LEUKEMIA

S.C. KREMBS · 2026 · Case ID: A26033613

MIXED

Summary

The veteran served from December 1964 to December 1967. This case concerns the severance of service connection for leukemia, specifically chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL), and the restoration of service connection for T-cell large granular lymphocytic (LGL) leukemia. The veteran was initially granted service connection for NHL as presumptively related to herbicide exposure. Subsequently, a VA examination diagnosed CLL, which was also granted service connection. However, the RO later proposed severance for both NHL and CLL, stating the veteran did not have these conditions but rather T-cell LGL leukemia. The Board reviewed the evidence, including opinions from the veteran's treating oncologist and private physician, as well as VA examinations. The Board found that while the CLL diagnosis was no longer accurate, the T-cell LGL leukemia diagnosis was supported by medical evidence and was related to the veteran's herbicide exposure. The Board concluded that the evidence did not clearly and unmistakably show that the veteran did not have service-related leukemia, making the severance of service connection for leukemia improper. Therefore, the restoration of service connection for T-cell LGL leukemia is granted. The severance of service connection for NHL was deemed proper as the evidence did not support that diagnosis.

Rationale

Grant of service connection for CLL was not clear and unmistakable error.; T-cell LGL leukemia diagnosis related to herbicide exposure.; Severance of service connection for leukemia was improper.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260113-627886

Full Decision Text

Citation Nr: A26033613
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 260113-627886
DATE: April 10, 2026

ORDER

Severance of service connection for leukemia, characterized as chronic lymphocytic leukemia (CLL), was improper; restoration of service connection for T-cell large granular lymphocytic (LGL) leukemia is granted.

The severance of service connection for non-Hodgkin's Lymphoma (NHL) was proper; restoration of service connection for NHL is denied.

FINDINGS OF FACT

1. The grant of service connection for leukemia, pursuant to a January 2022 rating decision was not clearly and unmistakably erroneous.

2. The Veteran's current disability of T-cell LGL leukemia is related to his exposures to herbicides in service.

3. The finding that the Veteran was diagnosed with NHL was a clear and unmistakable error.

CONCLUSIONS OF LAW

1. The criteria for severance of service connection for leukemia, characterized as CLL, was improper; the criteria for restoration of service connection for T-cell LGL leukemia are met. 38 C.F.R. §§ 3.105, 20.1403.

2. The severance of service connection for NHL was proper, the criteria for restoration of service connection for NHL are not met. 38 C.F.R. §§ 3.105, 20.1403.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1964 to December 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

Following the January 2025 rating decision, the Veteran submitted a VA Form 10182 (Notice of Disagreement) and selected the Direct Review docket. Based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of January 17, 2025-the date of the rating decision on appeal. See 38 C.F.R. § 20.301. If the Veteran submitted evidence that was added to the record after January 17, 2025, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. See 38 C.F.R. § 3.2501.

This matter has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c).

The Board considers the fact that the matter has been advanced on the docket as an implicit waiver of the Veteran's ability to switch dockets under Williams v. McDonough (37 Vet. App. 305 (2024)).

Severance

Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Previously granted benefits will be severed only where evidence establishes that the award of service connection was clear and unmistakable error (CUE) (the burden of proof being on the Government). 38 C.F.R. § 3.105(d).

When severance is considered warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The claimant will be notified at his or her latest address of record of the contemplated action, furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(d).

A change in diagnosis may be accepted as a basis for severance action if the examining physician or physicians or other proper medical authority certifies that, in the light of all accumulated evidence, the diagnosis on which service connection was predicated
be given 60 days for the presentation of additional evidence to show that service connection should be maintained. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(d).

To establish that a grant of benefits was the product of CUE, VA must show that (1) either the correct facts as they were known at the time were not before the adjudicator, the adjudicator made an erroneous factual finding, or the statutory or regulatory provisions were incorrectly applied; (2) the alleged error was undebatable, not merely a disagreement as to how the facts were weighed or evaluated; and (3) the error manifestly changed the outcome of the prior decision. See Allen v. Nicholson, 21 Vet. App. 54, 58-59 (2007); Stallworth v. Nicholson, 20 Vet. App. 482, 487-88 (2006); cf. Bustos v. West, 179 F.3d 1378, 1380-81 (Fed. Cir. 1999); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14, 319 (1992) (en banc). A clear and unmistakable error is one about which reasonable minds could not differ. See, e.g., 38 C.F.R. § 20.1403(a).

In most respects, the CUE standard under § 3.105(d) is equivalent to the CUE standard for reversing or revising a prior final decision under 38 C.F.R. § 3.105(a). See Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). Section 3.105(d) places at least as high a burden of proof on the VA when it seeks to sever service connection as § 3.105(a) places upon an appellant seeking to have an unfavorable previous determination overturned. See id.

However, the determination of severance is not limited to the law and the record that existed at the time of the original decision. VA may consider medical evidence and diagnoses that postdate the original award of service connection to demonstrate that the diagnosis on which service connection was predicated is clearly erroneous. Stallworth, 20 Vet. App. at 488. The Secretary's burden is not to prove clear and unmistakable error in the original decision in the same manner a claimant would show CUE under sections 5109A or 7111. Id.

A decision that is reversed or amended based on CUE is revised to conform to the true state of the facts or the law that existed at the time of the original adjudication. Allen, 21 Vet. App. at 62 (internal quotations omitted).

