Citation Nr: 18141386 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 16-43 579 DATE: October 10, 2018 ORDER Service connection for kidney disease is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has kidney disease due to a disease or injury in service, to include hydronephrosis in service. CONCLUSION OF LAW The criteria for service connection for kidney disease are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Air Force from June 1954 to November 1958. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision. The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in January 2018. Service connection for kidney disease The Board concludes that, while the Veteran has current diagnoses of chronic kidney disease and glomerulonephritis, and evidence shows treatment for hydronephrosis in service, the preponderance of the evidence weighs against finding that the Veteran’s current diagnoses began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Historically, the Veteran was diagnosed with hydronephrosis in July 1958. Evaluation revealed a retrocaval right ureter and he underwent a right ureteroplasty. He was noted to do well after the operation and was asymptomatic after 30 days of convalescent leave. At the time of his discharge examination in October 1958, he was noted to have albumin (proteinuria) of 4+. The record contains no additional findings until private records show the Veteran was seen for acute renal failure in February 1983 and diagnosed with progressive post-streptococcal glomerulonephritis. Additional records from February 1998 note a history of chronic renal insufficiency dating back to 1983. He underwent a kidney transplant in July 2008. Current records show diagnoses of chronic kidney disease and glomerulonephritis. The Board obtained a Veterans Health Administration (VHA) opinion in June 2018 from a VA nephrologist. He stated that the 4+ proteinuria finding in service could have come from the diseased right kidney which was then repaired. He also explained that the post-streptococcal glomerulonephritis diagnosed in 1983 is kidney inflammation triggered by an infection, and that this had no connection to the hydronephrosis diagnosed and surgically treated in 1958. He noted that the inflammation due to glomerulonephritis can lead to all the complications of chronic kidney disease that the Veteran subsequently developed. He also acknowledged that the record contained no evidence that the hydronephrosis found in 1958 independently resulted in any chronic kidney disease. If there were laboratory studies between 1958 and 1983 which demonstrated permanently impaired kidney function, then he could conclude that this impairment likely resulted from the events in service. However, in the absence of such evidence, the only firm conclusion one can draw is that the glomerulonephritis in 1983 was the cause of his chronic kidney disease. In other words, the VHA physician stated that the Veteran’s current kidney disease is traceable to glomerulonephritis. It was not traceable to active military service because there is no evidence of chronic kidney disease or permanently impaired kidney function after 1958, and there is no connection between hydronephrosis in service and glomerulonephritis in 1983. In a May 2014 opinion, a private physician stated that he cannot exclude the possibility that the Veteran’s kidney disease is service-connected. However, the Board finds this opinion insufficient for two reasons. First, the physician’s statement that he cannot “exclude the possibility” is not sufficient to establish an etiological link because service connection may not be based on speculation or remote possibility. See 38 C.F.R. § 3.102; Obert v. Brown, 5 Vet. App. at 30, 33 (1993). Second, this physician provides no explanation for how he reached his conclusion, which affects its value as evidence. Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). “The probative value of medical opinion evidence is based on the medical expert’s personal examination of the patient, the physician’s knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.” Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The credibility and weight to be attached to these opinions is within the province of the Board. Id. In this case, the most probative medical evidence is against a finding that current kidney disease and glomerulonephritis is etiologically related to service, including hydronephrosis diagnosed in service. The appeal is accordingly denied. In making this determination, the Board has considered the provisions of 38 U.S.C. § 5107(b) regarding benefit of the doubt,   but there is not such a state of equipoise of positive and negative evidence to otherwise grant the Veteran’s claim. M. TENNER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Shamil Patel, Counsel