Citation Nr: 18161242 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 16-62 626 DATE: December 31, 2018 ORDER Service connection for a left shoulder disability is granted. Service connection for a right shoulder disability is denied. Service connection for chronic renal disease, to include as due to exposure to contaminated water at Camp Lejeune, is denied. Service connection for sleep apnea, to include as secondary to chronic renal disease, is denied. Service connection for a blood in urine disability, to include as secondary to chronic renal disease is denied. Service connection for diabetes mellitus type II (diabetes), to include as due to chronic renal disease, is denied. REMANDED Service connection for hypertension, to include as secondary to chronic renal disease, is remanded. FINDINGS OF FACT 1. The Veteran’s left shoulder disability was incurred in and due to his time in service. 2. The Veteran does not have a right shoulder disability that was incurred in and due to his time in service. 3. The Veteran does not have currently diagnosed chronic renal disease that was incurred in and due to his time in service, to include as due to exposure to contaminated water at Camp Lejeune. 4. The Veteran’s sleep apnea was not incurred in or due to his time in service, nor is it due to any of his service connected disabilities. 5. The Veteran’s blood in urine disability was not incurred in or due to his time in service, nor is it due to any of his service connected disabilities. 6. The Veteran’s diabetes was not incurred in or due to his time in service, nor is it due to any of his service connected disabilities. CONCLUSIONS OF LAW 1. The criteria to establish service connection for a left shoulder disability are met. 38 U.S.C. §§ 1110, 1131, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 2. The criteria to establish service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 3. The criteria to establish service connection for chronic renal disease, to include as due to exposure to contaminated water at Camp Lejeune, are not met. 38 U.S.C. §§ 1110, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 4. The criteria to establish service connection for sleep apnea, to include as proximately due to chronic renal disease, are not met. 38 U.S.C. §§ 1110, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 5. The criteria to establish service connection for a blood in urine disability, to include as proximately due to chronic renal disease, are not met. 38 U.S.C. §§ 1110, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 6. The criteria to establish service connection for diabetes, to include as proximately due to chronic renal disease, are not met. 38 U.S.C. §§ 1110, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1983 to April 1991. As a preliminary matter, the Board notes there has been some minor confusion as to what issues are on appeal: On his Form 9, the Veteran only specifically appealed service connection for chronic renal disease, hypertension, and diabetes. However, he wrote the date of the statement of the case (SOC) on the Form 9. VA took that to mean the Veteran was appealing all issues listed on the SOC and the Form 8 noted all issues on appeal. Subsequently, VA received a letter from the Veteran inquiring about the status of his claim of service connection for a left shoulder disability. Therefore, the Board has addressed all the issues originally noted in the Veteran’s notice of disagreement (NOD) as listed above. Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). In order to establish presumptive service connection for a disease associated with exposure to contaminated water at Camp Lejeune, a veteran, former reservist, or member of the National Guard must show the following: (1) that he or she served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987; (2) that he or she currently suffers from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309 (f); and (3) that the current disease process manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307 (a)(7), 3.309 (f). The enumerated diseases associated with exposure to contaminants in the water supply at Camp Lejeune are as follows: (1) Kidney cancer, (2) Liver cancer, (3) Non-Hodgkin’s lymphoma, (4) Adult leukemia, (5) Multiple myeloma, (6) Parkinson’s disease, (7) Aplastic anemia and other myelodysplastic syndromes, (8) Bladder cancer. 38 C.F.R. § 3.309 (f). Left and Right Shoulders The Veteran contends he has a bilateral shoulder disability that was incurred in and due to his time in service. The Veteran has been diagnosed with a bilateral shoulder disability. (See April 2017 examination.) The Veteran’s service treatment records (STRs) show the Veteran suffered a left shoulder injury while in service. However, the Veteran’s STRs are negative for any treatment or symptoms of a right shoulder condition while in service. Therefore, service connection for a right shoulder disability must be denied. An April 2017 examiner opined the Veteran’s left shoulder disability was at least as likely as not due to his time in service. The examiner explained the Veteran’s STRs show the Veteran reported symptoms while in service. Because the Veteran has a currently diagnosed left shoulder disability that was incurred in and due to his time in service, service connection for a left shoulder disability will be granted. Chronic Renal Disease The Veteran contends he has chronic renal disease that is due to his time in service, to include his exposure to contaminated water while he was stationed at Camp Lejeune. The Veteran’s personnel records indicate he was stationed at Camp Lejeune for more than 30 days. Although kidney cancer is one of the enumerated diseases for which presumptive service connection can be granted based on exposure to contaminants in the water supply at Camp Lejeune, chronic renal disease is not. Therefore, even if the Veteran were