LEUKEMIA

Summary

The Veteran, a veteran who served from August 1990 to December 1992, is the subject of this appeal following their death in September 2024. The surviving spouse is substituted as the appellant. The Veteran sought service connection for multiple myeloma, claiming it was due to in-service toxic exposure risk activities (TERA). The Regional Office (RO) initially denied service connection in April 2025, but later made favorable findings that the Veteran had multiple myeloma, had non-deployment-related TERA exposures, and that the negative VA TERA opinions were inadequate. The appellant submitted a private physician's opinion in October 2024, which reviewed the evidence and medical literature. This opinion linked the Veteran's TERA exposure as an Abrams Armor Crewman to benzene, a known carcinogen linked to blood cancers like multiple myeloma. The private physician opined that it was at least as likely as not that the Veteran's multiple myeloma was a direct result of these TERAs. The Board found this evidence placed the question of service connection in relative equipoise. Resolving reasonable doubt in the appellant's favor, the Board granted direct service connection for multiple myeloma.

Rationale

Favorable finding of multiple myeloma diagnosis prior to death; Favorable finding of non-deployment-related TERA exposures during service; Favorable finding that negative VA TERA opinions were inadequate; Private physician opinion linked TERA exposure to benzene, a carcinogen linked to multiple myeloma; Private physician opined at least as likely as not that multiple myeloma was a direct result of TERA; Evidence placed question of service connection in relative equipoise; Reasonable doubt resolved in appellant's favor

Full Decision Text

Citation Nr: A26039950
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251211-614111
DATE: April 29, 2026

ORDER

Service connection for multiple myeloma is granted.

FINDINGS OF FACT

1. Prior to death the Veteran was diagnosed with multiple myeloma.

2. The multiple myeloma is related to one or more in-service toxic exposure risk activities (TERA).

CONCLUSION OF LAW

Resolving reasonable doubt in the appellant's favor, the criteria for direct service connection for multiple myeloma are met.  38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.326(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran had active service from August 1990 to December 1992.  The Veteran died in September 2024.  The appellant is the surviving spouse of the Veteran, who is substituted as the appellant for purposes of adjudicating the issues on appeal to completion.  See 38 U.S.C. § 5121A (allowing for substitution in case of death of a claimant who dies on or after October 10, 2008).

The Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA), creates a new framework of review for appellants disagreeing with the Agency of Original Jurisdiction's (AOJ) decision on a claim.

Following an April 2025 Department of Veterans Affairs (VA) Regional Office (RO) rating decision denying service connection for multiple myeloma, the appellant submitted a December 2025 VA Form 10182, Notice of Disagreement (NOD), appealing the denial.  The NOD requested direct review by the Board of Veterans' Appeals (Board).  Direct review is the appeal option to the Board in which a Board decision is issued based on evidence of record at the time of the prior decision.  The Board cannot hold a hearing or accept into the record additional evidence in its direct review.

Service Connection for Multiple Myeloma is Granted

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether persuasive weight of the evidence is against a claim, in which case, the claim is denied.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

Prior to death the Veteran sought service connection for multiple myeloma as due to one or more in-service TERAs.  In the April 2025 rating decision on appeal, the AOJ made favorable findings of a multiple myeloma diagnosis prior to the Veteran's death, and found that the Veteran had non-deployment-related TERA exposures during service related to the Veteran's duties as an Abrams Armor Crewman.  Under the AMA the Board is bound by such favorable findings.  38 C.F.R. §§ 3.104(c), 20.801.  Further, in a March 2026 Higher-Level Review (HLR) Return, the AOJ made a favorable finding that the negative VA TERA opinions of record are inadequate for VA rating purposes.  As the Board is bound by such finding, the Board will not rely on the negative VA opinions in this decision. 
 decision on appeal, the AOJ made favorable findings of a multiple myeloma diagnosis prior to the Veteran's death, and found that the Veteran had non-deployment-related TERA exposures during service related to the Veteran's duties as an Abrams Armor Crewman.  Under the AMA the Board is bound by such favorable findings.  38 C.F.R. §§ 3.104(c), 20.801.  Further, in a March 2026 Higher-Level Review (HLR) Return, the AOJ made a favorable finding that the negative VA TERA opinions of record are inadequate for VA rating purposes.  As the Board is bound by such finding, the Board will not rely on the negative VA opinions in this decision.  Id.

During the course of this appeal the appellant submitted an October 2024 private opinion letter.  Per the opinion letter, the private physician reviewed the evidence of record and consulted the medical literature.  The private physician explained that TERAs related to the Veteran's in-service responsibilities as an Abrams Armor Crewman would have resulted in the Veteran being exposed to benzene.  As the medical literature reflects a link between benzene exposure and blood-related cancers such as multiple myeloma, the private physician opined that it was at least as likely as not that the Veteran's multiple myeloma was a direct result of TERAs related to the Veteran's responsibilities as an Abrams Armor Crewman during service.

The above evidence is sufficient to render the question of direct service connection at least in relative equipoise.  For these reasons, resolving all reasonable doubt in favor of the appellant, the Board finds that the criteria for service connection for multiple myeloma, on a direct basis, have been met.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82.

 

 

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Blowers, 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.