Citation Nr: 21040613 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 15-43 141 DATE: July 6, 2021 ORDER Service connection for non-Hodgkin's lymphoma is granted. FINDING OF FACT The Veteran's non-Hodgkin's lymphoma is related to his active duty service in the U.S. Marine Corps. CONCLUSION OF LAW The criteria for service connection for non-Hodgkin's lymphoma have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1975 to October 1995 in the United States Marine Corps. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office. In February 2021, the Veteran testified before the undersigned during a virtual hearing. A transcript of the hearing is included in the electronic claims file. Service connection for non-Hodgkin's lymphoma is granted. VA provides compensation for disability resulting from disease or injury incurred in or aggravated by service. This is referred to as a "service connection." 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to show a service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Veteran has current non-Hodgkin's lymphoma, documented on VA examination in October 2015. On his April 1975 service entrance examination, no pertinent abnormalities were noted. While he served in the military for twenty years, the claims file contains only seven pages of service treatment records, and a July 2013 Formal Finding indicates that the remaining service treatment records are missing. In the absence of all of the records concerning his service, the Board has a heightened duty to explain its findings and conclusions and to carefully consider the benefit-of-the-doubt rule. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). At the February 2021 hearing, the Veteran testified that his primary military occupational specialty was in air crew rescue and firefighting. He had two secondary specialties, involving water survival instruction and drill instruction. He testified, and explained in written correspondence, that in the performance of his duties in air crew rescue and firefighting, he was exposed to numerous chemicals. He testified that when an aircraft crashes, the fibrous composite material from the aircraft becomes airborne. In the course of putting out fires in both training exercises and in real-world situations, he regularly inhaled these fibers, in addition to jet exhaust and fumes from firefighting foam. During his many years as a Marine, he did not wear a breathing apparatus for protection the majority of the time. He testified that was also regularly exposed to fumes from fire pits where multiple contaminated fuels and hydraulic fluids were dumped and burned together. He testified that as an aircrew instructor, he was exposed to fires and burning chemicals on a daily basis over the course of many years. The Veteran's service separation document (DD Form 214) indicates that his military occupational specialty for over nineteen years was Advance Crash Crew Specialist. His service personnel records indicate that he worked on numerous occasions with both military and civilian fire departments. He was noted to have a broad experience base, and to possess a wide range of professional specialties in firefighting. The records show that he served as an instructor at Aircraft Firefighting and Rescue School, and that he was responsible for the entry-level training of Marines in aircraft firefighting and rescue. The October 2015 VA examiner documented that the Veteran's reported chemical exposures involved metals, oxidizers, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, persistent organic pollutants, pesticides, volatile organic compounds, base neutral acids, dioxins, dibenzofurans, halogenated semi-volatile organic compounds, industrial cleaners, and solvents. A July 2014 report of the Veteran's treating oncologist, described below, indicated that the Veteran's exposure likely involved several carcinogens, particularly petrochemicals, organic solvents, and their burn products. The Board finds the Veteran's hearing testimony and written statements regarding his military duties and his routine exposure to chemical fumes to be both admissible and believable. The record clearly establishes that he served as an aircraft firefighter for approximately twenty years on a daily basis, and the Board finds that his reports of using firefighting foam and being exposed to jet exhaust and burning chemicals are consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). His reports have been both internally consistent, and consistent with the record as a whole. Caluza v. Brown, 7 Vet. App. 498 (1995). Two medical professionals reviewed the Veteran's statements in combination with pertinent information in the claims file, and classified the substances to which the Veteran was likely exposed. See Coburn v. Nicholson, 19 Vet. App. 427, 432 (2005); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (holding a medical opinion formed on the basis of the Veteran's reported medical history cannot be rejected without the Board first finding that the Veteran's allegations are not credible.) The Board thus accepts that he was exposed to burning chemical fumes and gases in the course of his military service. On the matter of the etiology of the disability, the record contains the July 2014 private medical opinion, and the October 2015 VA examination report. In July 2014, the Veteran's treating oncologist, Dr. P., opined that it is most likely that the Veteran's exposure to petrochemicals, organic solvents, and their burn products directly caused his lymphoma. As rationale, he noted that there is molecular evidence showing that the Veteran's disease most likely arose out of an indolent follicular lymphoma, which may have been slow-growing for years without symptoms. He explained that there is a long period of latency between carcinogenic exposure and the development of overt malignancy. He discussed the fact that historical evidence suggests a generally increased incidence of follicular lymphoma in veterans of World War II, the Korean Conflict, and the Vietnam War in comparison to age-matched controls. On VA examination in October 2015, the examiner discussed the Veteran's multiple chemical exposures in service, but opined that the current non-Hodgkin's lymphoma was not caused by or a result of military service. He noted that the claims file was silent for the evaluation or treatment of chemical exposure during active service or within one year of discharge. He stated that he was not aware of any general medical consensus or literature that would provide scientific evidence to support that the Veteran's type of lymphoma was caused by chemical exposures. In considering the evidence under the laws and regulations as set forth above, and resolving all reasonable doubt in his favor, the Board concludes that the Veteran is entitled to service connection for his non-Hodgkin's lymphoma as directly related to service. At a minimum, the evidence is in equipoise. The opinion of Dr. P. was founded on a history of treating the Veteran and medical knowledge regarding the latency and progression of his particular disease. He relied on historical data in reaching his opinion, and provided a rationale for the conclusions reached. The Board thus finds the report is fully adequate for adjudication. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The opinion of the October 2015 VA examiner provides a contrasting and also well-reasoned viewpoint. The report is less persuasive, however, to the extent that the examiner relied on a lack of pertinent documentation in the service treatment records, given that the great majority of the Veteran's service treatment records are missing and unavailable to review. As the evidence is at least in equipoise in showing that the Veteran has non-Hodgkin's lymphoma attributable to service, and resolving all doubt in his favor, the Board finds that service connection is warranted. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.