Citation Nr: 1320872	
Decision Date: 06/27/13    Archive Date: 07/05/13

DOCKET NO.  05-04 933	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Columbia, South Carolina


THE ISSUE

Entitlement to compensation under 38 U.S.C.A. § 1151 for ureteral obstruction with left hydronephrosis (claimed as a kidney disability).


REPRESENTATION

Appellant represented by:	The American Legion


ATTORNEY FOR THE BOARD

A.E.H. Gibson, Associate Counsel






INTRODUCTION

The Veteran had active duty service from June 1976 to June 1989.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2004 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Board remanded this appeal for additional development in August 2008, November 2010, February 2012, and December 2012. 

A review of the Virtual VA paperless claims processing system does not reveal any additional records that are not pertinent to this appeal.


FINDING OF FACT

The competent evidence of record does not show that the Veteran has additional disability caused by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA when it provided the Veteran with interferon-alpha treatment from June to December 1995, that there was a lack of informed consent, or that additional disability was caused by an event not reasonably foreseeable resulting from that treatment.


CONCLUSION OF LAW

The criteria for compensation under the provisions of 38 U.S.C.A. § 1151 for ureteral obstruction with left hydronephrosis have not been met. 38 U.S.C.A. § 1151 (West 2002); 38 C.F.R. § 3.361 (2012). 





REASONS AND BASES FOR FINDING AND CONCLUSION

In this decision, the Board will discuss the relevant law which it is required to apply. This includes statutes enacted by Congress and published in Title 38, United States Code ("38 U.S.C.A."); regulations promulgated by VA under the law and published in Title 38 of the Code of Federal Regulations ("38 C.F.R.") and the precedential rulings of the Court of Appeals for the Federal Circuit (as noted by citations to "Fed. Cir.") and the Court of Appeals for Veterans Claims (as noted by citations to "Vet. App.").

The Board is bound by statute to set forth specifically the issue under appellate consideration and its decision must also include separately stated findings of fact and conclusions of law on all material issues of fact and law presented on the record, and the reasons or bases for those findings and conclusions. See 38 U.S.C.A. § 7104(d); see also 38 C.F.R. § 19.7 (implementing the cited statute); see also Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999); Gilbert v. Derwinski, 1 Vet. App. 49, 56-57 (1990) (the Board's statement of reasons and bases for its findings and conclusions on all material facts and law presented on the record must be sufficient to enable the claimant to understand the precise basis for the Board's decision, as well as to facilitate review of the decision by courts of competent appellate jurisdiction). The Board must also consider and discuss all applicable statutory and regulatory law, as well as the controlling decisions of the appellate courts.

VA is to give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim for disability benefits. 38 U.S.C.A. § 1154(a) (West 2002). The Federal Circuit held that medical evidence is not always or categorically required in every instance to establish the required nexus or linkage between the claimed disability and the Veteran's military service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); but see Waters v. Shinseki, 601 F.3d 1274 at 1278 (Fed. Cir. 2010) ("VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to"). Citing to its previous decisions in Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) and Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007), the Federal Circuit stated in Davidson that it has previously and explicitly rejected the view that competent medical evidence is always required when the determinative issue in a claim for benefits involves either medical etiology or a medical diagnosis. See id. at 1316. 

The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a 3-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303 at 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. 

Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159. Lay evidence may be competent and sufficient to establish a diagnosis of a condition when:

(1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer);

(2) the layperson is reporting a contemporaneous medical diagnosis, or;

(3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. 

Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (where widow seeking service connection for cause of death of her husband, the Veteran, the Court holding that medical opinion not required to prove nexus between service connected mental disorder and drowning which caused Veteran's death). In essence, lay testimony is competent when it regards the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465 (1994). 

In ascertaining the competency of lay evidence, the Courts have generally held that a layperson is not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183 (1997). In certain instances, however, lay evidence has been found to be competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398 (1995) (flatfeet). Laypersons have been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). 

Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also include statements conveying sound medical principles found in medical treatises. It also includes statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1).

After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this function, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-512 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table); see Madden v. Brown, 125 F.3d 1447 (Fed Cir. 1997) (holding that the Board has the "authority to discount the weight and probative value of evidence in light of its inherent characteristics in its relationship to other items of evidence").

The standard of proof to be applied in decisions on compensation claims is set forth in 38 U.S.C.A. § 5107 (West 2002). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 
See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet.App. 518 (1996).


Duty to Notify and Assist

The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). 
	
Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2012); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and, (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). 

