MULTIPLE MYELOMA

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26033690

MIXED

Summary

The Veteran served in the U.S. Navy from June 1966 to June 1968, including service aboard the U.S.S. Coral Sea during the Vietnam era. The Appellant, the Veteran's surviving spouse, appeals the denial of service connection for multiple myeloma, heart disorder (including myocardial infarction), chronic kidney disease, and the cause of death. The Board granted service connection for multiple myeloma and heart disorder on a presumptive basis due to the Veteran's service in the Blue Water Navy area offshore of Vietnam, applying the benefit of the doubt due to conflicting evidence regarding the ship's exact location. The Board found the Veteran's chronic kidney disease to be secondarily service-connected to the now-service-connected multiple myeloma, based on medical opinions and the death certificate. Service connection for the cause of death was granted as the death certificate listed multiple myeloma as the underlying cause. Service connection for osteomyelitis was remanded for further development, including obtaining private treatment records, community care records, SSA benefit information, and a VA medical opinion on the etiology of osteomyelitis, considering conceded asbestos exposure and potential synergistic effects of toxic exposures.

Rationale

Veteran served in qualifying period and location for Blue Water Navy presumption.; Multiple myeloma is an enumerated disease under 38 C.F.R. § 3.309(e).; Benefit of the doubt resolved in Veteran's favor due to conflicting evidence on ship's exact location.

Service Branch

NAVY

Special Benefit

DIC / CAUSE OF DEATH

Docket No.

250911-574622

Full Decision Text

Citation Nr: A26033690
Decision Date: 04/13/26 Archive Date: 04/13/26

DOCKET NO. 250911-574622
DATE: April 13, 2026

ORDER

Entitlement to service connection for multiple myeloma, for substitution purposes, is granted.

Entitlement to service connection for heart disorder, to include myocardial infarction, for substitution purposes, is granted.

Entitlement to service connection for chronic kidney disease, for substitution purposes, is granted.

Entitlement to service connection for the cause of the Veteran's death is granted.

REMANDED

Entitlement to service connection for osteomyelitis, for substitution purposes, is remanded.

FINDINGS OF FACT

1. Resolving the benefit of the doubt in the Veteran's favor, the Veteran served in the Blue Water offshore of Vietnam between January 9, 1962, and May 7, 1975.

2. The Veteran is entitled to service connection for multiple myeloma on a presumptive basis as an herbicide-related disease under 38 C.F.R. § 3.309(e).

3. The Veteran is entitled to service connection for heart disorder on a presumptive basis as an herbicide-related disease under 38 C.F.R. § 3.309(e).

4. The most probative and persuasive evidence reflects that the Veteran's chronic kidney disease was caused by a service-connected disability.

5. The record reflects that the Veteran's death certificate lists cardiac arrest due to end stage renal disease due to multiple myeloma as the immediate cause of the Veteran's death.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for multiple myeloma, for substitution purposes, are met. 38 U.S.C. §§ 1116A, 1154, 5121; 38 C.F.R. §§ 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for heart disorder, to include myocardial infarction, for substitution purposes, are met. 38 U.S.C. §§ 1116A, 1154, 5121; 38 C.F.R. §§ 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for chronic kidney disease, for substitution purposes, are met. 38 U.S.C. §§ 1110, 5107, 5121; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria to establish service connection for the cause of the Veteran's death are met. 38 U.S.C. § 1310; 38 C.F.R. § 3.312.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1966 to June 1968. He died in April 2023, and the Appellant is his surviving spouse and, in accordance with 38 U.S.C. § 5121A, has substituted as the claimant in this matter.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2024 rating decision issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ) which denied entitlement to service connection for cause of death and denied service connection for multiple myeloma, heart disorder, chronic kidney disease, and osteomyelitis.

In September 2025, in a VA Form 10182, the Appellant appealed the decision to the Board and elected the Hearing docket. The Board notes that the Appellant submitted two additional appeals using a VA Form 10182 on the same day for other issues regarding service connection for substitution purposes.

