Multiple Myeloma service connection denied

[Mark Bradley]

I recently received a "Service connection for myeloma multiple is denied" rating decision. I visited my local Disabled American Veterans chapter and they are in the process of helping me submit a VA Form 20-0995 Decision Review Request: Supplemental Claim. 

My purpose for posting in this forum is to ask for advice on how to appropriately present my supplemental information; more specifically, are there "magical" words I should be using in my Nexus letter?

I retired from the Air Force after 24 years on active duty (1987-2011). I was stationed in Minot, ND (pesticides to mitigate mosquitos) and Korea (pollution and Chinese yellow dust); and also was deployed to Afghanistan. I was a missileer in Minot, and spent 200 alerts over 4 years underground in a capsule with air and sewage problems. I retired in Colorado Springs.

I was diagnosed with Multiple Myeloma on 20 Feb 20 and received a stem cell transplant on 22 Jul 20. My current life expectancy based on my Kappa Free Light Chains number is 6-10 years.

My Colorado Springs oncologist wrote a letter for my VA disability application. Part of it reads, "There are there are multiple etiologies/contributing risk factors for multiple myeloma and it is hard to pin-point one single event that could have caused his cancer. It is very possible Mark was exposed to something prior to his retirement in April 2011 that caused the cancer. It is possible during his deployment to Afghanistan in 2009 or his multiple trips to Korea he was exposed to a cancer-causing agent, but we cannot conclude this definitively at this time."  

It's impossible to narrow down the cause of multiple myeloma to one event or deployment. In fact, my Denver oncologist asked me if I had grown up on a farm. So it seems the trigger for multiple myeloma could have happened many years ago, and the cancer then manifested itself last year. Bottom line, I find it hard to believe my multiple myeloma was triggered in the past 10 years of retirement and not in the previous 24 years on active duty.

I'm going to visit my Denver oncologist on 13 July (who is a multiple myeloma specialist) and ask him to write a letter to the VA. I don't want him to misrepresent my condition or the cause for my cancer, but I want to be able to use the correct words to try to strengthen my disability case. 

Thanks for reading this all the way to the end.

Mark

[john999]

If you get a doctor to do a exam for you he/she must say that in their medical opinion you myeloma was caused by your exposure to cancer causing agents while you served your country.  You can't have half-steps like "possibly" or "could have".  The report from your oncologist is poison.  Your oncologist's opinion is probably the reason you were denied.  He did more harm than good.

[GBArmy]

I agree with John999, That IMO is terrible. Give your doc a draft that you do as a guide. It has to be definite, not a wishy-washy "could." "It is my opinion based on "x" years of practice  that ... IS the  cause of his  cancer. (or is at least as likely as not the cause of his cancer) It is also born out by studies and clinical trials.... . He lists and provides links to those technical journals or studies. 

[Berta]

There are many causes of Multiple Myeloma.

There are 238.972 decision at the BVA that awarded remand or deny this disability

Over 27, 000 involve Agent Orange as this is an Agent Orange preumptive but your period of service rules the AO nexus out.

I agree the IMO/IME will not help you at all. It does not follow the IMO criteria here at hadit in the IMO/IME forum.

You will need an IMO/IME based on the specific reason or exposure that gave you the Mukltiple Myelona.

These BVA cases show what I mean:

 

https://www.va.gov/vetapp14/Files6/1450421.txt

multiple myeloma  granted due to  exposure to ionizing radiation

https://www.va.gov/vetapp12/files5/1230710.txt

 

:Based upon the Veteran's conceded exposure (beyond Camp Lejeune), the kind of exposure as well as the duration of his exposure while stationed at El Toro, the statement from Dr. E. that it was biologically plausible that the Veteran's benzene exposure was the cause of his multiple myeloma, the statement from his treating physician's office that the Veteran's exposure to solvents could have contributed to his malignancy, and the possible interpretation of Dr. E's statement to mean (though this is very unclear) that it was at least as likely as not that the Veteran's multiple myeloma was related to his benzene/jet fuel exposure, reasonable doubt must be resolved in the Veteran's favor."

(Although the veteran was exposed to contaminated water at Camp LeJuene, his benezene exposure wasthe prime cause of his melanoma.

https://www.va.gov/vetapp19/files10/19182122.txt

This veteran proved constant sun exposure while in service, as causing his myeloma ( skin cancer)

You might find cases of exposure to solvents etc that are similar to yours:

If you can prove exposure to any solvent or extreme sunlight, or iodizing radiation on any form, by virtue of your MOS, then with a better IMO/IME that conforms to the IMO.IME criter here , you can succeed in the claim.

https://www.bva.va.gov/    the decisio search featureis on the right hand side.

 

[Berta]

https://community.hadit.com/topic/53826-read-first-if-getting-an-imo/

This is the format VA is familiar with as to the proper wording of the nexus statement.

I based this artile on 2 excellent IMOs I had obtained long ago from Dr.Bash, aNeuro radiologist, who

also had worked for the VA and knew exactly what the VA needed in the IMOs he did for me.

[Mark Bradley]

Thank you everyone for such detailed responses. This provides amazing content to create a sample document for my Denver oncologist to read and use as a template for a new IMO/IME. Thank you for taking the time to provide these responses. 

Mark