Citation Nr: 21027531 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 13-21 867 DATE: May 6, 2021 REMANDED Entitlement to service connection for multiple myeloma, to include as secondary to herbicide or jet fuel exposure, is remanded. Entitlement to service connection for mycobacterium-avium complex as secondary to multiple myeloma, is remanded. Entitlement to service connection for hypothyroidism as secondary to multiple myeloma, is remanded. Entitlement to service connection for atrial fibrillation as secondary to multiple myeloma, is remanded. Entitlement to service connection for diverticulitis as secondary to multiple myeloma, is remanded. Entitlement to service connection for a lumbar spine disability, to include as secondary to treatment for multiple myeloma, is remanded. REASONS FOR REMAND The Veteran had active service from May 1970 to March 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2016, the Veteran testified before Veterans Law Judge (VLJ) Reinhart. In December 2020, the Veteran was informed that the judge no longer worked at the Board and that he had the right to request a new hearing to be conducted by a VLJ who would decide the claims. In January 2021, the Veteran indicated that he did not wish to attend another hearing. Therefore, the Board will proceed with adjudication of the claims. These matters have an extensive procedural history. In January 2017, the Board denied the Veteran's claims for entitlement to multiple myeloma; mycobacterium-avium complex; hypothyroidism; diverticulitis and atrial fibrillation and remanded the matter of entitlement to service connection for a lumbar disability. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court) and in an order following a May 2018 Joint Motion for Remand (JMR), the Court vacated the Board's January 2017 denial. In December 2018, the Board denied all of the Veteran's claims. The Veteran again appealed the matters to the Court and in an order following a June 2019 JMR, the Court vacated the Board's December 2018 denial. In March 2020, the Board denied the Veteran's claims for a third time. The Veteran again appealed the matters to the Court and in an order following a December 2020 JMR, the Court vacated the Board's March 2020 denial. All matters are remanded. The Veteran contends that he is entitled to service connection for multiple myeloma as secondary to service. He claims that the remaining disabilities are secondary to his multiple myeloma. See March 2021 Representative's brief. To date, the Board has denied the matters due to insufficient proof of actual herbicide exposure. In March 2021, the Veteran, through his representative, alternatively contended that his multiple myeloma (and other disabilities by extension) were secondary to his in-service exposure to jet fuel while he was an airplane mechanic. In support of this theory, the Veteran cites to the American Cancer Society studies which found that there was a link between benzene and blood related cancers like multiple myeloma. There is no medical opinion which addresses whether jet fuel can be etiologically linked to multiple myeloma. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). As such, the Board finds that a remand is necessary to obtain the requisite VA medical opinion. The Veteran also contended that his back disability is directly related to a 1971 motorcycle accident or secondarily related to his multiple myeloma. See March 2021 Representative's brief. The Veteran stated that the January 2018 medical opinion failed to consider his account that he was told at separation that he would have back problems later and his subsequent 1983 spinal surgery. He also stated that his treatment of his multiple myeloma caused or aggravated his back disability. Accordingly, the Board finds that a remand is necessary to obtain an addendum opinion from the January 2018 VA examiner which addresses all theories of entitlement. The matters are REMANDED for the following action: 1. Obtain a medical opinion (from an oncologist) regarding the etiology of the Veteran's multiple myeloma. The Veteran's electronic claims file, including a copy of this remand, must be made available to the oncologist for review in connection with the opinion. If the oncologist finds that an examination is warranted, then one should be scheduled. The oncologist is requested to offer an opinion as to the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's multiple myeloma was incurred in or is otherwise related to service, to include due to exposure to jet fuel while working as an airplane mechanic. The oncologist's attention is directed to evidence submitted by the Veteran that states the American Cancer Society found that there was a link between benzene and blood related cancers like multiple myeloma. (b) If so, whether it is at least as likely as not (50 percent probability or greater) that the Veteran's mycobacterium-avium complex was caused or aggravated by his multiple myeloma. (c) If so, whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hypothyroidism was caused or aggravated by his multiple myeloma. (d) If so, whether it is at least as likely as not (50 percent probability or greater) that the Veteran's diverticulitis was caused or aggravated by his multiple myeloma. (e) If so, whether it is at least as likely as not (50 percent probability or greater) that the Veteran's atrial fibrillation was caused or aggravated by his multiple myeloma. If aggravation is found, provide the baseline manifestations and any increased manifestations due to the multiple myeloma. A complete rationale, including citation to appropriate medical principles, is requested. 2. Obtain an addendum medical opinion from the January 2018 VA examiner (or a suitable substitute if that examiner is not available). The Veteran's electronic claims file, including a copy of this remand, must be made available to the examiner for review in connection with the opinion. If the examiner finds that another examination is warranted, another examination should be scheduled. The examiner is requested to offer an opinion as to the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's lumbar disability was incurred in or is otherwise related to service. (b) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's lumbar disability was caused or aggravated by treatment of his multiple myeloma. (c) If aggravation is found, provide the baseline manifestations and any increased manifestations due to the treatment for multiple myeloma. The examiner is requested to address the Veteran's lay statements: (1) that he was told at separation that he would experience back problems in the future due to his 1971 motorcycle accident and ended up having spine surgery in 1983 and (2) that his back had increased stiffness after taking Zometa for multiple myeloma. A complete rationale, including citation to appropriate medical principles, is requested. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Baskerville, LaRita 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.