The record reflects the Veteran was provided with VCAA notice in February and March 2004, which informed him of his and VA's respective duties for obtaining evidence, and was provided prior to adjudications by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). He was not advised of the manner in which effective dates and disability ratings are assigned by a separate notice, however, information regarding these issues was included in the October 2009 Supplemental Statement of the Case (SSOC). Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Veteran is not prejudiced by the delay in this notification because his claim was readjudicated in December 2011, October 2012, and May 2013. Further, as the claim for benefits under 38 U.S.C.A. § 1151 is being denied, the issues of assigning an effective date and an appropriate disability rating will not be raised.

VA also has a duty to assist in the development of the claim. This duty includes assisting in the procurement of service treatment records (STRs) and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. A VA examination and opinion shall be provided when there is "an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service," but there is "insufficient competent medical evidence on file for the Secretary to make a decision on the claim." See 38 U.S.C.A. § 5103A(d); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 

The RO has obtained the Veteran's STRs and post-service VA and private treatment records. The Veteran has not identified any additional records that he wished the RO to obtain. Further, a VA examination was conducted in December 2010 and was added to and clarified in May 2013. The Board finds these examination reports, read in conjunction with one another, are adequate because the appropriate evaluations were conducted following a full review of the record; they are factually informed and fully explained. 

The RO complied with the Board's August 2008, November 2010, February 2012, and December 2012  remand directives. Stegall v. West, 11 Vet. App. 268 (1998); see D'Aries v. Peake, 22 Vet. App. 97 (2008) (finding that only substantial compliance, rather than strict compliance, with the terms of a Board engagement letter requesting a medical opinion is required). The RO obtained medical records, scheduled the appropriate VA examination, and readjudicated the claim as necessary.

All necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). Accordingly, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran in the development of this claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002).


Compensation under 38 U.S.C.A. § 1151

The Veteran argues that he is entitled to compensation under 38 U.S.C.A. § 1151  for additional disability resulting from treatment he received at the Columbia VA Medical Center (VAMC). Specifically, he asserts that the medication he was given to treat hepatitis C caused him to develop ureteral obstruction with hydronephrosis because the intravenous line was not adequately flushed. Alternatively, he argues that the obstruction was detected in 1993 and he was not told about it until 2003, causing him to incur undiagnosed back pain in the interim. 

The preponderance of the evidence is against the claim, and the appeal will be denied. Compensation is not warranted under 38 U.S.C.A. § 1151. 

The Veteran's claim for benefits under 38 U.S.C.A. § 1151 was filed after October 1, 1997, thus the current version of that statute and its implementing regulations applies. See VAOPGCPREC 40-97, 63 Fed. Reg. 31,263 (1998). Under section 1151, compensation shall be awarded for a qualifying additional disability or death of a veteran in the same manner as if the additional disability or death were service connected. Such is considered a qualifying additional disability or death under the law if it is not the result of the veteran's own willful misconduct and the disability or death was caused by VA hospital care, medical or surgical treatment, or examination, and the proximate cause of the additional disability or death was: 1) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the VA in furnishing the hospital care, medical or surgical treatment, or examination; or, 2) an event not reasonably foreseeable. 38 U.S.C.A. § 1151. 

In determining whether additional disability exists, VA compares the veteran's physical condition immediately prior to the hospital care or medical treatment upon which the claim for benefits is based with the physical condition after such care or treatment. 38 C.F.R. § 3.361(b). 

To establish causation, evidence must show that the VA medical treatment resulted in the veteran's additional disability. Merely showing that a veteran received care, treatment, or examination and that the veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). Medical treatment cannot cause the continuance or natural progress of a disease or injury for which the treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). The proximate cause of disability is the action or event that directly caused the disability, as distinguished from a remote contributing cause. 38 C.F.R. § 3.361(d). 

Whether the proximate cause of a veteran's additional disability or death was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. 38 C.F.R. § 3.361(d)(2). 

In addition to causation, it must also be shown that (1) VA failed to exercise the degree of care that would be expected of a reasonable health care provider, or (2) that VA furnished the hospital care, medical or surgical treatment, or examination without the veteran's or, in appropriate cases, the veteran's representative's informed consent. 38 C.F.R. § 3.361(d)(1); see also VAOPGCPREC 5-01. Determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32 (2012). Minor deviations from the requirements of 38 C.F.R. § 17.32 that are immaterial under the circumstances of a case will not defeat a finding of informed consent. 38 C.F.R. § 3.361(d)(1). The informed consent process must be appropriately documented in the medical record. 38 C.F.R. § 17.32(d). 

The Veteran's STRs show complaints of discharge and dysuria. He was tested for various sexually transmitted diseases, and was diagnosed with nonspecific urethritis. See STRs dated November 25, 1985; November 12, 1987; October 15, 1988. In June 1989, his creatinine was 1.3, which was within the normal range of 0.7 to 1.5. See id., dated June 12, 1989.

