MALIGNANT NEOPLASMS OF GYNECOLOGICAL SYSTEM OR BREAST

Summary

The veteran, who served from June 1997 to October 2001, appeals the denial of service connection for breast cancer. The veteran claims her cancer is linked to toxic exposure risk activities (TERAs) experienced during service, including exposure to chemicals in an operating room, a chemical leak, and PFAS. The Board found that the veteran has a current diagnosis of breast cancer and participated in TERAs during service, satisfying two of the three criteria for service connection. The central issue was the nexus between the breast cancer and the in-service TERAs, for which medical opinions conflicted. A VA examiner opined it was less likely than not that the cancer was related to TERAs, citing the lack of definitive studies linking PFAS to breast cancer and suggesting other risk factors like genetics and lifestyle. Conversely, the veteran's private oncologist opined it was more likely than not that the cancer was related to in-service chemical leaks and PFAS exposure, noting the absence of family history or genetic predisposition and the known carcinogenic properties of some chemicals. The Board found both opinions to be competent and reasoned, but ultimately applied the benefit of the doubt doctrine due to the conflicting evidence, granting service connection for breast cancer.

Rationale

Competent medical evidence of current disability (breast cancer); Competent medical evidence of in-service injury/disease (TERA exposure); Conflicting medical opinions on nexus, resolved by benefit of doubt

Full Decision Text

Citation Nr: A26039982
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250610-552593
DATE: April 29, 2026

ORDER

Entitlement to service connection for left breast cancer is granted.

FINDINGS OF FACT

1. The Veteran has breast cancer of the left breast.

2. During service, the Veteran participated in several toxic exposure risk activities (TERAs).

3. But for the Veteran's TERAs, she would not have developed breast cancer. 

CONCLUSION OF LAW

The criteria for service connection for breast cancer have been met.  38 U.S.C. § 1110, 5107(b); 38 C.F.R. § 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty from June 1997 to October 2001. The Board appreciates her service to our country, and the sacrifices it entailed.

This case comes before the Board of Veterans' Appeals (Board) from an April 2025 rating decision by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).  In that decision, the AOJ denied entitlement to service connection for breast cancer after the Veteran filed a VA Form 21-526 Veterans Application for Compensation or Pension. Following the April 2025 rating decision, the Veteran filed a VA Form 20-0996 Request for Higher-Level Review challenging the denial of her claim for entitlement to service connection for breast cancer. In a June 2025 rating decision, the AOJ continued the previous denial for entitlement to service connection for breast cancer.

In the June 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to service connection for breast cancer is granted.

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a relationship between the current disability and the in-service disease or injury.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).  Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

In the April 2025 rating decision, the AOJ favorably found that the Veteran had a diagnosis of breast cancer. The current disability requirement has thus been met.

In the April 2025 rating decision, the AOJ favorably found that the Veteran had participated in TERA during service.  Therefore, the in-service injury element has been met.

The remaining issue is thus whether there is a relationship between the current breast cancer and the in-service TERA.  There are conflicting medical opinions on this question.

In the January 2025 VA opinion, the examiner opined that it was less likely than not that the Veteran's breast cancer was related to in-service TERA. The examiner noted the Veteran's report that during her service at Fort Huachuca both she and another surgical tech had a miscarriage at the same time. The Veteran reported that her commanding officer was going to conduct tests to determine if the miscarriages were related to exposures experienced from duty, but the Veteran never heard anything further about it. The examiner noted that the Veteran went on to have three children. Further, the Veteran reported she was stationed at three other bases, and at those locations
 breast cancer and the in-service TERA.  There are conflicting medical opinions on this question.

In the January 2025 VA opinion, the examiner opined that it was less likely than not that the Veteran's breast cancer was related to in-service TERA. The examiner noted the Veteran's report that during her service at Fort Huachuca both she and another surgical tech had a miscarriage at the same time. The Veteran reported that her commanding officer was going to conduct tests to determine if the miscarriages were related to exposures experienced from duty, but the Veteran never heard anything further about it. The examiner noted that the Veteran went on to have three children. Further, the Veteran reported she was stationed at three other bases, and at those locations was exposed to "PCBs". The examiner noted that the Veteran did not have the gene for breast cancer and no one in her family had breast cancer. The examiner explained Polychlorinated biphenyls (PCBs) are mixtures of up to 209 individual chlorinated compounds that were used in manufacturing. However, in 1977 because of evidence that PCBs build up in the environment and cause harmful health outcomes, their use in manufacturing was discontinued. The examiner indicated that there is a blood test for PCBs, however, it is not recommended that people be tested because it is likely that everyone has detectable levels of PCBs and that testing does not tell when, where, or how much PCB the person came into contact with. 

Thus, the examiner determined that it was unlikely PCBs or any other TERA was the cause of the Veteran's breast cancer. Rather, the examiner reviewed the known causes of breast cancer and reported that the Veteran had met several criteria. Thus, the examiner opined that it was less likely than not that the Veteran's breast cancer was related to in-service TERA. 

In the January 2025 private opinion, the examiner opined that it was more likely than not that the Veteran's breast cancer was related to in-service TERA. The private examiner, the Veteran's oncologist and hematologist, noted that the Veteran had been under her care since September 2024. The examiner reported that she performed a thorough review of the Veteran's medical records and the relevant medical literature. She noted the Veteran's exposure to chemicals in the operating room during her service as a MOS Operating Room Specialist. The examiner noted that during her service the Veteran was exposed to a chemical leak. 