In December 2025, the Appellant testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript is of record. All three dockets were addressed at the hearing. The additional issues discussed included entitlement to a compensable evaluation for service-connected hearing loss and service connection for extreme fatigue, difficulty breathing, sepsis, and urinary tract infection, which are addressed in a separate Board decision under docket number 250911-574602, issued concurrently to this decision. Entitlement to a TDIU was also discussed at the hearing and is addressed in a separate Board decision, under docket number 250911-574607, issued concurrently to this decision.

As to the rules regarding the evidentiary record, under the Board's hearing docket, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, and any evidence submitted by the Appellant or her representative at the
issues discussed included entitlement to a compensable evaluation for service-connected hearing loss and service connection for extreme fatigue, difficulty breathing, sepsis, and urinary tract infection, which are addressed in a separate Board decision under docket number 250911-574602, issued concurrently to this decision. Entitlement to a TDIU was also discussed at the hearing and is addressed in a separate Board decision, under docket number 250911-574607, issued concurrently to this decision.

As to the rules regarding the evidentiary record, under the Board's hearing docket, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, and any evidence submitted by the Appellant or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the July 2024 rating decision and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in this decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.800. 38 U.S.C. § 7107.

Service Connection

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability if it is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

In addition, service connection may be established on a presumptive basis for certain diseases resulting from exposure to herbicide agents, such as Agent Orange, if a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period from January 9, 1962, to May 7, 1975, absent affirmative evidence to establish that the Veteran was not exposed to such herbicide agent during that service. See 38 C.F.R. §§ 3.307 (a)(6)(iii). If a Veteran is presumably exposed to an herbicide agent, then there is a presumption of service connection for certain enumerated diseases. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a) and 3.309(e). Multiple myeloma and ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease) are included in these enumerated diseases.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for multiple myeloma for substitution purposes

2. Entitlement to service connection for heart disorder, to include myocardial infarction, for substitution purposes

The Veteran and the Appellant have asserted that the Veteran's multiple myeloma and heart disorder were caused by exposure to herbicide agents while the Veteran was serving aboard the U.S.S. Coral Sea during the Vietnam War. See April 2022 Veteran statement and December 2023 VA Form 21-10210 attorney statement.

As noted above, a presumption of service connection applies if the evidence shows that the Veteran had a qualifying disability and he served during a qualifying period in a qualifying location. See 38 U.S.C. § 1116; 38 C.F
for multiple myeloma for substitution purposes

2. Entitlement to service connection for heart disorder, to include myocardial infarction, for substitution purposes

The medical evidence of record shows that the Veteran was diagnosed with multiple myeloma in December 2016. See October 2017 VA examination. The record also reveals that the Veteran's heart disorder included an inferolateral myocardial infarction which falls under the category of ischemic heart disease per 38 C.F.R. § 3.309(e). See July 2024 CAPRI, cardiology consultation of October 24, 2017. As such, the first element of presumptive service connection is met for the Veteran's multiple myeloma and heart disorder.

Turning next to the issue of timing, military personnel records show the Veteran's active duty service from June 1966 to June 1968, including time aboard the U.S.S. Coral Sea from July 1966 to June 1968. The Veteran had a military occupational specialty (MOS) of yeoman and was awarded several medals and awards, including the Republic of Vietnam Campaign Medal. See June 1968 VA Form DD 214N. Thus, the Veteran unquestionably served during a qualifying period.

Finally, as to the location element of qualification, the Board notes that the phrase "service in the Republic of Vietnam" in 38 U.S.C. 1116 includes the territorial seas of the Republic of Vietnam extending 12 nautical miles from the shores of that nation. See Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019).

Congress has enacted the Blue Water Navy Vietnam Veterans Act of 2019 (Blue Water Navy Act). Pub. L. No. 116-23, 133 Stat. 988 (2019). The effective date of the Blue Water Navy Act is January 1, 2020. The stated main purpose of this Act was "to amend title 38, United States Code, to clarify presumptions relating to the exposure of certain veterans who served in the vicinity of the Republic of Vietnam, and for other purposes." See Blue Water Navy Vietnam Veterans Act of 2019, Pub. L. No. 116-23, 133 Stat. 966 (2019), Synopsis.

