Citation Nr: 18149105 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-44 313 DATE: November 8, 2018 ORDER Service connection for a kidney condition, to include as due to service-connected hypertension, is denied. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s kidney condition had its onset in active service or was proximately caused or aggravated by his service-connected hypertension. CONCLUSION OF LAW The criteria for service connection for a kidney condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.310(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from March 1984 to May 2004. To establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The Veteran contends that his kidney condition had its onset in active service or was caused or aggravated by his service-connected hypertension. His service treatment records (STRs) contained no complaints, symptoms, diagnosis, or treatment for any kidney condition. Chemical panels conducted in February 1993, February 1994, October 2000, February 2002, August 2002, September 2003, and November 2003 revealed normal kidney function. Post-service, chemical panels in July 2004, June 2006, and July 2006 revealed normal kidney function. In October 2014, a mass on the Veteran’s left kidney was discovered. He subsequently underwent a partial nephrectomy to remove the mass. Numerous private treatment records in the claims file detailed the partial nephrectomy of the benign oncocytoma. The Veteran subsequently had treatment for pulmonary renal syndrome associated with his nonservice-connected ANCA vasculitis. There are three medical opinions of record regarding the etiology of the Veteran’s kidney condition. He underwent a VA examination in April 2015 which diagnosed status/post left partial nephrectomy to remove renal mass. The examiner noted that it was a benign mass, and the Veteran was in remission. He had a residual condition of pain in the left kidney, and abnormal BUN and proteinuria testing results. The examiner stated that these testing results meant that he possibly had pre-renal disease rather than continued sequelae from the partial nephrectomy. She determined that it was less likely than not that the Veteran’s kidney condition was proximately due to or the result of his service-connected hypertension. She stated that a review of his private treatment records showed that he had a benign tumor of the left kidney. She noted that a tumor is an abnormal growth of cells that serves no purpose, the causes of which include genetics, diet, trauma or injury, and inflammation or infection. She concluded that she was unable to make a connection of renal disease with hypertension. She continued that the Veteran’s lab results were normalizing, but a change in renal function would be expected after a partial nephrectomy. She noted that he was also diagnosed with and continued treatment for vasculitis after discharge, and that vasculitis can cause damage to major organs. The Veteran’s private clinician submitted a statement in May 2015 noting that the Veteran had chronic kidney disease secondary to ANCA vasculitis, history of partial nephrectomy, and hypertension. No rationale was provided for this opinion. Another VA opinion was obtained in August 2015. The clinician determined that the Veteran’s kidney condition was less likely than not proximately due to or the result of his hypertension. She stated that his kidney condition was an oncocytoma, which is a benign tumor, and that hypertension does not play into the etiology nor aggravation of this condition. The Board finds that service connection is not warranted. There is no evidence of a kidney condition in service to establish direct service connection. Further, the preponderance of the evidence indicates that the Veteran’s kidney condition was not proximately caused or aggravated by his service-connected hypertension. The Board attaches significant probative value to the VA opinions of record as they are well-reasoned, consistent with other evidence of record, and included consideration of the Veteran’s pertinent medical history. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The April 2015 examiner could not support a connection between renal disease and hypertension and listed several known causes of the type of tumor that the Veteran had removed. She also suggested that the Veteran’s nonservice-connected vasculitis may be associated with his kidney condition. The August 2015 VA clinician stated that his kidney condition was an oncocytoma and that hypertension does not cause or aggravate such a benign tumor. Although the private clinician found that the Veteran had kidney disease secondary to several nonservice-connected conditions and hypertension, there was no rationale provided for the opinion. As such, the Board assigns low probative value to this opinion. Further, the private treatment records detailed the partial nephrectomy and indicated subsequent treatment for pulmonary renal syndrome secondary to nonservice-connected ANCA vasculitis with no mention of hypertensive involvement. The Board acknowledges the Veteran’s belief that his hypertension has caused or aggravated his kidney condition. However, he has not been shown to have the requisite medical knowledge to provide competent evidence on this matter. As such, the preponderance of the medical evidence does not support a finding of service connection on a secondary basis. The benefit of the doubt doctrine is not applicable in this case as there is no doubt to be resolved. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 57. M. Donohue Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Rachel E. Jensen, Associate Counsel