In December 1993, the Veteran was found to have inactive hepatitis. See VA treatment dated December 1993. He was advised of the risks of treatment with interferon in March and May 1995, and he began such treatment in June 1995. It was discontinued in December 1995. See VA treatment dated December 12, 1995.

The Veteran recommenced interferon treatment in June 2003. He voiced understanding of the treatment and side effects of the medicine, and stated he was comfortable giving himself injections. See VA treatment dated June 11, 2003.

The Veteran's ureter obstruction and hydronephrosis was discovered while testing his liver. A June 2003 CT (computed tomography) scan showed some hydronephrosis of the left kidney, and that the left ureter was dilated to the level of the bladder. A September 2003 IVP showed that the Veteran's left kidney was markedly dilated to the level of the bladder, but no stones were seen. See VA radiology reports dated June 18, 2003 & September 9, 2003.

In November 2003, the Veteran's creatinine was 1.1. See VA treatment dated November 7, 2003. His left ureter was dilated and a stent was surgically put into place. No renal stone was seen. His preoperative diagnosis had been left hydronephrosis, but his post-operative diagnosis was left ureteral opening stricture. See VA treatment dated November 12, 2003. Later that month, the stent was removed. See VA treatment dated November 21, 2003.

In a May 2004 appointment to follow up on the November 2003 dilation, the Veteran said his flank pain had resolved. See VA treatment dated May 25, 2004.

An IVP report from June 2004 showed a partial obstruction at the level of the UVJ (ureterovesical junction). Etiology was not apparent. See InMed IVP report dated June 18, 2004. 

In July 2004, the Veteran's physician noted that the partial obstruction of the left ureter was likely congenital, as it was discovered serendipitously, and it had been asymptomatic with normal renal function for many years. The physician did not assess the condition as posing significant risks because the Veteran was nearing the age of fifty and had not yet had any significant symptoms or deterioration of his renal function due to the condition. It was noted that the Veteran steadfastly believed his renal function was compromised and he appeared fixated on seeking compensation benefits. See VA treatment dated July 13, 2004. 

In January 2005, the Veteran's creatinine was 0.9, within normal range. See VA treatment dated January 14, 2005. In October 2005, the Veteran's obstructed ureter and hydronephrosis was asymptomatic. See VA treatment dated October 27, 2005. In November 2008, the Veteran's creatinine was normal. His ureteral obstruction was asymptomatic. See VA treatment dated November 7, 2008. In January 2009, a CT scan showed left UVJ obstruction. The Veteran elected to continue monitoring the condition for the year rather than intervene with a ureteroscopy. His creatinine was 0.9. See VA treatment dated January 16, 2009.

In June 2009, it was noted that the Veteran's mild hydronephrosis persisted but that his creatinine was stable. See VA treatment dated June 2, 2009.

In July 2010, the Veteran was found to have hematuria and renal calculi in the left kidney. See VA treatment dated July 19, 2010. Bladder and renal stones were found. See VA treatment dated August 18, 2010. The Veteran sought to have the renal stone removed. It was noted to be asymptomatic, and intervention was not recommended.  See VA treatment dated August 25, 2010.

A December 2010 VA examiner opined that the Veteran's kidney disorders are not related to the treatment he received for his hepatitis C infection in 1993. She further indicated that there was no evidence of carelessness, negligence, lack of proper skill, an error in judgment, or any other fault on the part of the physicians that treated his hepatitis in 1993. She noted the Veteran's medical history, and his belief that interferon led to his ureteral obstruction with left hydronephrosis. He complained of chronic pain in his left flank, frequent urination, urinary urgency, and erectile dysfunction. She noted his creatinine was 1.2 in August 1993, and 0.9 in August 2010. In regard to hepatitis, he was treated with interferon from June to December 1995. There were no notes of any problems with the interferon treatment. In May 2003, he began treatment with interferon with ribavirin. In September 2003, he lost his measurable viral load, and it was noted he had mild left hydronephrosis and a left kidney stone.

In November 2003, he was diagnosed with left UVJ obstruction of unknown etiology, and a stent was placed in his left ureter. The surgical report did not mention any kidney stones. The Veteran's flank pain resolved. An IVP conducted in June 2004 found a partial obstruction at the level of the UVJ. Etiology was not apparent at that time. In September 2004, a renogram found left renal obstruction. It was noted the Veteran's physician indicated the obstruction was congenital, asymptomatic, and not disrupting normal renal function, and was therefore of no significant consequence. In April 2005, the ureter obstruction and hydronephrosis were asymptomatic. In November 2008, creatinine was normal and he was asymptomatic. In January 2009, a left UVJ obstruction was found, however creatinine was normal at that time, and the Veteran opted to continue to observe rather than intervene. A left renal stone was found in August 2010. The VA examiner reviewed the Veteran's creatinine levels since 1993, and noted it was never elevated. See VA examination dated December 8, 2010. 

