Citation Nr: 21067220 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-50 031 DATE: November 3, 2021 REMANDED Entitlement to service connection for leukemia is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1999 to June 2003. This matter comes before Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. In the Veteran's substantive appeal (VA Form 9), the Veteran requested a hearing before the Board via a live videoconference at a local VA office. A hearing was scheduled for May 2020. The Veteran did not appear, but VA rescheduled the hearing for February 2021. The RO sent notice of the rescheduled hearing in December 2020. The Veteran did not appear, nor request that VA reschedule the second hearing. Therefore, the Veteran's request for a hearing is deemed withdrawn. 38 C.F.R. § 20.704(e). Entitlement to service connection for leukemia is remanded. The Veteran contends that he has acute myeloid leukemia due to his service. In doing so, the Veteran referenced exposure to diesel fumes, and burn pits while stationed in Egypt in 2001. The Veteran contends that, as a result of his military occupational specialty as a firefighter, he was exposed to chemicals associated with firefighting foam and benzene from JP8 fuel fires. VA's duty to assist includes affording the claimant an examination or obtaining a medical opinion when there is competent evidence that a claimant has a current disability, or persistent or recurrent symptoms of a disability; there are indications that the disability may be associated with active service; and the record is insufficient to decide the claim. See 38 U.S.C. § 5103A (d). Under relevant VA regulations, action should be undertaken by way of obtaining a medical opinion if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: 1) contains competent evidence of diagnosed disability or symptoms of disability; 2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, which may be established by competent lay evidence; and 3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. 38 C.F.R. § 3.159 (c)(4); see McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran's private medical records reflect a current diagnosis of leukemia. The Veteran's DD214 shows his military occupational specialty (MOS) as Fire Protection Specialist during his four-year term of active service. The Board finds that exposure to chemicals of some type is consistent with his duties as a firefighter, and is, therefore, sufficient evidence of in-service event or injury. The issue remains whether or not the Veteran's leukemia is causally related to or associated with his MOS as a firefighter. The third prong of Section 3.159(c)(4), which requires that the evidence of record "indicate" that the claimed disability or symptoms may be associated with service, is a low threshold. To date, the Veteran has not been afforded a VA examination to address whether his leukemia is related directly to his service. After a review of record, the Board concludes that a medical examination is necessary. Under these circumstances, evidentiary development is needed to evaluate fully and fairly the Veteran's claim for service connection for leukemia. Thus, on remand, the Veteran must be afforded a VA examination in order to obtain a nexus opinion addressing whether the Veteran's leukemia is at least as likely as not caused by or related to his service, including from chemical exposures experienced as a firefighter. By this remand, the Board makes no determination, expressed or implied, as to the credibility of any statements on file. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination of his leukemia by an examiner with appropriate expertise to determine the etiology of the disorder. The electronic claims file should be made accessible to and be reviewed by the examiner. The examiner should provide an opinion addressing whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's leukemia is etiologically related to his active military service including exposure to any chemicals related to his military occupational specialty as a firefighter. The examiner should include a well-reasoned medical opinion addressing the Veteran's leukemia and should discuss the medical probabilities that the disorder is related to the Veteran's time in service. (Continued on the next page) The examiner should consider all relevant environmental and epidemiological factors in forming an opinion, as well as the Veteran's medical files. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Clevenger, Gordanna A. 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.