MULTIPLE MYELOMA

Summary

The Veteran, a Veteran who served from October 1969 to July 1973, appeals the denial of service connection for cancer, specifically multiple myeloma and malignant melanoma. The Veteran contended that his multiple myeloma was due to exposure to contaminated water at Camp Lejeune in 1970, and that his malignant melanoma was also related to this exposure. The Board denied service connection for multiple myeloma, finding no objective evidence of diagnosis in the Veteran's medical records, despite his assertions. The Board gave more weight to VA examinations which found no diagnosis or objective findings indicative of multiple myeloma, concluding the Veteran was not competent to provide a medical diagnosis. For malignant melanoma, the Board found the current disability element was met with a December 2024 VA examination report confirming the diagnosis. However, the Board denied presumptive service connection because malignant melanoma is not listed under 38 C.F.R. § 3.309(f) for Camp Lejeune exposures. For direct service connection, the Board reviewed VA examinations from September 2023 and December 2024. Both examiners concluded it was less likely than not that the malignant melanoma was related to service, citing the time lapse between service and diagnosis, the known causes of melanoma (UV exposure), and the lack of evidence linking it to Camp Lejeune water. The Board found these opinions persuasive and denied service connection for malignant melanoma, noting the benefit of the doubt doctrine was inapplicable as the evidence weighed against the claim.

Rationale

No current diagnosis of multiple myeloma; VA examinations found no objective evidence of diagnosis or treatment; Veteran not competent to provide medical diagnosis

Full Decision Text

Citation Nr: 26004508
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 18-19 173A
DATE: April 14, 2026

ORDER

Service connection for cancer, to include multiple myeloma and malignant melanoma, is denied.

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FINDING OF FACT

The Veteran is not diagnosed with multiple myeloma. 

The Veteran's cancer, to include malignant melanoma, did not have its onset in service and is not related to service.

CONCLUSION OF LAW

The criteria for service connection for cancer, including multiple myeloma and malignant melanoma, have not been met.  38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1969 to July 1973.

The case is on appeal from a September 2017 rating decision.

In March 2023, the Veteran testified at a Board hearing.

In August 2023, the Board remanded the claim for additional development. 

Additional evidence was received subsequent to the most recent supplemental statement of the case issued in January 2025.  As the evidence is not pertinent to the claim decided herein, a remand for RO consideration of the evidence is not necessary.  See 38 C.F.R. § 20.1305(c).

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service connection for cancer, to include myeloma and melanoma. 

Legal Criteria

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. § 1110; 38 C.F.R. § 3.303.  A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) 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."  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Regarding contaminant exposure at Camp Lejeune, VA regulation provides, in pertinent part, that a veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at U.S. Marine Corps Base Camp Lejeune, North Carolina during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply.  38 C.F.R. § 3.307(a)(7).  "Contaminants in the water supply" means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at Camp Lejeune, during the period beginning on August 1, 1953, and ending on December  31, 1987.  Id.

For veterans who are presumed to have been exposed to contaminants in the water supply while serving at Camp Lejeune for no less than 30 days from August 1, 1953, to December 31, 1987, VA has established a presumption of service connection for certain diseases, including multiple myeloma.  38 C.F.R. § 3.307(a)(7), 3.309(f).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 999 F.3d 1391, 1395 (Fed. Cir. 2021) (holding that
 from August 1, 1953, to December 31, 1987, VA has established a presumption of service connection for certain diseases, including multiple myeloma.  38 C.F.R. § 3.307(a)(7), 3.309(f).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 999 F.3d 1391, 1395 (Fed. Cir. 2021) (holding that if the positive and negative evidence is in approximate balance, which includes but is not limited to equipoise, the claimant receives the benefit of the doubt).

Analysis

The Veteran is seeking service connection, initially and specifically for multiple myeloma.  He asserts he has multiple myeloma due to exposure to contaminated water while he was serving at Camp Lejeune in 1970.  See May 2017 Claim Form. At the Board hearing, the Veteran's representative asserted that the Veteran believes he has many types of cancer due to exposure to contaminated water while he was serving at Camp Lejeune.  See Board Hr'g. Tr. at 8.

Initially, the Board will address the Veteran's contention that service connection is warranted for multiple myeloma due to exposure to contaminated water at Camp Lejeune.  The Board finds service connection is not warranted for multiple myeloma.  In this regard, the Board concludes that the Veteran does not have a current diagnosis of multiple myeloma and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

A September 2017 VA examination report reflects that there is no evidence in the Veteran's medical records of a diagnosis or treatment for multiple myeloma.  A February 2018 VA examination report reflects that after reviewing additional medical records provided by the Veteran in which he asserted reflected diagnosis and treatment for multiple myeloma, the examiner found that there was no objective evidence that the Veteran was diagnosed with multiple myeloma in the records.  The examiner who provided a December 2024 VA examination explained that there is no evidence in the medical file of diagnosis or treatment of multiple myeloma.  In addition, clinically relevant laboratory testing was performed in conjunction with the December 2024 VA examination and the examiner found that it did not reflect findings indicative of a diagnosis of multiple myeloma.  The Board notes that if the Veteran were diagnosed with multiple myeloma, it is expected that his medical records would reflect such a finding.   

While the Veteran believes there is a current diagnosis of multiple myeloma, the Veteran is not competent to provide a diagnosis in this case.  The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the competent medical evidence.  

Accordingly, the evidence weighs persuasively against the Veteran's claim of service connection specifically for multiple myeloma.  Therefore, the benefit of the doubt doctrine is not applicable and service connection for multiple myeloma is not warranted.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

However, Board finds the current disability requirement for the claim is established, as it concerns malignant melanoma.  A December 2024 VA examination report reflects a diagnosis of malignant melanoma.  Thus, the current disability element of the claim is satisfied.  