The Blue Water Navy Act defines service "offshore of the Republic of Vietnam" as encompassing service in the territorial sea extending 12 nautical miles from the shores both of that nation and of Cambodia. See 38 U.S.C. 1116A(d). It provides that the 12 miles are measured seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia and intersecting at certain points (latitude North, longitude East); these are set out in a Points Geographic table included there. See 38 U.S.C. 1116A(d). A veteran's service must take place during the period January 9, 1962, to May 7, 1975. 38 U.S.C. 1116A(a).

VA researchers attempted to verify the Veteran's exposure to herbicides aboard the U.S.S. Coral Sea between July 1, 1966, and June 11, 1968, via deck logs and the ship locator tool. Results from the VA ship locator tool could not confirm that the U.S.S. Coral Sea was in a Blue Water area during the Veteran's period of service, although the results do reflect that the ship was in positions close to the shoreline of North Vietnam, and positions immediately adjacent to the Blue Water demarcation line. The results also indicate that the Coral Sea entered Blue Water during other periods between 1965-1975. See April 2021 Logbooks.

An August 2021 records research center response noted that the U.S.S. Coral Sea had deployments in the Western Pacific Theater from July 29, 1966, to February 23, 1967, and from July 26, 1967, to April 6, 1968. The researcher reported that a
.S. Coral Sea was in a Blue Water area during the Veteran's period of service, although the results do reflect that the ship was in positions close to the shoreline of North Vietnam, and positions immediately adjacent to the Blue Water demarcation line. The results also indicate that the Coral Sea entered Blue Water during other periods between 1965-1975. See April 2021 Logbooks.

An August 2021 records research center response noted that the U.S.S. Coral Sea had deployments in the Western Pacific Theater from July 29, 1966, to February 23, 1967, and from July 26, 1967, to April 6, 1968. The researcher reported that a review of the 1966-1968 Command History Reports offered no evidence of the claimed exposure event. An additional records research center response later that month noted that the National Archives and Records Administration (NARA) was unable to locate the missing deck logs from August 9, 1966, and August 8, 1967.

VA memoranda conceded the Veteran's non-deployment asbestos exposure based on his MOS; however, herbicide exposure was not conceded due to lack of service in a qualifying nautical location. See May 2024 VA Memo and document labeled as Other.

In a December 2023 statement, the Appellant's attorney asserted that the Veteran should have been considered a Blue Water Navy Vietnam veteran as the ship's log shows that the U.S.S. Coral Sea entered the Blue Water on January 1, 1967. Specifically, VA documentation containing a chronological record of the ship's location and coordinates, shows coordinates for that date of 171° 15.0'N by 107° 16.0'E. See June 2021 Logbooks. When plotted on the Interactive Vietnam Map from Hill & Ponton, P.A., these coordinates place the ship within the designated offshore waters as defined by the Blue Water Navy Act of 2019. See December 2023 VA form 21-10210; December 2023 correspondence, Exhibit E, Hill & Ponton Interactive Vietnam Map.

The Appellant's attorney submitted a copy of the U.S.S. Coral Sea absentee record for January 1, 1967, which shows a single absentee, identified as someone other than the Veteran. See March 2024 Logbooks at 4. The Appellant's attorney also submitted a copy of the deck log remarks sheet from January 1, 1967, which indicates that the ship was underway in the South China Sea, escorted by two destroyers, and had commenced "flight operations." See December 2023 military personnel record, Exhibit D.

The Appellant's attorney further explained at the December 2025 Board hearing that while an aircraft carrier such as the U.S.S. Coral Sea typically avoids entering the 12 nautical mile zone around a nation (which is sovereign territory), it will often skirt the area during wartime, going in and out as necessary for safe "flight operations" (wind requirements) or for maneuvering space for aircraft recoveries.

At the December 2025 Board hearing, the Appellant testified that she had the impression that the Veteran had gone ashore during his Vietnam War service with the public affairs office. The Appellant testified that the Veteran wrote her every day, often describing the "planes flying off the deck and how they were near Vietnam." She recalled one letter where he stated how he was excited to be transported by plane to Vietnam so he could make a phone call. The Appellant also recalled that the Veteran spoke to his granddaughter about his war experiences in connection with her school report and he mentioned that he could see Vietnam from the ship and that he had gone ashore. The Appellant further testified that the Veteran had no known exposure to herbicides following service (he worked in the city) and had no family history of multiple myeloma.

