed abnormal blood counts. The January 2000 report suggested his history of excessive smoking was the possible cause of the Veteran’s elevated blood counts. A myeloproliferative disorder was also suggested. An outpatient clinic record, dated December 2003, indicated that a diagnosis of polycythemia vera was warranted based upon recent laboratory findings. The diagnostic results show a hemoglobin of 18.0. In April 2013, a Disability Benefits Questionnaire was prepared by the Veteran’s private physician. The report listed a date of diagnosis as 1998. Diagnostic findings included a hemoglobin level of 11.9 and a positive finding for a JAK-2 mutation. In July 2015, a radiation oncology evaluation confirmed the Veteran’s diagnosis of polycythemia vera. The original date of diagnosis was listed as March 2013. An additional diagnosis of macrocytosis was rendered and the condition was deemed causally related to prescribed medication, Hydrea. The Veteran denied any adverse effects with use of prescribed dosage. In January 2020, the Veteran submitted a private medical opinion, dated October 2019, from Dr. M.L., a licensed and board-certified physician with specialties in internal medicine, oncology, and eligible in hematology. Dr. M.L. concluded that it was more likely than not that the Veteran’s polycythemia vera was caused by his exposure to trichloroethylene, tetrachloroethylene, and benzene while in the course of his duties on active service in the United States Coast Guard. Dr. M.L. stated that the etiology of myeloproliferative neoplasm (MPN) (polycythemia vera; essential thrombocythemia; primary myelofibrosis) was unknown; however, they were associated with a somatic mutation-JAK2 V617F-suggesting a potential role for environmental mutagens that caused mutations. There was evidence suggesting that certain individuals had genotypes that predisposed them to the development of myeloproliferative disorders when exposed to mutagens. Dr. M.L. stated that the Veteran was unusually young when he developed MPN, which was a condition most frequently diagnosed in late middle or early age, with the median age of 70 years for polycythemia vera. The private physician opined that it was his opinion that the Veteran’s polycythemia vera was more likely than not caused by his exposure to trichloroethylene, tetrachloroethylene, and benzene while in the course of his duties on active service ein the United States Coast Guard. Benzene, by itself, was sufficient to be causative with the more likely than not certainty as well. The Board acknowledges that a previous VA opinion found the Veteran’s disability not to be related to his active service. Even if the Board were to find the earlier examination and its conclusions to be probative, the evidence would still be, at the least, in equipoise. Under these circumstances, any reasonable doubt is resolved in the Veteran’s favor, and service connection for polycythemia vera is warranted. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, 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.