Citation Nr: 21073433 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 18-55 142 DATE: December 8, 2021 ORDER Entitlement to service connection for non-Hodgkin's lymphoma is granted. FINDING OF FACT The probative evidence is at least in relative equipoise as to whether the Veteran's non-Hodgkin's lymphoma is related to his active-duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for non-Hodgkin's lymphoma 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 honorably on active duty from August 1989 to December 1989, from June 1990 to March 1993, from July 1999 to October 1999 and from March 2003 to February 2004. These periods of service included service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a hearing in November 2020. A transcript of this hearing has been associated with the claims file. As a preliminary matter, the Board notes that the Veteran has raised the issue of entitlement to compensation pursuant to 38 U.S.C. § 1151 based on failure to diagnose or properly treat the Veteran for his lymphoma during the November 2020 Board hearing. While the Veteran has raised this issue, the claim may be granted on a direct service connection basis and as such, the Board declines to refer the issue to the RO as no additional benefits would be available to the Veteran following the adjudication of the service connection claim itself. 1. Entitlement to service connection for non-Hodgkin's lymphoma is granted. The Veteran contends that his non-Hodgkin's lymphoma was caused by exposure to Gulf War environmental hazards during his active-duty service in Southwest Asia. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For benefits to be denied, "the preponderance of the evidence must be against the claim." Id. at 54. The Board finds that in the present case, the evidence is at least in equipoise that the Veteran's non-Hodgkin's lymphoma disability was caused by exposure to burn pits, oil fumes, jet fuel, and other environmental hazards during his Gulf War service and that service connection is therefore warranted. The evidence of record reflects that the Veteran was diagnosed with B-cell lymphoma in 2018. The Veteran underwent a VA examination in February 2018. The VA examiner confirmed that the Veteran was diagnosed with lymphoma and shortly thereafter began chemotherapy. The Veteran reported he has never smoked and has no lung disease history in his family. The Veteran endorsed environmental exposures including burn pits, dust storms, sandstorms, burning oil, and exhaust during his service in the Gulf War. The VA examiner opined that "[b]ased on the history, physical exam, and review of the medical records, the Veteran meets the diagnostic criteria for B-cell lymphoma. B-cell lymphoma is a disease with a clear and specific etiology and diagnosis. Literature search was performed in PubMed using key words 'Gulf War' and 'B-cell lymphoma.' There is no literature to support that Gulf War exposures cause B-cell lymphoma. Based on this fact, it is less likely than not that B-cell lymphoma is related to a specific exposure event experienced by the Veteran during service in Southwest Asia." The Veteran submitted a letter from his private treatment provider, Dr. A. A., in support of a relationship between his current disability and his active-duty service. Dr. A. A. stated that "[the Veteran] has recently been diagnosed with non-Hodgkin's lymphoma and is currently undergoing chemotherapy. He first presented to the hematology clinic in November 2017 with three-month history of unintentional weight loss, night sweats, pruritis, and intermittent fever. He was evaluated for chest pain and other respiratory symptoms, where he was found to have a mediastinal mass. The patient was instructed to follow up with a PCP. He was evaluated by pulmonology and bronchoscopy confirmed non-Hodgkin's lymphoma. Currently, he is scheduled for six cycles of chemotherapy. [The Veteran] was deployed to Saudi Arabia in October 1990 through April 1991 while serving in the Army. He traveled to multiple cities in Saudi Arabia. His unit, the HHB 11th Brigade, crossed over into Iraq after the war started. His unit stayed close to the Euphrates River until March 1991. [The Veteran] was burning human waste in burn pits, and was also exposed to solvents and fuel fumes, ingestion of pyridostigmine bromide tablets for nerve agent exposures, [and] smoke from burning oil wells. Many of his exposures during active duty in Iraq and Saudi Arabia have been linked to non-Hodgkin's lymphoma and other malignancies. This patient's prolonged exposure to these chemicals while in Saudi Arabia and Iraq make it more likely than not that he developed non-Hodgkin's lymphoma due to the conditions of his service tour." At the outset, the Board finds that the above examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on in-person examinations and the examiners' observations, the Board finds they are entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30205 (2008). At the November 2020 Board hearing, the Veteran testified that he was consistently exposed to oil fires and burn pits. The Veteran stated that the oil fires were approximately one mile away from where he was stationed at the time in Saudi Arabia. Further, the Veteran testified that during the oil fires, the base camp had soot on their clothing, bedding, tents, and work area; that there was "no way to escape" the smoke. The Veteran also reported that while stationed in Iraq, he was assigned to a Hawk missile unit, where his primary duty was to ensure that the missile communications were working properly. In order to do so, the Veteran would spend time outside digging trenches for the communication lines, further exposing him to jet fuel, burn pits, and other environmental hazards. The Board notes that the Veteran is competent to report the nature of his job during service and accords his statements significant probative weight. Moreover, the undersigned has had the opportunity to observe the Veteran and finds him to be credible. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). The Board therefore finds that the evidence is at least in equipoise regarding the etiology of the Veteran's lymphoma. The Veteran has submitted competent and credible lay evidence regarding his duties in service involving exposure to certain environmental hazards in Southwest Asia area of operations. Although the February 2018 VA examiner opined that it was less likely than not that the Veteran's cancers were caused by his Gulf War environmental exposures, the Veteran's private provider, Dr. A. A., specifically found that his non-Hodgkin's lymphoma was likely due to exposure to burning human waste in burn pits, solvents and fuel fumes, ingestion of pyridostigmine bromide tablets for nerve agent exposures, [and] smoke from burning oil wells, citing studies showing a link between many of his exposures during active duty in Iraq and Saudi Arabia and non-Hodgkin's lymphoma and other malignancies Therefore, resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's non-Hodgkin's lymphoma was at least as likely as not caused by exposure to Gulf War environmental exposures, such as oil fires, burn pits, and fuel fumes, in service and service connection is warranted. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, 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.