In light of the above, and considering the evidence as a whole, the Board finds that the evidence is in at least approximate balance as to whether the U.S.S. Coral Sea sailed within 12 nautical miles from the contiguous waters of Vietnam with the Veteran on board.

In addition, the Board finds no reason to doubt the credibility of the lay testimony that the Veteran had gone ashore to the Republic of Vietnam and cannot say that going ashore would have been inconsistent with his service duties. Thus, although the Veteran's service ashore in Vietnam has not been confirmed by official military records, such is not specifically required in the applicable law and regulations, and the Board accepts the lay statements and testimony as credible.

As the reasonable doubt created by the relative balance of the evidence must be resolved in favor of the Appellant, the Board finds that entitlement to the presumption of herbicide exposure based on service
.S. Coral Sea sailed within 12 nautical miles from the contiguous waters of Vietnam with the Veteran on board.

As the reasonable doubt created by the relative balance of the evidence must be resolved in favor of the Appellant, the Board finds that entitlement to the presumption of herbicide exposure based on service in Vietnam during the requisite time period is warranted. 38 U.S.C. §§ 1116A, 5107; Lynch, 21 F.4th at 776.

As the above claimed disabilities are among those listed at 38 C.F.R. § 3.309(e) as being presumptively related to herbicide agent exposure, the Board finds that service connection is warranted for multiple myeloma and heart disorder, to include myocardial infarction, on a presumptive basis for substitution purposes. 38 C.F.R. § 3.309 (e).

With service connection now being granted in full on a presumptive basis, the Board finds that consideration of other theories of entitlement is unnecessary, as a grant on another basis will not result in an earlier effective date, given that Nehmer effective date provisions are implicated in this case.

3. Entitlement to service connection for chronic kidney disease for substitution purposes

During his lifetime, the Veteran asserted that his chronic kidney disease was caused by his multiple myeloma. See January 2023 VA 21-526EZ.

The rating decision on appeal made favorable a finding that the Veteran was diagnosed with chronic kidney disease. As the instant decision has granted service connection for multiple myeloma, the first two elements of secondary service connection are met.

Regarding the last element, nexus, the evidence of record includes review of the clinical notes from the Veteran's private nephrologist who stated that the Veteran's chronic kidney disease was likely due at least in part to his multiple myeloma. See October 2017 VA hematologic and lymphatic conditions examination, evidence reviewed from Desert Kidney Associates. In addition, in a June 2024 VA kidney disease medical opinion, the examiner noted that the death certificate shows that the Veteran's end-stage renal disease was secondary to his multiple myeloma. The examiner explained that end-stage renal disease or renal failure is one of the most common and most serious complications of multiple myeloma, as multiple myeloma causes kidney complications through various mechanisms such as excess immunoglobulins that are nephrotoxic, hypercalcemia, infection, etc. See June 2024 VA opinion.

Upon review, the Board finds that the competent and probative evidence of record at the time of the Veteran's death tends to establish that the Veteran's chronic kidney disease was a result of the now service-connected multiple myeloma. Accordingly, resolving all doubt in the Appellant's favor, and as there is no opinion to the contrary, the Board finds that service connection for the Veteran's chronic kidney disease as secondary to service-connected myelopathy is warranted. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310; Lynch, 21 F.4th at 776.

4. Entitlement to service connection for the cause of the Veteran's death

When a veteran dies from a service-connected disability, the veteran's surviving spouse may be entitled to dependency and indemnity compensation (DIC) benefits for the cause of death. 38 C.F.R. § 1310; 38 C.F.R. §§ 3.5(a), 3.312. In order to establish service connection for the cause of death, the evidence must show that a disability incurred in or aggravated by service was either the principal cause of death or contributed substantially or materially to the veteran's death. 38 C.F.R. § 3.312.