A May 2013 VA opinion was issued to add to and clarify the December 2010 report. The examiner indicated that there is no indication that the Veteran's kidney disorder, or urethral or ureteral obstruction, were discovered when he was treated for hepatitis from 1993 to 1995. In August 1993, his creatinine was normal, he made no complaints of back or flank pain, and there were no other indications to suggest a kidney condition. The examiner said without any indications of a problem, there was nothing to investigate. She further noted his creatinine levels have always been normal since June 1989. Mild left hydroureteronephrosis was found in 2003, and it is asymptomatic with normal renal function. 

The examiner observed that while previous physicians were unsure of etiology, but she agreed with the author of the July 2004 opinion that the Veteran had congenital ureterovesical stenosis. 

The examiner observed that previous physicians' inability to find etiology supported the ureteral obstruction as being congenital, noting his age and that he always had normal renal function. She observed that because the condition was  congenital and asymptomatic, it is not disabling, and there are no residuals. She also said that it could not be the result of carelessness, negligence, lack of proper skill, error in judgment or similar instance of fault because it was congenital, and because she knew of no medical evidence supporting a relationship between interferon treatment and the development of hydronephrosis or ureteral obstruction. Rather, the reported genitourinary side effects include: polyuria, scrotal/penile edema, cystitis, dysmenorrhea, dysuria, hematuria, impotence, incontinence, leukorrhea, menstrual irregularity, micturition disorder, micturition frequency, nocturia, pelvic pain, penis disorder, sexual dysfunction, uterine bleeding, vaginal dryness, and gynecomastia. See VA examination dated May 16, 2013.

The Veteran alleges that he had severe back pain throughout the years due to his obstructed ureter and hydronephrosis. See Veteran's statement dated November 14, 2003 & November 18, 2004. He alleges treatment with interferon caused the condition. See Statement dated March 19, 2004.

The Board has considered the Veteran's assertions that his obstructed ureter and hydronephrosis were caused by interferon treatments, that his renal function is seriously compromised, but does not find them probative. However, the Veteran does not have the medical training or expertise to form a competent opinion on the cause of his condition, or on the state of his kidneys. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). 

Indeed, his theories have been investigated by a physician, as in the third prong of Jandreau, supra, and they were rejected. No relationship is known between interferon and his conditions, and his renal function has consistently been found to be normal. Therefore, the Veteran's medically untrained opinion is not competent and not probative. 

The Veteran has also asserted that his undiagnosed obstructed ureter and hydronephrosis caused him to have severe back pain throughout the years. The Veteran is competent to report symptoms that are non-medical in nature, such as pain. Barr v. Nicholson, 21 Vet. App. 303 (2007). To the extent that he alleges pain,   which he reported resolved in May 2004, was indicative of disability, his opinion is not competent because he does not have expertise to competently associate any back pain with a ureteral obstruction or a hydronephrosis. See Davidson, 581 F.3d at 1316; Jandreau, 492 F. 3d at 1376-77; Barr, 21 Vet. App. at 309; Washington, 19 Vet. App. at 368; Layno, 6 Vet. App. at 469-71. Additionally, this statement is of questionable credibility, as the Veteran expressed many times that he was looking for compensation for this condition, and was noted to disregard his physician's opinion if contrary to his claim. See VA treatment dated July 13, 2004; see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (personal interest in the outcome of the claim may affect credibility).

The VA physician's July 2004 record of treatment and the May 2013 VA examination report are the most probative to the issue, and outweigh the Veteran's statements in support of his claim. The physicians who authored them are competent to opine on the issues, and the opinions directly address the relevant inquiries.  

The competent evidence indicates the Veteran's claimed condition, ureteral obstruction with hydronephrosis, is a congenital condition and it is not disabling. Both his treating physician and the VA examiner made this finding, which was based on his normal renal function, and that he had yet not shown kidney deterioration despite his age. Instead, the condition has been asymptomatic for years. The December 2010 VA examiner similarly noted that a review of his creatinine levels dating since 1993 did not reveal a single elevated result. Because kidney function has not been compromised, there is no additional disability. There is no competent evidence that offers a differing opinion. 

Accordingly, as the preponderance of the evidence is against this claim, the benefit-of-the-doubt doctrine does not apply and the Veteran's claim for compensation under 38 U.S.C.A. § 1151 must be denied. 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). See also Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).


ORDER

Entitlement to compensation benefits under 38 U.S.C.A. § 1151 for ureteral obstruction with hydronephrosis is denied.



____________________________________________
Vito A. Clementi
Veterans Law Judge, Board of Veterans' Appeals



Department of Veterans Affairs