Further, she noted that the Veteran had a miscarriage and underwent D&E surgery while in service. Importantly, the examiner noted that the Veteran was exposed to PFAS (polyfluoroalkyl substance) which also put her at high risk for cancer development. The examiner explained that there is extensive research that supports a link between exposure to chemical leaks in an operating room that can potentially increase the risk of cancer due to the presence of known carcinogenic compounds which can be inhaled by surgical staff if not mitigated. Moreover, exposure to PFAS has been researched and found that it can cause a number of health issues, including cancer. The examiner noted that the Veteran was tested for a breast cancer gene and it was negative. 

Also, the Veteran has no family history of breast cancer or any other known significant risk factors for breast cancer. Thus, the examiner found, after considering the detailed medical history, known scientific evidence, and lack of alternative explanations, it is more likely than not that the Veteran's breast cancer was related to in-service TERA. 

In an April 2025 VA opinion, the examiner opined that it was less likely than not that the Veteran's breast cancer was related to an in-service TERA after considering 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. The examiner reviewed the Veteran's medical file and the relevant medical literature and noted the Veteran's MOS as Operating Room Specialist. Further, the examiner noted that the Veteran's TERA memo conceded for exposure to bodily fluids, contagious diseases, biohazards, and other toxins. However, the examiner found that there were no peer reviewed studies in the medical literature that indicate working in the operating room directly exposes healthcare workers to higher risks of breast cancer than other professions. Further, the examiner noted that Polychlorinated biphenyls (PCBs) are manufactured organic chemicals that are no longer produced in the United States, but are still in the environment and can cause health problems. The examiner explained that products made before 1977 that may contain PCBs include old fluorescent lighting fixtures and electrical devices containing PCB capacitors, and old microscope and hydraulic oils. The examiner noted that the Veterans at risk for PCB exposure during military service are those who, before 1977, worked on repair and maintenance of PCB transformers, capacitors, and conduits. However, the Veteran's service dates of June 1997,
 working in the operating room directly exposes healthcare workers to higher risks of breast cancer than other professions. Further, the examiner noted that Polychlorinated biphenyls (PCBs) are manufactured organic chemicals that are no longer produced in the United States, but are still in the environment and can cause health problems. The examiner explained that products made before 1977 that may contain PCBs include old fluorescent lighting fixtures and electrical devices containing PCB capacitors, and old microscope and hydraulic oils. The examiner noted that the Veterans at risk for PCB exposure during military service are those who, before 1977, worked on repair and maintenance of PCB transformers, capacitors, and conduits. However, the Veteran's service dates of June 1997, to October 2001, would place her at no risk for exposure to PCB. Further, the most common health problems for people exposed to large amounts of PCBs are skin conditions such as acne and rashes. 

The examiner noted that as to Perfluoroalkyl and polyfluoroalkyl substances (PFAS), they are synthetic chemicals found in many products, such as clothing, carpets, fabrics for furniture, adhesives, paper packaging for food, and heat-resistant/non-stick cookware. They are persistent in the environment and can accumulate in the body, leading to potential health concerns. Exposure to PFAS has been linked to various health concerns, including cancer, hormone disruption, and immune system problems. However, there are no peer reviewed studies in humans which have shown link between exposure to PFAS and breast cancer. PFAS have endocrine-disrupting abilities, which can increase circulating estrogen levels and potentially contribute to breast cancer development and progression. In vitro studies suggest that PFAS may also act as androgen antagonists and activate the estrogen receptor, although experimental evidence in animals is inconsistent. For example, PFAS did not induce outcomes in mice that would be indicative of substantial estrogenic potency, suggesting PFAS may be only weakly estrogenic. A growing number of epidemiologic studies have evaluated the relationship between PFAS and breast cancer although conclusions have been limited by largely inconsistent findings. The study in the American Journal of Epidemiology concluded that the current epidemiologic evidence is not adequate to draw conclusions regarding the association between PFAS exposure and breast cancer risk. 

The examiner noted that the Veteran's TERA memorandum also indicated exposure to bodily fluids, contagious diseases, biohazards, and other toxins. The examiner opined that this is a vague statement of exposure with respect to biohazards and other toxins. Further, there is no known association between breast cancer and exposure to bodily fluids or contagious diseases. Breast cancer risk factors include being female, age, family history, genetics, certain breast changes, radiation exposure, and lifestyle choices like alcohol consumption, obesity, and lack of physical activity. Being a woman is the primary risk factor, as breast cancer is far more common in women than men. Premenopausal breast cancer risk factors include a family history of breast cancer, genetic mutations (like BRCA1 and BRCA2), early menstruation, late menopause, and dense breasts. The examiner concluded these factors were more likely the cause of the Veteran's breast cancer. Thus, the examiner opined that it was less likely than not that the Veteran's breast cancer was related to an in-service TERA.

The Board assigns some probative weight?to both the VA opinions and the private opinion as both explained their rationale in the context of the evidence of record. Nieves-Rodriguez v. Peake,?22?Vet. App.?295, 304?(2008) (most of the probative value of a medical opinion comes from its reasoning); Acevedo v. Shinseki,?25?Vet. App.?286, 294?(2012) (medical reports must be read as a whole and in the context of the evidence of record).

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Thus, the Board finds the evidence here boils down to competent medical experts providing contradictory opinions.? By definition, then, despite any flaws in the pro-Veteran opinion, the positive and negative evidence is at least approximately balanced or nearly equal. As such, service connection is warranted, and this appeal is granted.

 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.D. Strain, Associate 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. 


 approximately balanced or nearly equal. As such, service connection is warranted, and this appeal is granted.

 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.D. Strain, Associate 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.