Citation Nr: 21042807 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-63 542 DATE: July 13, 2021 ORDER Entitlement to service connection for multiple myeloma is denied. FINDING OF FACT The preponderance of the evidence weighs against a finding that multiple myeloma began in active service or is otherwise etiologically related to service, to include in-service chemical exposure. CONCLUSION OF LAW The criteria for service connection for multiple myeloma have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1967 to August 1970, including in the Republic of Vietnam. He died in 2019. The appellant is a substitute claimant. 38 U.S.C. § 5121A; 38 C.F.R. § 3.1010. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The appellant requested a video conference hearing before the Board in a February 2018 VA Form 9. In April 2021, the appellant's representative reported that they were unable to contact the appellant prior to a rescheduled hearing and requested that the request for a hearing be withdrawn. See 38 C.F.R. § 20.704(e) (a request for a hearing may not be withdrawn by the appellant's representative without the consent of the appellant). The Board will proceed as though the request for a hearing has been withdrawn as the appellant did not appear for the rescheduled hearing and no request for postponement was received. 38 C.F.R. § 20.704(d). Service connection for multiple myeloma due to chemical exposure In March 2012, the Veteran initiated a claim for entitlement to service connection for multiple myeloma. He contended that his multiple myeloma was due to benzene exposure from oil and fuel handling while assigned to a bulk fuel company at Camp Pendleton. The appellant further elaborated that the Veteran wiped down equipment with diesel fuel without hand or eye protection and was exposed to fumes during his four years at Camp Pendleton; she reported observing symptomatology, to include a cold head and numb feet, since the 1970s. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board notes that although multiple myeloma may be considered for presumptive service connection due to exposure to radiation, herbicides, or contaminated water at Camp Lejeune, such is not for application in this case as neither the Veteran nor the appellant has contended, nor does the evidence of record demonstrate, that the veteran may be eligible for any of these presumptive categories. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309. VA has established certain rules and presumptions for chronic diseases, such as tumors, malignant, or of the brain or spinal cord or peripheral nerves. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); see also 59 Fed. Reg. 5162 (February 3, 1994) (noting multiple myeloma is a malignant proliferation of plasma cells which are derived from B lymphocytes and is closely related biologically to B-cell non-Hodgkin's lymphoma). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The Board concludes that the preponderance of the evidence weighs against a finding that multiple myeloma was incurred during the Veteran's active service or is otherwise related to service. Initially, the Board notes that the evidence does not support a finding that multiple myeloma was shown in service, manifested to a compensable degree within one year of the Veteran's August 1970 separation from service, or has a continuity of symptomatology after discharge. 38 C.F.R. §§ 3.307(a)(3), 3.309(b). Service treatment records (STRs) are negative for treatment for, or diagnosis of, multiple myeloma and post-service medical records indicate an initial diagnosis of multiple myeloma in December 2011. Further, the preponderance of the evidence weighs against a finding of a continuity of symptoms after discharge to warrant service connection based on a chronic disease. Although the appellant may sincerely believe that the Veteran's multiple myeloma is related to benzene exposure in active service and that he had symptoms such as a cold head and bilateral foot numbness since the 1970s, there is no indication that she has the training or experience required to render a competent opinion diagnosing the disorder or linking the reported symptoms of a cold head and extremity numbness to the disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Additionally, the Board finds the December 2018 VA medical opinion to be highly probative evidence against a finding that the symptomatology the Veteran may have exhibited in the 1970s was due to multiple myeloma. Specifically, the January 2018 medical opinion explained that multiple myeloma was a very debilitating condition with an average life expectancy of four years when concluding that the Veteran did not have undiagnosed multiple myeloma in the 1970s. Further, the examiner noted the appellant's reports of 1970 symptomatology but report that the most frequent symptoms were bone pain, anemia, thrombocytopenia, neutropenia, hypercalcemia, renal failure, and recurrent bacterial infection. The medical opinion also supported the negative nexus opinion by noting that the Veteran's lab studies from the mid-1990s to early 2000s did not suggest multiple myeloma. As such, the probative evidence weighs against a finding that the Veteran's multiple myeloma is a chronic disease pursuant to 38 C.F.R. § 3.303(b). Further, the preponderance of the evidence weighs against a finding that multiple myeloma is otherwise etiologically related to service, to include in-service chemical exposure. The most probative evidence of record supports a finding that the Veteran's multiple myeloma was not due to his active service. Specifically, private medical records document treatment for a right lung mass in April 2010 that was negative for malignancy and a December 2011 pathology reports reflect the first diagnosis of multiple myeloma with subsequent in-patient treatment including chemotherapy and stem-cell transplant. VA treatment records do not reflect any treatment for multiple myeloma. Articles submitted by the Veteran and the appellant in support of this claim generally conclude there is limited or no evidence of a causal link between benzene and multiple myeloma. A 1999 medical journal's review article appraising the scientific evidence of a causal link between benzene and multiple myeloma reviewed different case studies and laboratory findings to conclude no causal relationship existed between benzene exposure or other petroleum products and the risk of developing multiple myeloma. A January 2016 American Cancer Society article noted that benzene was a known human carcinogen but based this finding on evidence that benzene causes acute myeloid leukemia. A 2010 World Health Organization report found benzene exposure to be a major public health concern and noted that there was limited evidence that benzene may cause multiple myeloma. Moreover, the Board finds the May 2013 VA examination report and January 2018 VA medical opinion to be highly probative evidence against the claim. Here, the May 2013 examination notes multiple myeloma was first diagnosed in December 2011 with symptoms of weakness, dyspnea, low back pain, and extremity numbness; the veteran reported onset of numbness of the feet in 2005 and a work history included ten years janitorial services using commercial cleaners. The May 2013 examiner reviewed the submitted medical literature, noting that benzene exposure was an anecdotal cause of multiple myeloma and that the Veteran's history included exposure between 1962 and 1985, but also noted that the 2011 diagnosis at the age of 72 was at a prime age for developing age-related multiple myeloma. The examiner concluded that the length of time between exposure and diagnosis made it less likely than not causally related to benzene exposure in service. In addition, the January 2018 medical opinion reviewed the medical literature and noted that the majority showed no scientific evidence of a causal relationship between benzene exposure and an increased risk of developing multiple myeloma. Rather, the medical opinion explained that any inhalation or ingestion of benzene resulted in acute and persistent lung damage, genetic factors may be involved due to the influence of race and occurrence of family clusters, and concluded that in-service benzene exposure was not the etiological cause of the Veteran's multiple myeloma due to the length of time between exposure and diagnosis. The Board acknowledges that the 2016 American Cancer Society article notes that benzene exposure has been linked with multiple myeloma; however, the Board finds this statement to be less probative than the other evidence of record as this statement attributed to the International Agency for Research on Cancer did not provide a rationale. Further, the Board finds the article's generalized statement to be less probative than the May 2013 and January 2018 medical opinions that based their conclusions on a review of the Veteran's medical records and specific history along with the medical literature. In summary, the preponderance of the evidence is against a finding that the veteran's multiple myeloma had onset during service or is otherwise etiologically related to his active service and the claim for service connection must be denied. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Odya-Weis 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.