Citation Nr: 18158431 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 09-11 844 DATE: December 14, 2018 ORDER Service connection for polycystic kidney disease (PKD) is granted. FINDINGS OF FACT 1. PKD was not noted at the time of examination on the Veteran’s entrance into service. 2. The Veteran’s current PKD was first clinically diagnosed during his active military service. 3. The evidence is debatable, and as such is not clear and unmistakable that the Veteran’s PKD, even if a congenital disease that pre-existed service, was not aggravated by the Veteran’s military service. CONCLUSION OF LAW The criteria to establish service connection for polycystic kidney disease have been met. 38 U.S.C. §§ 1110,1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from March 2002 to February 2005. The Veteran appeared before the undersigned Veterans Law Judge in a Travel Board hearing in December 2010 to present testimony on the issue on appeal. Service connection for polycystic kidney disease (PKD) The Veteran was first clinically diagnosed with PKD during service in October 2003. See Service treatment records. The Board has found, and the Veteran does not contest, that this is an inherited genetic disorder that pre-existed the Veteran’s active service period. However, the Veteran asserts that his PKD was aggravated by his service, or increased in severity during service, due to excessive salt intake from consuming meals ready to eat (MREs) during deployment, and due to his now service-connected hypertension which was also identified during service. Multiple medical opinions on these matters have been obtained by both VA and the Veteran, including recent private opinions received from the Veteran in September 2018. After a complete review of the Veteran’s claims file, including the newly submitted medical evidence, the Board finds that the evidence is not clear and unmistakable that the Veteran’s PKD was not aggravated by his military service. Preservice disabilities noted in service are discussed in 38 C.F.R. § 3.303(c). This regulation states that “There are medical principles so universally recognized as to constitute fact (clear and unmistakable proof), and when in accordance with these principles existence of a disability prior to service is established, no additional or confirmatory evidence is necessary.” However, any veteran is also considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. 38 C.F.R. § 3.304(b). This is known as the presumption of soundness. In this case, the Veteran’s PKD was not noted at the time of his entrance into service. It was not diagnosed and recorded on the examination report at that time, although the subsequent medical evidence clearly and unmistakably shows that the Veteran carried the genetic inheritance for PKD prior to service. However, for the presumption of soundness to attach, two elements must be met. The evidence must clearly and unmistakably demonstrate that the disease existed prior to service, as it does here, but the evidence must also clearly and unmistakably demonstrate that the disease was not aggravated by the Veteran’s service. In this case, the second element regarding clear and unmistakable absence of aggravation is not met. “The development of symptomatic manifestations of a preexisting disease or injury during or proximately following action with the enemy…will establish aggravation of a disability.” 38 C.F.R. § 3.306(b)(2) (2017). Here, the Veteran was diagnosed with PKD within weeks of returning from combat operations in Kuwait and Iraq. Additionally, the varying medical opinions of record, all of which appear to be from competent medical professionals with the requisite knowledge and education to render such opinions, have opposing views on the matter of whether the Veteran’s PKD was aggravated by the place, type, and circumstances of his service, particularly during his deployment to Kuwait and Iraq. By the very nature of these disagreeing opinions, the evidence is not clear and unmistakable that the Veteran’s PKD was not aggravated by the particular circumstances of his service. Where the evidence regarding absence of aggravation is not clear, the presumption of soundness attaches and the case must be analyzed as one of service connection, rather than one of aggravation or worsening of a pre-existing condition. 38 C.F.R. § 3.304. Service connection generally requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a causal relationship, or nexus, between the claimed in-service event, injury, or disease and the current disability. 38 C.F.R. § 3.303; see Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In this regard, the evidence documents a current diagnosis of PKD, a diagnosis of PKD during the Veteran’s active military service, and a medical relationship between the in-service disease and the current disability. See, e.g., Private medical opinions, April 2018; VA opinions, June 2012 & September 2008; Service treatment records, October & September 2003. On this basis, service connection is warranted. 38 C.F.R. § 3.303. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. McDonald