Citation Nr: 21028987 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 19-00 590A DATE: May 12, 2021 ORDER Entitlement to service connection for solitary bone plasmacytoma is granted. FINDING OF FACT The Veteran's solitary bone plasmacytoma is as likely as not causally related to his exposure to contaminants, including pesticides and other chemicals, during service on Adak Island, Alaska. CONCLUSION OF LAW The criteria for service connection for solitary bone plasmacytoma have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. § 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1992 to April 1997. For part of 1994 he served on Adak Island, Alaska. In May 2017 the Veteran submitted a claim for service connection for solitary bone plasmacytoma. In an August 2017 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied service connection for solitary bone plasmacytoma. The Veteran appealed that denial to the Board of Veterans' Appeals (Board). 1. Service connection for solitary bone plasmacytoma The Veteran contends that while he served on Adak Island he was exposed to multiple contaminants, including but not limited to pesticides, petroleum, solvents, and asbestos. He contends that those exposures caused his solitary bone plasmacytoma, which was diagnosed in 2016. Service connection may be established on a direct basis for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The United States Court of Appeals for Veterans Claims (Court) has indicated that the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Multiple records from the Veteran's service show that he served on Adak Island for a period in 1994. While there his duties were in demolition, construction, and renovation in indoor and outdoor settings. The Veteran submitted a 2017 internet article from the Alaska Department of Environmental Conservation, Division of Spill Prevention and Response. The article discusses environmental cleanup on the island after military use of half of the island beginning in the early 1940s. The article reports the identification of 181 sites of contamination from petroleum, metals, and chemicals including pesticides and volatile organic compounds. The article indicates that the majority of the contamination sites were fuel tanks and lines, drum disposal areas, spill sites, pits for waste oil disposal and firefighting training, and landfills. The article states that in 1994 the Naval Air Facility was added to a national priority list of contaminated sites. In a May 2017 statement, the Veteran wrote that for seven months in 1994 he participated in the cleanup and demolition of the Naval Base on Adak. He stated that the environment, including the drinking water, in Adak was very contaminated from many substances, including asbestos, pesticides, and jet fuel. He reported that in November 2016 he was diagnosed with solitary bone plasmacytoma, a rare disorder related to and often preceding multiple myeloma. He contended that his exposure to hazardous chemicals on Adak caused the disorder in his case. In October 2017, T. K., M.D., a hematologist and oncologist with the Mayo Clinic in Rochester, Minnesota, reported on the Veteran. Dr. K. reported that the Veteran was diagnosed with solitary plasmacytoma (SP) when he was 41 years old. He stated that the Veteran underwent radiotherapy and surgery at the Mayo Clinic in December 2016. He said that the Veteran was under his care for his long term follow-up. Dr. K. wrote that he specializes only in plasma cell disorders. He explained that SP is a very uncommon plasma cell malignancy. He stated that SP predominantly affects elderly patients and more commonly affects African American patients. He reported that patients younger than 45 years old were a very small minority of cases. Dr. K. noted that Veteran's exposure at the Adak Naval Air facility to contaminants including pesticides, benzene, and trichloroethane (TCE). Dr. K. stated that it is not clear what environmental factors cause SP, but he cited large medical studies and evidence linking exposure to pesticides, benzene, and TCE to the development of plasma cell malignancies, hematologic malignancies, and myeloma. Dr. K. stated that SP was extremely rare and unlikely in a person of the Veteran's age and race (Caucasian). Considering that rarity in combination with the Veteran's exposure to contaminants linked to SP and similar disorders, Dr. K. opined that the Veteran's SP is more likely than not related to his environmental exposures in service. The Veteran's Mayo Clinic treatment records show surgery in February 2017 to address plasmacytoma in his T8 vertebra. In follow-up in 2018 and 2019 he had intractable thoracic spine pain. In July 2018 it was noted that testing showed persistent elevation of monoclonal proteins. (Continued on the next page) In October 2020 Dr. K. wrote that the Veteran's SP had progressed into symptomatic multiple myeloma that requires combination chemotherapy and a stem cell transplant. The Veteran's service records include repeated and clear evidence of his service at Adak. The information from the Alaska state environmental agency is convincing evidence of contaminants in the general environment around the military facilities in Adak in the 1990s. The Veteran's duties there, in demolition and construction, present a reasonable likelihood of heightened exposure to contaminants. Dr. K.'s area of specialization, his citation of scientific studies, and his explanation of the Veteran's otherwise low risk, all add persuasive weight to his opinion supporting the likelihood of a nexus between the Veteran's exposures and his SP. The evidence of a nexus in the Veteran's case is sufficiently persuasive to grant service connection for his solitary bone plasmacytosis. K. PARAKKAL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. J. Kunz, 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.