Citation Nr: 21025477 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 19-32 299 DATE: April 28, 2021 ORDER Entitlement to service connection for acute myeloid leukemia, to include as due to exposure to chemicals such as benzene, is granted. FINDING OF FACT The most probative evidence is at least in equipoise as to whether the Veteran’s acute myeloid leukemia is etiologically related to military service, to include as due to exposure to chemicals such as benzene. CONCLUSION OF LAW The criteria for entitlement to service connection for acute myeloid leukemia have been met. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Air Force from June 1985 to August 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of an August 2017 rating decision issued by the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge during a virtual hearing held on April 23, 2021. Entitlement to service connection for acute myeloid leukemia, to include as to due to exposure to chemicals such as benzene Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing direct service connection generally requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1039, 1043 (Fed. Cir. 2004). The Veteran is seeking service connection for acute myeloid leukemia. He contends that as a jet engine craftsman, he was exposed to benzene and this exposure caused his acute myeloid leukemia. See Statement in Support of Claim, received September 2019. The record reflects that the Veteran has a current diagnosis of acute myeloid leukemia. See C&P Exam, July 2019. Thus, the current disability element of the claim has been satisfied. The Board also finds that the evidence of record establishes the occurrence of an in-service event or injury. The Veteran contends that while he was in service, he was regularly exposed to the chemical benzene. See Statement in Support of Claim, received September 2019. He asserts that he was exposed to benzene, as it is a chemical found in jet and aircraft fuel, due to his duties as a jet engine craftsman involving daily launches and recoveries of F-15 aircrafts. He stated that the F-15 aircrafts with Pratt & Whitney F100-PW-100 engines had unified fuel control anomalies which resulted in many fuel control replacements. He explained that the fuel control replacements resulted in JP-8 exposure to the technicians skin 100 percent of the time, as the technician had to sit below the fuel control to remove fittings and fuel would run down their arms often soaking their shirts or coverall sleeves. He further explained that technicians were also exposed to benzene when they carried the fuel controls after they were removed from the F-15 aircrafts. He stated that this often resulted in his uniform bottoms or coveralls being soaked with fuel. He explained that the technicians did not change out of their coveralls and/or uniform during a shift, which meant that they were exposed to any fuel that got their coveralls/uniform during their shifts throughout the remainder of their shift. The Board notes that the Veteran’s military personnel records confirm that the Veteran’s primary specialty during his 22 years and 2 months of service was aerospace propulsion craftsman, jet engines. Thus, the Board finds that the Veteran’s credible lay statements are consistent with the circumstances of his service and suggest that he was exposed to at least some level of benzene during service. The Veteran submitted a letter from his physician dated July 2018. See Medical Treatment Record – Non-Government Facility, received July 2019. In this letter, the private physician noted that the Veteran was exposed to benzene from direct skin contact and breathing exhaust fumes while in service. She explained that benzene is a known carcinogen that has been linked with various forms of bone marrow cancers, particularly myelodysplastic syndrome and acute myeloid leukemia. She stated that benzene exposure linked bone marrow cancers have latency periods. She noted that the Veteran was diagnosed with acute myeloid leukemia in May 2017 at the age of 50. She explained that because it is rare for a 50-year-old to develop acute myeloid leukemia with cytogenic abnormalities, his exposure to benzene during service would seem a probable etiological culprit. To support this opinion, the Veteran submitted an August 2007 Toxicological Profile for Benzene published by the U.S. Department of Health and Human Services, as well as a pdf from the Agency for Toxic Substances and Disease Registry (ATSDR) that discussed benzene. See Web/HTML Documents, received July 2019. The Veteran was afforded a VA examination in July 2019 to determine the nature and etiology of his acute myeloid leukemia. The examiner opined that the Veteran’s acute myeloid leukemia was less likely than not incurred in or caused by active duty service, to include chemical exposure to jet fuel and exhaust fumes during service. As rationale, she explained that there was no evidence per medical literature that exposure to jet fuel and exhaust fumes causes acute myeloid leukemia. She stated that the Veterans Benefits Administration (VBA) does not regard exposure to jet fuel or fumes as a presumptive cause of acute myeloid leukemia. She noted that the Veteran’s service treatment records were silent for a leukemia diagnosis during service. She then cited an Up to Date: pathogenesis of acute myeloid leukemia which found that exposure to high levels of benzene has been associated with a higher risk of developing acute myeloid leukemia. Although the Up to Date article reported that a low-level of exposure to benzene by petroleum distribution workers did not result in an increased risk of developing acute myeloid leukemia, it went on to state that the “risk of developing a myeloid malignancy after benzene exposure appears to be dose-related and it is unknown whether there is any safe threshold for benzene exposure.” While the July 2019 VA examiner concluded that the Veteran’s acute myeloid leukemia was not causally related to active duty service, to include exposure to chemicals such as benzene, her mention of VBA not regarding exposure to jet fuel or fumes as a presumptive cause of acute myeloid leukemia in her rationale calls into question whether she based her opinion on a presumptive standard rather than the unique facts and circumstances of this case. Hence, the Board does not afford the opinion significant probative value. Additionally, the Up to Date article cited by the examiner appears to reflect that exposure to benzene increases the risk of developing a myeloid malignancy, include acute myeloid leukemia, which contradicts the opinion provided by the examiner. The law is clear. Pursuant to the “benefit-of-the-doubt” rule, where there is “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Although there is some evidence against the claim, the Board finds that the private physician’s opinion places the evidence at least in relative equipoise as to whether the Veteran’s acute myeloid leukemia is related to military service, to include exposure to chemicals such as benzene. The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran’s favor, a grant of service connection for acute myeloid leukemia is warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (“[T]he ‘benefit of the doubt’ standard is similar to the rule deeply embedded in sandlot baseball folklore that ‘the tie goes to the runner’.... [I]f... the play is close, i.e., ‘there is an approximate balance of positive and negative evidence,’ the veteran prevails by operation of [statute].”). ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fairlie, 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.