Here, service connection for NHL was initially granted in a May 2021 rating decision as presumptively related to the Veteran's conceded exposures to herbicides in service. In a November 2021 VA examination, the Veteran was noted to have a diagnosis of CLL, and the examiner opined that the condition was related to the Veteran's herbicide exposure in service. The RO granted service connection for CLL in a January 2022 rating decision and proposed to combine it with NHL in a December 2022 rating decision. In a March 2023 rating decision, the RO combined the NHL and CLL ratings. The RO proposed to sever service connection for NHL in a July 2023 rating decision and proposed to server service connection for CLL in a July 2024 rating decision. Severance for NHL and CLL was accomplished in the January 2025 rating decision on appeal on the grounds that the Veteran did not have either condition, but was diagnosed with T-cell LGL leukemia.

Initially, the Veteran does not contend, and the record does not reflect, that the RO violated due process in the severance of service connection for NHL and CLL. The questions before the Board are thus whether the grants of service connection for NHL and CCL were clearly and unmistakably erroneous.

In support of
decision, the RO combined the NHL and CLL ratings. The RO proposed to sever service connection for NHL in a July 2023 rating decision and proposed to server service connection for CLL in a July 2024 rating decision. Severance for NHL and CLL was accomplished in the January 2025 rating decision on appeal on the grounds that the Veteran did not have either condition, but was diagnosed with T-cell LGL leukemia.

In support of the claim for NHL, the Veteran submitted an April 2020 letter from his treating oncologist indicating that he had NHL and longstanding lymphocytosis. A May 2021 VA examination confirmed the NHL diagnosis. In support of the claim for service connection for CLL, the Veteran submitted private treatment records documenting relative lymphocytosis, described as T-cell LGL leukemia and large granular lymphocytic leukemia. A November 2021 VA examiner diagnosed CLL and opined that it was related to the Veteran's herbicide exposure. The CLL diagnosis was confirmed in a September 2022 VA examination.

In response to the proposals to reduce the ratings for NHL and CLL, the Veteran submitted January 2023, March 2023 and May 2023 letters from his treating oncologist indicating that the Veteran had a diagnosis of LGL leukemia. A March 2023 letter from the Veteran's private treating physician indicated that the Veteran had been diagnosed with NHL. A May 2023 VA examiner indicated that the Veteran had been found to have NHL in 2019 and that it had progressed to CLL in 2021. Private treatment records submitted by the Veteran included the assessments that the Veteran had LGL leukemia that was consistent with T-cell LGL leukemia. A June 2024 VA examiner noted a diagnosis of T-cell LGL leukemia, indicating that it was a new diagnosis and a correction of the previous erroneous service-connected diagnosis. The examiner reviewed the pertinent medical records and explained that T-cell LGL leukemia was a distinct entity that was not the same as CLL. The examiner also explained that the diagnosis was not a non-Hodgkin lymphoma.

In an October 2024 letter, the Veteran's private treating physician indicated that the T-cell LGL leukemia diagnosis was a direct result of the Veteran's exposure to herbicides during service. The treating physician noted that the condition was a rare and distinct subtype of NHL lymphoma and that the Veteran did not have any other environmental or occupational exposures that would have contributed to the risk for the disease. According to the private physician, the exposure to herbicides was the sole significant factor in the development of the disease and current medical literature supported the conclusion that it was related to the herbicide exposure. VA treatment records document T-cell LGL leukemia as an active problem.

In addition to the June 2024 VA medical examination documenting T-cell LGL leukemia as the correct diagnosis, there was evidence of record at the time of the January 2025 severance establishing that the leukemia diagnosis was related to the Veteran's exposure to herbicides. Thus, the Board finds that the evidence does not clearly and unmistakably show that the Veteran did not have leukemia, such that service connection was undebatably not warranted.

Based on the medical history as set forth in the letters from the private treating physicians and the June 2024 VA examination, the Veteran's claim for service connection for CLL has been recharacterized in order to more accurately reflect the record. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). While there is evidence that the CLL diagnosis was no longer accurate, the Board finds the opinions that the Veteran has T-Cell LGL leukemia and that the condition was related to his herbicide exposure significant.

Based on the foregoing, the Board finds that the evidence does not clearly and unmistakably show that the Veteran did not have leukemia, such that service connection was undebatably not warranted. Given the evidence supporting of the existence of T-cell LGL leukemia related to the Veteran's herbicide exposure, the countervailing evidence does not rise to the level of proof needed to show that the Veteran clearly and unmistakably did not have service-related leukemia.

Accordingly, since VA has not met the high evidentiary burden of showing clear and unmistakable error, the severance of service connection for leukemia was improper and the claim to restore service connection is granted. See 38 C.F.R. § 3.105(d).

The Board also finds that, given the clear evidence that the NHL
does not clearly and unmistakably show that the Veteran did not have leukemia, such that service connection was undebatably not warranted. Given the evidence supporting of the existence of T-cell LGL leukemia related to the Veteran's herbicide exposure, the countervailing evidence does not rise to the level of proof needed to show that the Veteran clearly and unmistakably did not have service-related leukemia.

The Board also finds that, given the clear evidence that the NHL diagnosis was erroneous, severance of service connection for that condition was proper, and will not be disturbed. As set forth in the explanation of the medical evidence, the record does not demonstrate that the Veteran has a current diagnosis of NHL. Rather, as noted, the correct diagnosis is T-cell LGL leukemia, which is not a non-Hodgkin lymphoma.

S.C. KREMBS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Snyder, M.

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.

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