Citation Nr: 21061592 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 18-30 515 DATE: October 4, 2021 ORDER Service connection for pancreatic cancer is granted. FINDING OF FACT The Veteran's pancreatic cancer was related to his service, including his exposure to burn pits. CONCLUSION OF LAW The criteria for service connection for pancreatic cancer have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1980 to December 1980 and November 2004 to March 2006. He died in May 2021. The appellant is his surviving spouse. She has been recognized as a substitute claimant in this appeal. The case is on appeal from an October 2017 rating decision. In the June 2018 substantive appeal, the Veteran requested a Board hearing. As noted, he died in May 2021. Thereafter, the appellant indicated in a May 2021 correspondence that she wishes to continue the appeal; however, she does not want a hearing. Accordingly, the Board considers the request for a hearing to be withdrawn. See 38 C.F.R. § 20.704(e). Service connection for pancreatic cancer. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Analysis During his lifetime, the Veteran asserted that his pancreatic cancer was related to his service in Iraq where he was constantly exposed to burn pits. The Veteran's service personnel records (SPRs) show that he had service in Iraq for approximately one year and his military occupational specialty (MOS) was petroleum supply specialist. Further, the Board notes the Veteran's death certificate reflects that his cause of death was pancreatic cancer with metastatic disease to the bone. The Veteran was diagnosed with pancreatic cancer in July 2017. Following his August 2017 claim, he was afforded an October 2017 VA examination in which the examiner determined the Veteran's pancreatic cancer was not associated with his service. He indicated pancreatic cancer is a disease with a clear and specific etiology and diagnosis and therefore, is not a manifestation of an undiagnosed Gulf War illness. The examiner stated pancreatic cancer is caused by transformation of normal pancreatic cells to cancerous cells that is associated with inherited gene mutations. He noted risk factors for the disease include smoking and the Veteran smoked during his lifetime until approximately 2005. As such, the examiner concluded the Veteran's pancreatic cancer was not a disability pattern or diagnosed disease related to a specific exposure event experienced by the Veteran during his service in Southwest Asia. The Veteran submitted a January 2018 statement in which he reported during his service in Iraq, he was exposed to burn pits which were "burning everything." He stated he was not provided with any protection from the fumes which were inhaled on a daily basis, and he contended that such in-service burn pit exposure resulted in his pancreatic cancer. Additionally, a January 2018 private medical opinion was submitted in support of the claim. Dr. Chong, an oncology physician, indicated that the Veteran was his patient and was found in July 2017 with a pancreas mass and adjacent adenopathy. He noted a later July 2017 percutaneous biopsy confirmed a pancreatic ductal carcinoma. The physician reported the Veteran's Middle East exposure to environmental and/or chemical toxins during his service is responsible for the initiation and/or proliferation of his pancreatic malignancy. He stated pancreatic cancer is uncommon in a person of the Veteran's young age (55 years old when diagnosed) and its genesis may be related to carcinogenic exposure. The Board finds the most probative medical evidence of record to be the January 2018 private medical opinion. The physician opined the Veteran's Middle East exposure to environmental and/or chemical toxins during service is responsible for the onset of his pancreatic cancer, particularly since the Veteran's cancer was uncommon in a person of his age. Dr. Chong is a Chief of oncology at Queen's Medical Center in Honolulu, Hawaii. As such, he is a physician specializing in cancer and is especially well-qualified to give a nexus opinion on the cause of the Veteran's pancreatic cancer. The level of training, education, and experience of the person conducting the examination can be a factor considered in assigning weight to the report. Cox v. Nicholson, 20 Vet. App. 563, 568-69 (2007). The Board finds the January 2018 private medical opinion highly probative, as the opinion contains clear conclusions with supporting data, as well as well-reasoned medical explanations connecting the two. As such, the opinion is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board acknowledges the October 2017 VA opinion which provided a negative nexus opinion. However, when reviewing the medical evidence in favor of and against the claim, in association with the other evidence of record, the Board determines the evidence is at least in equipoise. Therefore, in view of the relevant medical opinion in support, and when resolving reasonable doubt in the Veteran's favor, the Board finds his pancreatic cancer was related to service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection for pancreatic cancer is warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Isaacs, Brandon 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.