Citation Nr: 18146719 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 16-40 479 DATE: November 1, 2018 ORDER Entitlement to service connection for kidney disease, to include as secondary to service-connected hypertension, is denied. FINDING OF FACT The Veteran’s current kidney disease did not have its onset during service, was not manifested to a compensable degree within one year of service discharge, was not diagnosed until many years after service discharge, is not otherwise related to service, and is not caused or aggravated by the service-connected hypertension. CONCLUSION OF LAW The criteria for entitlement to service connection for kidney disease, to include as secondary to hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Navy from July 1972 until November 1996. The Veteran declined a hearing in this case. The Veteran contends that his kidney disease is related to his service-connected hypertension. Service Connection – Generally Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Where a Veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Renal/kidney disease is a chronic disease. Service connection may also be granted on a secondary basis for a disability which is “proximately due to or the result of a service-connected disease or injury.” 38 C.F.R. § 3.310(a). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b). The Board has thoroughly reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, each piece of evidence of record. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, regarding the Veteran’s claim on appeal. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000). 1. Entitlement to service connection for kidney disease, to include as secondary to hypertension The Veteran claims entitlement to service connection for kidney disease, to include as secondary to hypertension. The Veteran has a current diagnosis of kidney disease, as documented on May 2014 Medicare records. Thus, the Veteran meets the first element of a claim for secondary service connection. Where the Veteran’s claim for secondary service connection fails is failure to establish that his kidney disease is “proximately due to or the result of a service-connected disease or injury.” 38 C.F.R. § 3.310(a). For example, the Veteran was afforded an in-person VA examination in January 2015. The examiner reviewed the Veteran’s military service treatment records and documents in VBMS, which is his electronic file. The examiner acknowledged that the Veteran’s service medical records show a normal test for serum creatinine (a measure of kidney function) in 1991 and in 1994, and that there were no additional tests for kidney function prior to the Veteran’s retirement in December 1996. The examiner explained that the Veteran reports that after his retirement from the U.S. Navy, his EGFR (another measure of kidney function) declined rapidly from 2010 to 2013 after which he had a shunt placed in his arm to begin dialysis three times each week. The Veteran was afforded a VA addendum opinion in January 2015, wherein the examiner opined that the Veteran’s claimed condition is less likely than not proximately due to or the result of the service-connected hypertension. The examiner reviewed the Veteran’s electronic medical records in VBMS and medical treatment records from the Department of Defense. The examiner reviewed the Veteran’s November 2013 nephrology consultation records, and reasoned that the Veteran’s progressive kidney disease is secondary to his biopsy-proven diabetic nephropathy diagnosed in 2007. The examiner further noted that the Veteran’s end-stage renal disease is described as secondary to his diabetic nephropathy on September 2014 medical records. This is further evidence that the Veteran’s kidney disease is less likely than not related to his service-connected hypertension. May 2014 dialysis records indicate that the Veteran is suffering from end stage renal disease. November 2014 private treatment records indicate that the primary cause of the Veteran’s renal failure is diabetes with renal manifestations type II. May 2014 Medicare records indicate that the Veteran is receiving hemodialysis, has been diagnosed with diabetes, and is currently on insulin. October 2014 consultation notes from a Department of Defense facility indicate that the Veteran requires hemodialysis and has been under evaluation for a kidney transplant for three years. January 2015 private treatment records indicate that the Veteran is receiving dialysis for end-stage renal disease. On his August 2016 VA Form 9, the Veteran asserts a belief that his kidney failure is directly related to his hypertension. The Board finds the January 2015 VA examiner’s opinion to be of great probative value in the context of the Veteran’s claim. The examiner’s opinion was based upon consideration of the Veteran’s claims file, the Veteran’s medical history, and included a reasoned rationale. Notably, the only evidence that the Veteran’s current kidney disease is related to his service-connected hypertension is the Veteran’s lay statement. To the extent that this statement asserts a nexus between the Veteran’s current kidney disease and his service-connected hypertension, such statement is afforded no probative value, as the Veteran has not been shown to possess the expertise necessary to render a nexus opinion regarding the cause of his kidney disease. Regardless, the Veteran’s statement that his kidney disease is related to his service-connected hypertension is outweighed by the January 2015 opinion of a VA medical professional, who concluded that the Veteran’s current kidney disease is less likely than not related to his service-connected hypertension. Moreover, the earliest indication of kidney disease within the record is a May 2014 Medicare report, many years after the Veteran’s discharge from active service. Such a lengthy time interval between service and the earliest post-service clinical documentation of the disability is of itself a factor for consideration against a finding that the disability is related to service. See Maxson v. Gober, 230 F.3d 330 (Fed. Cir. 2000). In other words, the preponderance of the evidence is against a finding that kidney disease had its onset in service or that it manifested to a compensable degree within one year of service discharge. There is no competent evidence of a nexus between the kidney disease and the Veteran’s period of service. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for kidney disease, to include as secondary to service-connected hypertension. Thus, as the preponderance of the evidence is against the claim, there is no reasonable doubt to be resolved, and the claim is denied. 38 U.S.C. § 5107(b). A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Caruso, Associate Counsel