Presumptive Service Connection

The Board will first address whether presumptive service connection is warranted for malignant melanoma as related to exposure to contaminated water at Camp Lejeune.  The Veteran's service personnel records (SPRs) confirm he was stationed at Camp Lejeune from January to February 1970.  Thus, the Veteran served on active duty during the periods known to be associated with presumed exposure to contaminated water.  As a result, exposure to contaminants at Camp Lejeune is presumed.  However, malignant melanoma is not included as diseases associated with such exposure under 38 C.F.R. § 3.309(f) for the purposes of presumptive service
, the current disability element of the claim is satisfied.  

Presumptive Service Connection

The Board will first address whether presumptive service connection is warranted for malignant melanoma as related to exposure to contaminated water at Camp Lejeune.  The Veteran's service personnel records (SPRs) confirm he was stationed at Camp Lejeune from January to February 1970.  Thus, the Veteran served on active duty during the periods known to be associated with presumed exposure to contaminated water.  As a result, exposure to contaminants at Camp Lejeune is presumed.  However, malignant melanoma is not included as diseases associated with such exposure under 38 C.F.R. § 3.309(f) for the purposes of presumptive service connection.  As such, service connection cannot be established on a presumptive basis for the claim of service connection for malignant melanoma based on exposure to contaminated water at Camp Lejeune.

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Direct Service Connection

Having established presumptive service connection is not warranted, the Board's analysis will now address "direct" service connection.  That is, whether the Veteran's malignant melanoma is nevertheless related to service, specifically presumed exposure to contaminated water at Camp Lejeune.

The Board finds the evidence of record establishes the occurrence of an in-service injury or event as it concerns the Veteran's exposure to contaminated water at Camp Lejeune.  As noted above, the Veteran's service personnel records (SPRs) reflect that the Veteran was stationed at Camp Lejeune during the applicable period; thus, exposure to contaminants has been presumed.  

Thus, the determinative issue for the Board is whether a nexus, or causal link, exists between the Veteran's active military service and his malignant melanoma.  Concerning the question of whether there is a causal link between the Veteran's malignant melanoma and his exposure to contaminated water at Camp Lejeune, the evidence of record includes VA opinions obtained in September 2023 and December 2024.  

The examiner who provided a VA examination in September 2023 concluded it is less likely than not that the Veteran's malignant melanoma and squamous cell carcinoma were incurred in or caused by the claimed in-service injury, event, or illness.  The examiner explained that the Veteran was diagnosed with the claimed condition 32 years after his separation from active duty.  

The examiner who provided a VA examination in December 2024 determined the Veteran's malignant melanoma was less likely than not incurred in or caused by the claimed in-service event.  The examiner explained that malignant melanoma is a dangerous type of skin cancer that occurs when melanocytes, the cells that produce melanin, grow out of control, with symptoms that include a new unusual growth or change in an existing mole and that melanomas can occur anywhere on the body.  She noted further that according to the Mayo Clinic's website, melanoma is caused by exposure to ultraviolet light from the sun or sunbeds and other risk factors for the development of melanomas include pale skin, a family history of skin cancer, and many moles.  The examiner explained that in the case of the Veteran, there is no indication in the Veteran's STRs regarding melanoma and there is no medical or scientific evidence available that provides any indication of a relationship between malignant melanoma and exposure to contaminated water at Camp Lejeune. 

The Board acknowledges the Veteran's contentions that his melanoma is related to exposure to contaminated water at Camp Lejeune.  However, the Veteran's statements may not be used to establish a nexus opinion regarding this issue.  The issues are medically complex, as they require knowledge of the interaction between multiple organ systems in the body.  Therefore, it is outside the competence of the Veteran in this case.  See Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  As such, the Veteran's opinion lacks probative value, and an opinion by a qualified medical expert is required to decide the claims.

Consequently, the Board gives more probative weight to the VA opinions described above.  The Board finds the opinions, cumulatively, to be persuasive, as they rely on expert knowledge and the Veteran's medical history.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The opinions support that the Veteran's melanoma is unrelated to his exposure to contaminated water at Camp Lejeune.  In this regard, the December 2024 opinion explains the etiology of melanoma as related to exposure to ultraviolet light and that there is no evidence suggesting it is related to exposure contaminated water at Camp Lejeune and the September 2023 noted the significant duration of time between the Veteran's exposure and diagnosis of the condition.
 above.  The Board finds the opinions, cumulatively, to be persuasive, as they rely on expert knowledge and the Veteran's medical history.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The opinions support that the Veteran's melanoma is unrelated to his exposure to contaminated water at Camp Lejeune.  In this regard, the December 2024 opinion explains the etiology of melanoma as related to exposure to ultraviolet light and that there is no evidence suggesting it is related to exposure contaminated water at Camp Lejeune and the September 2023 noted the significant duration of time between the Veteran's exposure and diagnosis of the condition.  Moreover, there is no similar medical opinion of record weighing in favor of service connection.  The Board also acknowledges the Veteran's contention that he has other types of cancer.  However, the evidence reflects that he is diagnosed only with skin cancer.  As noted, if the Veteran were diagnosed with any other cancer, it is expected that his medical records would reflect such a finding.   

In reaching the conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the evidence is persuasively against the claim, under the presumptive and direct theories of service connection, that doctrine is not applicable in this case.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  Accordingly, service connection is not warranted for cancer, to include melanoma.

 

 

RYAN T. KESSEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Gray, Elissa A.

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.