LEUKEMIA

TIMOTHY COTHREL · 2026 · Case ID: A26040850

GRANTED

Summary

The Veteran served on active duty from March 1969 to January 1972. The appellant, the Veteran's surviving spouse, appealed the denial of service connection for lymphocytic leukemia, diabetes mellitus type II, bilateral lower extremity neuropathy, and cause of death. The Board found that the Veteran's MOS as a Dental Hygienist and his service at Dugway Proving Ground, where chemical tests including herbicide agents were conducted, established a likely exposure to various chemicals. The Veteran also reported potential exposure to Agent Orange at Dugway. Medical literature and the Veteran's own statements linked these exposures and his diabetes to his lymphocytic leukemia. The Board applied the "but-for" causation standard and the benefit-of-the-doubt doctrine, finding that the evidence was at least approximately balanced, warranting service connection for lymphocytic leukemia and diabetes. The Board also granted secondary service connection for bilateral lower extremity neuropathy, noting it was a complication of the now service-connected diabetes. Finally, because the leukemia and diabetes were significant contributing factors to the Veteran's death, service connection for cause of death was also granted. The Board granted service connection for lymphocytic leukemia, diabetes, bilateral lower extremity neuropathy, and cause of death.

Rationale

38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303; MOS as Dental Hygienist at Dugway Proving Ground; Likely exposure to chemicals including mercury, PRA, BisGMA, BHT, HMBP, DPCL, TPSb, HERAM, TEGOMA; Veteran reported potential exposure to Agent Orange at Dugway; Medical literature links exposures to lymphocytic leukemia; Benefit-of-the-doubt doctrine applied

Special Benefit

DIC / CAUSE OF DEATH

Docket No.

250822-569886

Full Decision Text

Citation Nr: A26040850
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250822-569886
DATE: April 30, 2026

ORDER

Entitlement to service connection for chronic lymphocytic leukemia (lymphocytic leukemia) is granted.

Entitlement to service connection for diabetes mellitus type II (diabetes) is granted.

Entitlement to service connection for bilateral lower extremity neuropathy is granted.

Entitlement to service connection for cause of death is granted.

FINDINGS OF FACT

1. The Veteran died in July 2021, and the appellant is his surviving spouse.

2. The appellant's claim for accrued benefits was received on July 22, 2022, thus, within one year of the Veteran's death.

3. At the time of the Veteran's death, claims for service connection for lymphocytic leukemia, diabetes, and bilateral lower extremity neuropathy were pending.

4. The Veteran was exposed to a variety of toxic substances during service.

5. But for his in-service exposure to toxic substances, the Veteran would not have developed lymphocytic leukemia or diabetes.

6. The Veteran's bilateral lower extremity peripheral neuropathy was caused by his diabetes.

7. Lymphocytic leukemia and diabetes both significantly contributed to the Veteran's death.

CONCLUSIONS OF LAW

1. The criteria for service connection for lymphocytic leukemia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for diabetes have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for bilateral lower extremity peripheral neuropathy, to include on a secondary basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for the Veteran's cause of death have not been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1969 to January 1972. The Board appreciates his service to our country, and the sacrifices it entailed. The Veteran passed away on July 31, 2021. The appellant in this case is the Veteran's surviving spouse. She has been substituted as the appellant for purposes of the claim for service connection for lymphocytic leukemia, diabetes, and bilateral lower extremity neuropathy that were pending at the time of the Veteran's death.

This case comes before the Board of Veterans' Appeals (Board) from an August 2024 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 lymphocytic leukemia, diabetes, bilateral lower extremity neuropathy, and cause of death after the appellant submitted a VA Form 21-534EZ Application for Dependency and Indemnity Compensation or Death Pension by a Surviving Spouse or Child.

In the August 22, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may consider only that evidence of record at the time of the August 2024 AOJ decision on appeal, as well as any evidence submitted within 90 days of receipt of, the VA Form 10182. If other evidence was received, the Board could not consider it. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider evidence the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify such evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, 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 lymphocytic leukemia is denied.

2. Entitlement to service connection for diabetes is denied.

Service connection will be granted if the evidence demonstrates that a current disability had its onset during service, or resulted from an injury or disease incurred during service. 38 U.S.C. § 1110; 38 C.F
al Claim (VA Form 20-0995) and submit or identify such evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, 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 lymphocytic leukemia is denied.

