Citation Nr: A25035309 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240813-466123 DATE: April 16, 2025 REMANDED Entitlement to service connection for chronic myelogenous leukemia is remanded. Entitlement to service connection for an acquired psychiatric disorder to adjustment disorder with mixed anxiety and depressed mood (adjustment disorder) as secondary to chronic myelogenous leukemia is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to May 1986. In a February 2024 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for chronic myelogenous leukemia and adjustment disorder. The Veteran timely appealed this decision to the Board and requested direct review of the evidence considered by the AOJ. See VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD). Therefore, the Board may only consider the evidence of record at the time of the February 2024 rating decision. 38 C.F.R. § 20.301. Normally, if the Veteran wanted VA to consider any evidence that was submitted that the Board could not consider, they could file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. However, given that the claims are being remanded, any such evidence will be considered as part of the readjudication of the claims. chronic myelogenous leukemia The Veteran contends she developed chronic myelogenous leukemia as a result of daily exposure to radiation from her military duties as a satellite communications systems specialist. Service records confirm the Veteran's exposure to non-ionizing radiofrequency radiation from super high frequency (SHF) and ultra-high frequency (UHF) equipment. An Air Force Department memo indicates that while there are no long-term effects (including cancer) from low-level exposures to radiofrequency radiation, they were unable to determine the specific exposures for the Veteran. In July 2021, the Veteran's private physician stated that medical literature has identified radiofrequency radiation as a risk factor for chronic myelogenous leukemia and that "numerous studies" have classified radio-frequency radiation as a Group1 known human carcinogen. They then linked the Veteran's chronic myelogenous leukemia to in-service exposure to radiofrequency radiation. Unfortunately, the referenced studies and literature do not necessarily support the physician's conclusion. For example, at least one study appears to be related to childhood leukemia and another related to radiofrequency exposure in rats and mice. The private physician did not adequately explain their relevance to the Veteran's case. A VA opinion was obtained in September 2023 wherein the examiner confirmed the chronic myelogenous leukemia diagnosis. However, because they did not address its etiology, the Board finds it is inadequate and relying on it amounts to a pre-decisional duty-to-assist error warranting remand. Therefore, a VA examination and opinion are necessary. The record also does not include a Toxic Exposure Risk Activity (TERA) memorandum and/or corresponding Individual Longitudinal Exposure Record (ILER). This appeal originated after the passage of the PACT Act, so it is unclear why such a memorandum has not been prepared. On remand, such should be completed. anxiety disorder The Veteran contends that she has a psychiatric disorder related to her chronic myelogenous leukemia diagnosis. Because the disability picture is unresolved, the psychiatric disorder claim is inextricably intertwined with the chronic myelogenous leukemia claim. Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a veteran's claim for the second issue). Thus, adjudication of this claim must be deferred until after completion of the actions requested below. By this remand, the Board makes no determination, express or implied, as to the credibility of any statements on file. The matters are REMANDED for the following action: 1. Prepare a TERA memorandum and ILER report for the Veteran. 2. Schedule the Veteran for a VA examination. The examiner should elicit a detailed history regarding the onset and progression of relevant symptoms, and the examination report should include a discussion of the Veteran's documented medical history. Any medically indicated testing should be conducted and the results included in the examination report. The examiner should state whether it is at least as likely as not, (i.e., a 50 percent probability or greater), that the Veteran's chronic myelogenous leukemia is related to active service, specifically the conceded in-service exposure to non-ionizing radiofrequency radiation as a satellite communications systems specialist. If the chronic myelogenous leukemia is considered unrelated to service, the examiner should explicitly indicate so and explain why. The examiner should also consider and discuss the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Although an independent review of the entire claims file is required, the examiner's attention is directed to the following evidence, and he/she should discuss its significance: a) The February 22, 1984, service record confirming the Veteran's exposure to non-ionizing radiofrequency radiation from SHF and UHF equipment; b) The November 2021 Air Force Department Memo; and c) The July 2021 private opinion suggesting a nexus between the conceded in-service radiofrequency exposures and the Veteran's development of chronic myelogenous leukemia; the examiner should specifically discuss the medical resources referenced in support of that opinion. (Continued on the next page) ? The examiner should provide a clear rationale for the opinion offered, including discussion of the facts of this case and any medical studies or references relied upon. If he or she is unable to provide an opinion without resorting to speculation, they must provide a reasoned explanation for such conclusion. 3. Readjudicate the inextricably intertwined anxiety disorder claim. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.R. Bryant 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.