Citation Nr: 21030772 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-60 826 DATE: May 19, 2021 REMANDED Entitlement to service connection for acute myelogenous leukemia is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 2010 to November 2011, and February 2012 to February 2013. This matter comes before the Board of Veterans' Appeals ("Board") on appeal from a January 2017 rating decision of the Department of Veterans Affairs ("VA") Regional Office ("RO"). The Veteran testified before the undersigned Veterans Law Judge at a March 2021 Board's hearing. A transcript of the hearing is associated with the record. Entitlement to service connection for acute myelogenous leukemia is remanded. In October 2016, the Veteran filed a claim for entitlement to service connection for acute myelogenous leukemia and asserted that his claimed condition was due to the exposure to chemicals released from burn pits during his active service in Afghanistan from April 2012 to January 2013. In the November 2017 VA Form 9, Appeal to the Board, the Veteran stated that he believed his leukemia was due to the exposure to chemicals, biological, and radiological warfare agents. At the March 2021 Board's hearing, the Veteran testified that he served at Camp Leatherneck, Afghanistan, where he worked as a bridge repair crewmember. His "bridge park" was 50 feet from a burn pit, where all kinds of plastic and garbage were burned, to which he was exposed eight hours a day. He was also exposed to diesel fumes. The Veteran asserted that two other crewmembers came down with blood related diseases. He further stated that he might not have active leukemia after chemotherapy, however, the Veteran had after-effects that included joint pain and his skin would easily start bleeding. Initially the Board notes that a January 2013 Department of the Army Memorandum for Record, regarding exposure concerns, identified the Veteran as one of the soldiers who were deployed to Camp Leatherneck, Afghanistan from April 2012 to January 2013. The memorandum indicated that Camp Leatherneck had two incineration plants that produced fumes and scattered particles of debris into the air. The high level of dust and sand particles often left Soldiers feeling short of breath after exercising outside. The Veteran was diagnosed with acute myelogenous leukemia in January 2016 and has received chemotherapy. In an August 2016 letter, the Veteran's oncologist, Dr. Carroll, opined that the Veteran was diagnosed with acute promyelocytic leukemia that may or may not have been caused by his military time while serving in Afghanistan. The Veteran underwent a VA examination in November 2016, the examiner noted the diagnosis of leukemia, and opined that the Veteran's claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As a rationale, the examiner cited to medical literature on pathogenesis of acute myeloid leukemia and stated that exposure to high levels of benzene had been associated with a higher risk of developing acute myeloid leukemia. Relatively low-level exposure to benzene by petroleum distribution workers had been associated with an increased risk of developing myelodysplastic syndrome, but not acute myeloid leukemia. 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. The examiner concluded that he could not find any research study in the medical literature showing the relationship between the Veteran's diagnosis of acute myeloid leukemia and his exposure to the environmental hazards during deployment to Afghanistan, especially with no known chemical exposures. The Board finds the November 2016 VA medical opinion inadequate for deciding the issue on appeal because the examiner rendered an opinion only based on medical literature without discussing types of chemicals released by burn pits and their relationship with leukemia. Furthermore, the examiner did not consider the Veteran's lay statements and contentions regarding exposure to chemicals from burn pits. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Accordingly, the Board concludes that a supplemental medical opinion should be obtained on the nature and etiology of the Veteran's diagnosed acute myelogenous leukemia. The matter is REMANDED for the following action: 1. Afford the Veteran a VA examination and obtain a supplemental medical opinion from a suitably-qualified medical professional, preferably one specializing in oncology or toxic environmental exposures, on the nature and etiology of the Veteran's diagnosed acute myelogenous leukemia. The examiner should be provided with access to the claims file, including a copy of this remand as well as copies of the "Fact Sheet: Burn Pits throughout Iraq, Afghanistan, and Djibouti"; and "Fact Sheet: Particulate Matter in Iraq, Afghanistan, and Djibouti." 2. The examiner is asked to opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed acute myelogenous leukemia had its onset during his period of active service or manifested to a compensable degree within a year of active service; or related to an in-service injury, event, or disease, including the in-service exposure to diesel fumes and chemicals released from burn pits. In providing the above opinion, the examiner is advised that the exposure to burn pits is conceded. The examiner is also advised to address the Veteran's contentions and other evidence of record regarding the exposure to burn pits and diesel fumes noted in the documents associated with the claims file with entries dated: (i) 07/15/2015, titled "STR Reserve STR," page number 53 of 57, which includes a January 2013 memorandum for record from Department of the Army regarding exposure concerns to the soldiers, including the Veteran, who were deployed to Camp Leatherneck, Afghanistan and were exposed to numerous potential health hazards from fumes and scattered particles of debris into the air produced by two burn pits; (ii) 10/20/2016, titled "Medical Treatment Record Government Facility," page number 5 of 9, which includes an August 2016 letter from the Veteran's oncologist, Dr. Carroll, opining that the Veteran's promyelocytic leukemia may or may not have been caused by his military time while serving in Afghanistan; (iii) 11/16/2017, titled "Correspondence," which includes an article regarding the soldiers exposure to environmental hazards in Afghanistan; (iv) 03/31/2021, titled "Hearing Transcript," which includes the Veteran's testimony regarding symptoms of leukemia and the in-service exposure to diesel fumes and chemicals released from burn pits. The examiner should indicate that the claims files has been reviewed before rendering the opinion. A complete rationale for the opinions rendered must be provided. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tariq, Nadeem, 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.