For a service-connected disability to constitute a contributory cause of death, it must be shown to have contributed substantially or materially to the veteran's death; combined to cause death; aided or lent assistance to the production of death; or resulted in debilitating effects and general impairment of health to an extent that would render the veteran materially less capable of resisting the effects of other disease or injury causing death, as opposed to merely sharing in the production of death. 38 C.F.R. § 3.312.

As described, the Veteran is now service-connected for multiple myel
aggravated by service was either the principal cause of death or contributed substantially or materially to the veteran's death. 38 C.F.R. § 3.312.

As described, the Veteran is now service-connected for multiple myeloma. The Veteran died in April 2023, and his death certificate lists the immediate cause of his death as cardiac arrest due to end stage renal disease due to multiple myeloma. See March 2024 death certificate. As the death certificate indicates that multiple myeloma was the underlying cause of the Veteran's death, the Board therefore finds that service connection for cause of the Veteran's death is also warranted. 38 U.S.C. § 1310; 38 C.F.R. § 3.312.

REASONS FOR REMAND

1. Entitlement to service connection for osteomyelitis, for substitution purposes, is remanded.

The Veteran and the Appellant have asserted that the Veteran's osteomyelitis was due to multiple myeloma which ultimately stemmed from herbicide exposure in service. See January 2023 VA 21-526EZ.

The Board notes that the Appellant was not afforded a VA opinion regarding her claim for service connection for osteomyelitis for substitution purposes.

The rating decision on appeal made favorable a finding that the Veteran had been diagnosed with osteomyelitis.

In May 2024, a toxic exposure risk activity (TERA) memorandum was associated with the record in which VA conceded the Veteran's in-service exposure to asbestos based on his MOS. Thus, an in-service event of exposure to asbestos is conceded.

In light of the above, the duty to provide a VA opinion was triggered pursuant to McLendon v. Nicholson, 20 Vet. App. 79 (2006). The failure to obtain a VA opinion was a pre-decisional duty to assist error. Remand is warranted so this can be done. 38 U.S.C. § 5103A; 20 C.F.R. § 20.802(a).

Further, a review of the Veteran's file reveals that there are private treatment records related to the Veteran's claim that were not sought prior to the AMA decision on appeal. VA treatment records indicate that the Veteran was treated by private health care providers, including a primary care physician, oncologist, and cardiologist. See e.g., June 2024 CAPRI, social work assessment of May 4, 2021, and clinical note of April 10, 2019.

The Board notes that there are other pertinent outstanding records, as VA treatment records indicate that the Veteran received non-VA care through VA's Community Care program. In addition, the Appellant reported that the Veteran was receiving disability benefits from the Social Security Administration (SSA).

The failure to attempt to obtain the above records constitutes a pre-decisional duty to assist error, as they may contain information which could help substantiate the Appellant's claim. Accordingly, a remand is also warranted so appropriate attempts may be made to obtain the outstanding records. 38 C.F.R. §§ 3.159(c)(1), 20.802(a).

This matter is REMANDED for the following actions:

1. Make appropriate efforts to obtain the Veteran's private treatment records pertinent to osteomyelitis and associate them with the claims file.

2. Ensure that all records created through the Community Care program, to include those scanned into VISTA Imaging, are associated with the file in a way which is reviewable by the AOJ and the Board.

3. Request all documents pertaining to the Veteran's application for, and award of, Social Security Administration (SSA) disability benefits, including any medical records considered in deciding his claim.

4. After the completion of the above, obtain a VA medical opinion from an appropriate examiner to evaluate the etiology of the Veteran's osteomyelitis. The claims folder, including a copy of this remand, must be provided to and reviewed by the examiner.

(a.) The examiner must opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's osteomyelitis is etiologically related to his service, to include his conceded participation in toxic exposure risk activities.

(b.) In providing
Veteran's application for, and award of, Social Security Administration (SSA) disability benefits, including any medical records considered in deciding his claim.

(b.) In providing an opinion regarding the relationship of the Veteran's osteomyelitis to his toxic exposure risk activities, the examiner is asked to consider the total potential exposure through the Veteran's military deployment(s) and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

(c.) A complete rationale must be provided for all opinions or conclusions expressed. If the examiner is unable to provide an opinion without resorting to speculation, the examiner must explain why this is so.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Horan, Deborah E.

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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