LEUKEMIA

P.M. DILORENZO · 2026 · Case ID: A26040519

GRANTED

Summary

The Veteran, a Veteran who served from April 1969 to November 1970, including service in Vietnam, appeals the denial of service connection for acute myeloid leukemia (AML). The Veteran claims his AML is related to herbicide agent exposure during service. The Board reviewed the case under the Appeals Modernization Act, noting the Veteran elected the Hearing docket and a hearing was held on April 23, 2026. The Board considered evidence of record up to the January 2026 AOJ decision and evidence submitted before the hearing. The Veteran's AML was diagnosed in September 2025, satisfying the current disability element. Due to his Vietnam service, herbicide exposure is presumed under 38 U.S.C. § 1116. The Board found a private medical opinion from the Veteran's treating oncologist, R.R., M.D., to be especially probative. This opinion linked the AML to herbicide exposure, citing TCDD's role in leukemogenesis and the association between herbicide exposure, myelodysplastic syndrome (MDS), and AML. The Board found this opinion well-reasoned and based on specific facts. In contrast, a January 2026 VA medical opinion was found inadequate because it relied on general medical principles and did not meaningfully analyze the Veteran's specific circumstances, despite acknowledging smoking as a risk factor. The Board found the evidence persuasively favored service connection, granting it due to the probative private opinion and presumed herbicide exposure, rendering the benefit of the doubt rule inapplicable. Service connection for AML is granted.

Rationale

Current disability established by September 2025 diagnosis.; In-service exposure presumed due to Vietnam service.; Probative private medical opinion linked AML to herbicide exposure.; Inadequate VA medical opinion did not outweigh private opinion.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260210-631524

Full Decision Text

Citation Nr: A26040519
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260210-631524
DATE: April 30, 2026

ORDER

Entitlement to service connection for acute myeloid leukemia (AML) is granted.

FINDING OF FACT

The Veteran is diagnosed as having acute myeloid leukemia that was caused by his exposure to herbicide agents during his service in Vietnam.

CONCLUSION OF LAW

The criteria for entitlement to service connection for acute myeloid leukemia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 1969 to November 1970. For the Veteran's service, he was awarded the Vietnam Service Medal and the Vietnam Campaign Medal with Device (1960) and 2 O/S Bars.

The Rating Decision on appeal was issued in January 2026; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the February 10, 2026, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 23, 2026.

On January 13, 2026, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of his claim for service connection for AML most recently addressed in a November 2025 Rating Decision. On January 28, 2026, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

Therefore, the Board may only consider the evidence of record at the time of the January 2026 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or 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 AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Here, the Board acknowledges it is adjudicating the Veteran's claim for service connection for AML prior to the expiration of the 90 days following the April 23, 2026, Hearing. However, the Board finds there is no prejudice to the Veteran in adjudicating this matter prior to the expiration of the 90 days, given the Board's decision here, granting service connection, a full grant of the benefits sought on appeal.

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 Veteran's claim for service connection for AML, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection generally will be awarded when a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1112; 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).

To establish service connection on a direct basis, the evidence must show: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link between the current disability and the disease or injury incurred or aggravated in service (the "nexus" element). See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

In the case of Veterans who served in the Republic of Vietnam during the period beginning on January 9, 1962, and
to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In the case of Veterans who served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, service connection can be presumed for certain diseases based on presumed exposure to herbicides. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). However, AML is not such a disease. Id. Notwithstanding the foregoing, service connection for colon cancer based on herbicide exposure may still be granted with proof of direct causation. See 38 U.S.C. § 1113; Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet. App. 40, 44 (1996).

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 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. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply. Lynch, 21 F.4th at 781-82.

Entitlement to service connection for AML is granted.

The Veteran seeks entitlement to service connection for AML related to his herbicide agent exposure while he was serving in Vietnam from September 1969 to November 1970. The AOJ decision on appeal denied entitlement to service connection as the evidence of record did not demonstrate a "nexus" or link between the Veteran's AML and his herbicide agent exposure. For the reasons discussed below, the Board finds that service connection is warranted.

The January 2026 VA Hematologic and Lymphatic Conditions, Including Leukemia Disability Benefits Questionnaire, demonstrates that the Veteran was diagnosed with AML in September 2025. A September 2025 private Bone Marrow Pathology Report states that genetic studies support a finding of AML with myelodysplasia. Therefore, the first element of service connection, a current disability, is satisfied.

Here, because the Veteran served in the Republic of Vietnam, as shown in the service personnel records, he is presumed to have been exposed to an herbicide agent such as Agent Orange and its chemical ingredients such as dioxin, as there is no affirmative evidence to the contrary. See 38 U.S.C. § 1116(c) and (d).

Based on the above, the Board finds that the first two elements of service connection have been met-a current disability and an injury or a disease incurred in service. Thus, the only remaining question is whether there is evidence establishing a nexus between the Veteran's AML and his in-service herbicide agent exposure. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury, or a disease incurred in service.").

