Citation Nr: 22018949 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 17-36 016A DATE: March 30, 2022 ORDER Service connection for leukemia is granted. REMANDED Service connection for a disability manifested by weight loss, weakness, and lightheadedness, to include as due to an undiagnosed illness, is remanded. FINDING OF FACT The Veteran's diagnosed leukemia is at least as likely as not related to service. CONCLUSION OF LAW The criteria for service connection for leukemia are met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1984 to July 1991 in the U.S. Army. He was awarded the Southwest Asia Service Medal with two Bronze Service Stars and the Kuwait Liberation Medal. The Veteran died in November 2018. The appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) from a February 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. This matter was previously before the Board in September 2021, at which time the issue on appeal was remanded for additional development. This case has now returned to the Board for appellate consideration. As noted in the September 2021 Board Remand, the claim has been recharacterized to include any disability resulting in weight loss, weakness, and lightheadedness. Service Connection for Leukemia Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. The Veteran was diagnosed with leukemia in June 2017. See VA Treatment Records received October 2019. In January 2022, a VA physician opined that it is at least as likely as not that the claimed disability is due to his post-service diagnosis of leukemia. As such, the first element of service connection is satisfied. Regarding the second element of service connection, the record shows that the Veteran served in the Southwest Asia Theater of Operations from August 1990 to March 1991. See Military Personnel Record received December 2021. His military occupational specialty was unit supply specialist. See DD Form 214 received July 1991. The Veteran reported that he was exposed to environmental hazards during his deployment in Southwest Asia during Operation Desert Storm, including exposure to benzene and other chemicals from the use of burn pits, depleted uranium and benzene from burning vehicles, and benzene and smoke from daily burning oil fires. See July 2017 Correspondence. The Veteran's statements are consistent with the places, types, and circumstances of his service. As such, the second element of service connection is satisfied. Turning to the third element, medical nexus, the January 2022 VA physician opined that the Veteran's leukemia is at least as likely as not related to in-service exposure to benzene during his service in Southwest Asia. The rationale stated that previous benzene exposure represents a well-established primary etiology of leukemia in the medical literature and there are no more likely alternate etiologies. Based on the foregoing, the Board finds that service connection for leukemia is warranted. REASONS FOR REMAND Service connection for a disability manifested by weight loss, weakness, and lightheadedness, to include as due to an undiagnosed illness Although further delay is regrettable, the Board finds that remand is necessary to obtain an adequate VA medical opinion regarding whether the Veteran's claimed disability manifested by weight loss, weakness, and lightheadedness, to include anemia, thrombocytosis, and pancreatic cancer, is related to service. The Veteran was afforded a VA examination in March 2015. The examiner found that the Veteran has a diagnosis of anemia and thrombocytosis. The examiner stated that the determination of whether it is at least as likely as not that the disability is related to a specific exposure event by the Veteran during service in Southwest Asia cannot be rendered without resorting to mere speculation. No rationale was provided. Another VA opinion was obtained in May 2017. The examiner opined that the Veteran's weight loss is a disease with a clear and specific etiology and diagnosis and is less as likely as not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The rationale stated that the Veteran's weight loss is secondary to extreme thrombocytosis which was diagnosed in April 2013. The examiner also stated that between June 1991 and October 1998 the Veteran only lost 13 pounds and began to gain weight thereafter until 2014 when he was diagnosed with thrombocytosis. The Board finds this opinion inadequate for adjudication purposes because the examiner does not consider the Veteran's other reported symptoms, including weakness and lightheadedness. Additionally, the rationale does not address whether the Veteran's thrombocytosis is directly related to environmental exposures in Southwest Asia. Another VA medical opinion was obtained in January 2022. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale stated that the complaints noted in the service treatment records are nonspecific and not synonymous with a diagnosis of leukemia or pancreatic cancer. The examiner also opined that the Veteran's claimed disability is less likely than not due to his diagnosis of pancreatic cancer, however no rationale was provided. Additionally, the examiner opined that the Veteran's pancreatic cancer is less likely than not related to service, to include environmental exposures in Southwest Asia because there is no evidence of any specific exposures or events having occurred in Southwest Asia which represent an established primary etiology of the condition. The Board finds this opinion inadequate for adjudication purposes because it is conclusory. Based on the foregoing, remand is warranted to obtain a new VA opinion to determine the etiology of the Veteran's claimed disability manifested by weight loss, weakness, and lightheadedness, to include anemia, thrombocytosis, and pancreatic cancer. The matter is REMANDED for the following action: Obtain a VA medical opinion from an appropriate physician to determine the etiology of the Veteran's claimed disability manifested by weight loss, weakness, and lightheadedness. The physician must identify all diagnoses that caused the Veteran's claimed symptoms, to include to include anemia, thrombocytosis, and pancreatic cancer. Upon complete review of the claims file, the physician is asked to opine as to the following for each diagnosis: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's disability had its onset in service. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's disability is related to any in-service injury, event, or disease, to include environmental exposures in Southwest Asia. In doing so, the examiner should address the following: a June 1991 report of medical history shows a history of "dizziness or fainting spells;" the August 2012 statement that the Veteran experienced symptoms of weight loss, weakness, and lightheadedness since service; post-service treatment records showing a history of weight loss as early as 2006, a diagnosis of extreme thrombocytopenia as early as April 2013, and a diagnosis of pancreatic cancer as early as June 2017; and July 2017 correspondence wherein the Veteran wrote that the only time he had been exposed to hazardous chemicals was during his deployment to Southwest Asia during Desert Storm (wherein he was exposed to benzene, depleted uranium, and other chemicals), found himself suffering from daily fatigue and weakness for unknown causes. See VBMS, documents labeled STR Medical, receipt date 9/12/11, page 16; VA Examination, receipt date 11/2/11, page 9; C&P Exam, receipt date 3/2/15, page 2; C&P Exam, receipt date 5/5/17, page 2; CAPRI, receipt date 7/12/19, page 259; Correspondence, receipt date 8/9/12, page 1; and Correspondence, receipt date 7/6/17, pages 1-2. A complete rationale must be provided for all opinions offered. If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the examiner must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kernen, 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.