found to have currently diagnosed chronic renal disease, service connection under the Camp Lejeune presumption would not be warranted. Further, the record does not indicate the Veteran has a currently diagnosed chronic renal disease. While the Veteran was seen in 2001 and 2002 for blood in his urine and kidney stone disease, an April 2015 examiner opined the Veteran’s current records were silent for any current renal dysfunction as his BUN, creatinine, and urinalysis were all normal. The examiner noted the Veteran’s history of renal stones in 2003 but there was no evidence of a current disability. The Veteran’s STRs are also silent for any mention or treatment of chronic renal failure while in service. Lastly, an April 2015 examiner reported current medical evidence does not link renal stones with contaminated water, such as at Camp Lejeune. The examiner opined it was less likely than not the Veteran’s renal stones were related to the Veteran’s time in service at Camp Lejeune. Therefore, based on the above, service connection for chronic renal disease, to include as due to exposure to contaminated water while at Camp Lejeune, is denied. Sleep Apnea, Blood in Urine, Diabetes, In his claim, the Veteran contended his sleep apnea, blood in urine, and diabetes were all secondarily due to his chronic renal disease. However, as discussed above, the Veteran is not service connected for chronic renal disease and therefore, it cannot be the basis for a finding of secondary service connection. Additionally, none of the above disabilities qualifies for presumptive service connection for contaminated water exposure at Camp Lejeune and therefore, this cannot be the basis for service connection either. The Board will still address whether the Veteran can be directly service connected for any of the above conditions. The Veteran has been diagnosed with sleep apnea and diabetes. However, the Veteran’s STRs are negative for any treatment or symptoms of either of these two conditions. The Veteran’s record does not contain a link between the Veteran’s sleep apnea or diabetes and his time in service. Therefore, service connection will be denied. The Veteran’s medical records indicate he was seen for blood in his urine in 2001 and 2002. However, as discussed above, an April 2015 examiner opined the Veteran did not have any currently diagnosed renal problems. Additionally, the Veteran’s STRs are silent for complaint or treatment of blood in his urine and the Veteran’s record does not contain evidence of a link between his time in service and any current problem that would cause blood in his urine. Therefore, the claim will be denied. Regarding the claims above, the Board acknowledges the Veteran’s statements that he believes his conditions are due to his time in service, to include his exposure to contaminated water. The Board also understands the Veteran continues to seek treatment for his medical problems and that his conditions continue to give him problems and cause him distress. However, the Veteran is not competent to opine on medical issues, such as the nature and etiology of medical conditions, such as those discussed above. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board places more probative weight on the objective medical evidence of record. It is important for the Veteran to understand that these medical findings provide highly probative evidence against these claims that the Board cannot, unfortunately, ignore, outweighing the Veteran’s belief that his problems are the result of service, providing a highly clear basis for the opinion. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). REASONS FOR REMAND The Board finds a remand is necessary for the Veteran’s claim of service connection for hypertension, to include as due to chronic renal disease. The Board notes the Veteran is not service connected for chronic renal disease and it therefore, cannot be the basis for a finding of secondary service connection for hypertension. However, the Veteran may still be entitled to service connection for hypertension on a direct basis. The Veteran has been diagnosed with hypertension and continues to seek treatment for this condition. The Veteran’s STRs show multiple readings of high blood pressure while in service. In a November 1990 record, the Veteran’s blood pressure was found to be 150/80. In another record, his blood pressure was found to be 150/100. The Veteran has not been afforded an examination for his hypertension. The Board finds an examination is warranted in order to determine the nature and etiology of the Veteran’s hypertension. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. The AOJ should obtain any of the Veteran’s outstanding VA and private medical records and associate them with the claims file. If possible, the Veteran himself should submit any pertinent new evidence regarding the condition at issue in order to expedite the claim. 2. Schedule the Veteran for an appropriate examination to determine the nature and etiology of his hypertension. After reviewing the claims file, the examiner should answer the following questions. (a) Is it at least as likely as not (a 50 percent or greater probability) the Veteran’s hypertension had its onset during service, or is otherwise due to service? (b) Is it at least as likely as not the Veteran’s hypertension is proximately due to or aggravated by any of his service-connected disabilities? The examiner should explain in detail any opinion provided. 3. After undertaking any other appropriate development deemed necessary, readjudicate the Veteran’s claim. If the determinations remain adverse to the Veteran, he must be provided with a supplemental statement of the case. An appropriate period of time must then be allowed for a response before the record is returned to the Board for further review. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Snoparsky, Associate Counsel