Citation Nr: A21019394 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 200416-82472 DATE: December 6, 2021 ORDER Entitlement to service connection for indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia, to include as due to in-service chemical exposures, is granted. FINDING OF FACT Probative evidence of record showed that indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia was causally related to in-service chemical exposures. CONCLUSION OF LAW The criteria for entitlement to service connection for indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia, to include as due to in-service chemical exposures, have been met. 38 U.S.C. §§ 1110, 1116, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from December 1965 to April 1966 and from March 2003 to February 2005. The Veteran was also a member of the Air National Guard of New York from 1975 to 2005, including additional periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2020 rating decision that found new and relevant evidence had been received to readjudicate this service connection claim. This is a favorable finding by the agency of original jurisdiction (AOJ) and the Board will proceed to address the claim on the merits. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). In the April 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. In August 2021, the Veteran testified at a Board virtual hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran or his attorney at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Entitlement to service connection for indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia, to include as due to in-service chemical exposures, is granted. In written statements of record and during his August 2021 Board hearing, the Veteran asserted that his claimed disorder was related to anthrax shots, chemical exposures, and herbicide exposure during active service. He further indicated that he had worked with numerous chemicals on a daily basis, such as hydraulic fluid, ethylene glycol, aviation fuel, and zinc chromate, while repairing multiple types of aircraft during active service. He indicated that he worked on the C-97 aircraft after they returned from Vietnam. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2021). Service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d) (2021). Service connection may be established under the provisions of 38 C.F.R. § 3.303(b) when the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during the applicable presumptive period. For certain chronic disorders, such as malignant tumors, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2021). In addition, service connection on the basis of continuity of symptomatology can only be established for the chronic diseases as specified at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A veteran who served in Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, is presumed to have been exposed to herbicides during that service. 38 C.F.R. § 3.307(a)(6). This presumption also extends to individuals who performed service in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era. Id. Under 38 C.F.R. § 3.309(e), non-Hodgkin's lymphoma is presumptively associated with exposure to herbicide agents. The Veteran's service personnel records showed that his continued duty assignments in aircraft maintenance squadrons during periods of active service included military occupational specialties like Aircraft Accessories Helper, Mechanic Accessories & Equipment Repair Technician, and Systems Manager. Post-service VA and private treatment records dated from 2007 revealed findings of indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia. While an October 2019 Disability Benefits Questionnaire from a private physician listed the Veteran's cancer as in remission, additional private treatment records dated in 2020 and 2021 as well as the August 2021 hearing testimony detailed that the Veteran was not in remission. He was shown to be undergoing additional testing, monitoring, and treatment for lymphoma with palpable umbilical mass, elevated Immunoglobulin M (IgM) level, mild anemia, and thrombocytopenia. Evidence of record fails to establish the Veteran's exposure to herbicide agents during his military service. The Veteran did not serve in the Republic of Vietnam and did not regularly and repeatedly operate, maintain, or serve onboard C-123 aircraft. Thus, he is not presumed to have been exposed to herbicide agents under 38 U.S.C. § 1116 and 38 C.F.R. §§ 3.307, 3.309(e). However, probative medical evidence has been submitted by the Veteran that linked his claimed disorder to his periods of active military service, including asserted in-service chemical exposures. In the June 2021 medical opinion, M. B. S., M. D., a private physician with a specialty in internal medicine, noted that the Veteran had been definitively diagnosed in 2007 with indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia. Citing medical treatise information, the physician noted it was a rare disease and that lymphomas were well established to be related to environmental toxins. Specifically, organic solvents were known to cause a variety of hematologic malignancies. The physician further detailed that the Veteran's recent tests unfortunately showed the need for further treatment. The physician indicated that the Veteran's primary mission while in service was to refurbish aircraft to return for fully operational status. He highlighted that the Veteran had direct exposure to multiple chemicals, including organic solvents on a daily basis, and was offered very little, if any, protective personal equipment (particularly during the mid-1960's into the early 1970's). Based on his training, experience, the Veteran's medical history, and his review of the entire claims file as well as pertinent medical literature, the physician opined that the Veteran's lymphoma was the direct result of organic solvent exposure sustained during service. He indicated that his report met the standard of being at least as likely as not in favor of the Veteran. In fact, he asserted that his opinions on this matter were actually much higher than that standard, as they were within a high degree of certainty. In view of the totality of the evidence, including the Veteran's credibly asserted in-service chemical exposures while on active duty; the findings of indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia during the appeal period; the probative medical opinion in the June 2021 private physician statement; and the competent and credible lay assertions of record, the Board finds that the Veteran's claimed disorder cannot be reasonably disassociated from events during his active military service, specifically credibly asserted chemical exposures while working on aircraft. The Board finds that the evidence is at least in equipoise and, therefore, applying the benefit-of-the-doubt doctrine, service connection for indolent non-Hodgkin's lymphoma with Waldenstrom macroglobulinemia is warranted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. D. Deane, 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.