2. Entitlement to service connection for diabetes is denied.

Service connection will be granted if the evidence demonstrates that a current disability had its onset during service, or resulted from an injury or disease incurred during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a), (d). Thus, if the claimed disability did not manifest until after service, establishing service connection generally requires evidence of three things: (1) a current disability; (2) an in-service disease or injury; and (3) a cause-and-effect relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018).

In the August 2024 VA rating decision, the AOJ favorably found that the Veteran had diagnoses of lymphocytic leukemia and diabetes. The current disability requirement has thus been met.

The April 2024 TERA opinion found that the Veteran's military specialty (MOS) was Dental Hygienist, and found further that considering his period of service it was possible that he was exposed to many chemicals used in composite resin for tooth filling such as mercury, PRA, BisGMA, BHT, HMBP, DPCL, TPSb, HERAM, and TEGOMA. Therefore, the in-service injury element has been met.

The remaining issue is thus whether there is a relationship between the current lymphocytic leukemia and diabetes and the in-service exposure.

In a June 2013 VA 21-4138 Statement in Support of Claim the Veteran reported that while stationed at Dugway he was ordered to work on a broken cooler. Further, the Veteran reported that he was advised that there was Agent Orange stored in the cooler and was advised not to physically touch it. However, the Veteran reported that, at the time, he was not aware of the dangers and effects of Agent Orange exposure. The Veteran reported that he was diagnosed with lymphocytic leukemia and was told by his VA physician that his lymphocytic leukemia was directly related to this incident.

In addition, the appellant submitted a medical article titled, "Occupational hazards to dental staff". There the researchers outlined potential occupational hazards faced by dental staff, in relevant part, exposure to toxins including mercury that can have a long-term effect on health. The appellant also submitted a collection of articles that discussed the effects of Agent Orange and other herbicide agents tested and stored at Dugway. Within, it was reported that Dugway, where the Veteran was stationed, had chemical tests including the use of herbicide agents with potential soil contamination due to these tests. In turn, it is suggested that soil blowing into the air possibly resulted in exposure to these herbicide agents. See July 28, 2022, Web/ HTML Documents pg. 12, 24-25, 28. Further, the articles reported secret military tests that exposed sailors to chemical and germ weapons in the 1960's referred to as Project 112. This testing program was overseen in part at Dugway. See July 28, 2022, Web/ HTML Documents pg. 29-31.

Moreover, the appellant's representative included several articles discussing soil contamination due to Agent Orange in places such as Vietnam and the potential health effects of inhalation of dioxin contaminated soil. See July 28, 2022, Web/ HTML Documents pg. 50-51, 61, 68-70, 116-120. Sacks v. West, 11 Vet. App. 314, 317 (1998) (medical article and treatise evidence may suffice to establish nexus in instances where "standing alone, [it] discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion").

The April 2024 TERA memorandum indicated that the Veteran served at Dugway Proving Ground. While his service was several years after Agent Orange was tested at the site and there was no indication in his military records that he was exposed to herbicides, due to his MOS of Dental Hygienist, he was likely exposed to chemicals used in composite resin for tooth filling.

The Board is cognizant of the need to
) (medical article and treatise evidence may suffice to establish nexus in instances where "standing alone, [it] discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion").

The Board is cognizant of the need to "stay in its lane," so to speak, and avoid invading the province of scientific or medical experts by exercising independent judgment on matters requiring specialized knowledge. See, e.g., Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Yet, the Board also notes lay evidence can establish any element of service connection. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Kahana v. Shinseki, 24 Vet. App. 428 (2011); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).

When evaluating claims for service connection, the Board must scrupulously apply the standards of proof pertaining to the award of disability benefits, which may sharply diverge from the type of evidence and degree of certainty employed in a medical setting.

As the Supreme Court has explained, the standard of proof instructs the fact finder as to two key matters: 1) the "degree of confidence" they should feel in the correctness of the finding; and 2) the allocation of the risk of error-in other words, where to assign the benefit of the doubt. Addington v. Texas, 441 U.S. 418, 423 (1979); Santosky v. Kramer, 455 U.S. 745, 754-55 (1982).

When adjudicating entitlement to service connection, only a "but-for" causal relationship between an in-service disease or injury and a present disability is required. Therefore, an in-service injury, disease, or event need not be the sole cause or even the primary cause of the claimed disability for service connection to apply-rather, it need only be an essential factor in the development of the disability. In other words, no matter how much or how many other factors also contributed to the claimed disability, if removing the service-connected injury, disease, or event from the equation would have prevented the development of the disability, then service was an essential factor in and a but-for cause of the disability, and service connection for that disability is established. 38 U.S.C. § 1110; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023); see also, Burrage v. United States, 571 U.S. 204, 211-12 (2014).