The Veteran's claims file contains a December 2025 private medical opinion from his treating medical oncologist, R.R., M.D., that concludes that his AML is associated with his in-service herbicide agent exposure. In support, the private medical opinion states that exposure to herbicide agents is associated with myeloid cancers primarily through the presence of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD), a highly toxic contaminant that can alter human genetic code. TCDD acts through the aryl hydrocarbon receptor (AHR), which is critical for the health of hematopoietic stem cells and defects in this receptor have been directly implicated in leukemogenesis or the development of leukemia. The private medical opinion provides that herbicide agent exposure is strongly linked to myelodysplastic syndrome (MDS), which is a group of bone marrow disorders often referred to as "pre-leukemia" that frequently progresses to AML. Clinical data show that veterans exposed to herbicide agents tend to develop these blood cancers earlier and experience more aggressive disease progression, which is characterized by a higher frequency of genetic mutations.

The Board finds that the determination of the December 2025 private examiner concerning the relationship between the Veteran's AML and his in-service herbicide agent exposure to be especially probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that the probative value of a medical opinion comes from its reasoning and therefore is not entitled to any weight if it contains only data and conclusions). The findings contained in the private medical opinion are made by the physician who is treating the Veteran for his AML, and are underpinned by sufficient rationale, consideration of the medical and lay evidence of record, and citation to relevant medical literature. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"); see also Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion). And although there is no "treating physician rule" requiring the Board to give additional evidentiary weight to the opinion of a physician or other healthcare provider that has treated the Veteran, such a clinician does have an intimate knowledge of the severity of his condition over a span of time and his reported medical history. See White v. Principi, 243 F.3d 1378 (Fed. Cir. 2001); Van Slack v. Brown, 5 Vet. App. 499, 502 (1993); Chisem v. Brown, 4 Vet. App. 169 (1993) (noting that there is no "treating physician rule" requiring the Board to give additional evidentiary weight to opinions of doctors who have evaluated or treated the Veteran over time, but it is permissible for the Board to bear this length of treatment in mind when considering just how familiar with the Veteran's condition the clinician may be).

The Board notes that the Veteran's claims file contains a January 2026 VA medical opinion that concludes that it is less likely than not that the Veteran's AML is related to his in-service herbicide agent exposure. In support, the medical opinion states that several factors have been implicated in the causation of AML, including antecedent hematologic disorders, familial syndromes, environmental exposures, and drug exposures.

The January 2026 VA medical opinion provides that most patients who present with de novo AML have no identifiable risk factor. However, the most common risk factor for AML is the presence of an antecedent hematologic disorder, the most common of which is myelodysplastic syndrome (MDS). MDS is a bone marrow disease of unknown etiology that occurs most often in older patients and manifests as progressive cytopenias that occur over months to years. Patients with low-risk MDS generally do not develop AML, whereas patients with high-risk MDS frequently do.

The January 2026 VA medical opinion goes on to discuss certain hematological disorders, congenital disorders, genetic disorders, hereditary cancer syndromes, radiation exposure, and tobacco use can predispose some patients to AML. The medical opinion provides that people who smoke tobacco have a small but statistically significant increased risk of developing AML. In several studies, the risk of AML was slightly increased in people who smoked compared with those who did not smoke. The medical opinion states that the Veteran
unknown etiology that occurs most often in older patients and manifests as progressive cytopenias that occur over months to years. Patients with low-risk MDS generally do not develop AML, whereas patients with high-risk MDS frequently do.

The January 2026 VA medical opinion goes on to discuss certain hematological disorders, congenital disorders, genetic disorders, hereditary cancer syndromes, radiation exposure, and tobacco use can predispose some patients to AML. The medical opinion provides that people who smoke tobacco have a small but statistically significant increased risk of developing AML. In several studies, the risk of AML was slightly increased in people who smoked compared with those who did not smoke. The medical opinion states that the Veteran's significant smoking history has likely led to the development of his AML.

However, the Board declines to accept the January 2026 VA medical opinion as it relies on general medical principles and articles and does not include a meaningful analysis of the Veteran's exposure or medical history, lay evidence, or other facts specific to him in concluding that his AML is not related to his in-service herbicide agent exposure. See Barr, 21 Vet. App. at 312 (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); see Stefl, 21 Vet. App. at 124-25; see also Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (an opinion is inadequate when based solely on general articles without a meaningful discussion of the facts pertaining to a veteran's condition or individual circumstances. The medical opinion simply states that several studies show the risk of AML is slightly increased in smokers and that the Veteran has a history of smoking before stating a conclusion but does not discuss the relationship between smoking and AML. See Dennis v. Nicholson, 21 Vet. App. 18, 22 (2007) "[M]erely listing evidence before stating a conclusion does not constitute an adequate statement of reasons and bases."

In sum, the evidence persuasively favors service connection for AML. Lynch, 21 F.4th at 781-82. In the absence of any probative evidence to the contrary concerning the relationship between the Veteran's AML and his in-service exposure to herbicide agents during his service in Vietnam, service connection for AML is warranted. 38 C.F.R. § 3.303. Consequently, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

P.M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mussey, Sean

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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