Additionally, in many cases, where "positive proof" of a fact is not realistically possible, the Board, as the finder of fact, will "resort to circumstances as the means of ascertaining the truth," and even when the circumstances are independently inconclusive, the Board may determine they "constitute conclusive proof" based on "their number and joint operation, especially when corroborated by moral coincidences." Slavers, 69 U.S. 383, 401 (1865). See also, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011) (drawing inferences from the available evidence is the "heart" of the Board's adjudicatory role).

Turning to the degree of certainty necessary to find in favor of an appellant, in American jurisprudence, there is a "wide spectrum" of standards, and the VA's "benefit-of-the-doubt" doctrine lies at "the farthest end of the spectrum...." Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). In other words, no party in any adjudicative forum is entitled to greater deference in establishing their case than a veteran who has brought an appeal to the Board.

This is a matter not only of judicial precedent, but of legislative intent and moral logic: Congress created the benefit-of-the-doubt doctrine as a unique and intentionally generous standard of proof for veterans' appeals, in recognition of the nation's great
in American jurisprudence, there is a "wide spectrum" of standards, and the VA's "benefit-of-the-doubt" doctrine lies at "the farthest end of the spectrum...." Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). In other words, no party in any adjudicative forum is entitled to greater deference in establishing their case than a veteran who has brought an appeal to the Board.

In operation, the benefit-of-the-doubt doctrine mandates a finding in favor of a claimant if the evidence before the Board is insufficient to eliminate all reasonable doubt concerning the existence of a disability, the occurrence of an in-service event, or the but-for cause-and-effect relationship between service and a claimed disability. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

"Reasonable doubt" is deemed to exist if the positive evidence for the claim and the negative evidence against it are at least "approximately balanced" or nearly equal." Id.; Ortiz v. Principi, 274 F.3d 1361, 1364-1365 (Fed. Cir. 2001). As a result, the Board denies an appeal only when the evidence as a whole is persuasively against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc); Mattox v. McDonough, 56 F.4th 1369, 1378-1379 (2023).

After a review of the evidence as a whole, the Board finds there is sufficient evidence to find it is at least approximately as likely as not the Veteran was exposed to toxic substances during service that were a "but-for" cause of his leukemia and diabetes. As a result, service connection for those two disabilities is warranted. This appeal is granted.

3. Entitlement to service connection for bilateral lower extremity neuropathy secondary to diabetes is granted.

Secondary service?connection?is warranted for a disability if that disability is caused by a service-connected?disease or?injury. 38?C.F.R. §?3.310.

In the August 2024 rating decision, the AOJ favorably found that the Veteran was diagnosed with bilateral lower extremity neuropathy. Thus, the existence of the claimed disability has been established.

A May 2021 podiatry note from the North Little Rock Veterans Healthcare Center alludes to the Veteran's "diabetes mellitus with neuropathy," and references a December 2010 diagnosis of "diabetic neuropathy." Additionally, a May 2020 endocrinology note from the same facility describes the Veteran's neuropathy as a complication of this diabetes. See May 2023 CAPRI record. Therefore, the evidence that the Veteran's neuropathy was caused by his diabetes is compelling, and as a result of this decision, the Veteran's diabetes is now service connected.

In conclusion, secondary service connection is warranted here. This appeal is granted.

4. Entitlement to service connection for cause of death is granted.

A veteran's cause of death is service-connected when the evidence establishes a service-connected disability was either the principal cause or a contributory cause of their death. 38 C.F.R. § 3.312(a).

The principal (or primary) cause of death is a condition that by itself or jointly with some other condition was an immediate or underlying cause of death, or was etiologically related to the immediate or underlying cause of death. 38 C.F.R. § 3.312. A contributory cause of death is a condition unrelated to the principal cause of death that nevertheless played a substantial or material role in causing the veteran's death. 38 C.F.R. § 3.312(c)(1); see also Gabrielson v. Brown, 7 Vet. App. 36, 39 (1994).

In this case, the Veteran's official "immediate" causes of death were respiratory failure and pneumonia, but leukemia and diabetes were "significant conditions contributing to [the Veteran's] death. See July 2022 Death Certificate.

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The Veteran's leukemia and diabetes are now service connected, and therefore, by operation of law, so is his death. This appeal is granted.

Timothy Cothrel

Veterans Law Judge

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