Citation Nr: 19190526 Decision Date: 12/02/19 Archive Date: 12/02/19 DOCKET NO. 17-56 927 DATE: December 2, 2019 ORDER Service connection for hepatitis C is granted. Service connection for renal failure is granted. Service connection for diabetes mellitus is denied. Service connection for macular disability is denied. Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran’s hepatitis C is at least as likely as not due to service. 2. The Veteran’s hepatitis C is a factor causing his renal failure. 3. The Veteran’s current diabetes mellitus was not manifest in service or to a degree of 10 percent within 1 year of separation and is unrelated to service. 4. The Veteran’s macular disability was not manifest in service and is unrelated to service. 5. The Veteran’s current hypertension was not manifest in service or to a degree of 10 percent within 1 year of separation and is unrelated to service. CONCLUSIONS OF LAW 1. The criteria for service connection for hepatitis C have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 2. The criteria for service connection for renal failure have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.310. 3. The criteria for service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5107; 38 C.F.R. §§ 3.307, 3.309. 4. The criteria for service connection for macular disability have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. 5. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1975 to January 1981. He appeals for service connection for the disabilities indicated above. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). Service connection may be awarded on a presumptive basis for certain chronic diseases listed in 38 C.F.R. § 3.309(a) that manifest to a degree of 10 percent within 1 year of service separation or during service and then again at a later date. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed.Cir.2013). Diabetes mellitus and cirrhosis of the liver are considered to be chronic diseases under 38 C.F.R. § 3.309. Service connection for such chronic diseases may also be granted based on continuity of symptomatology if a claimant demonstrates (1) that a condition was “noted” during service; (2) evidence of postservice continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the postservice symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (citing Savage v. Gober, 10 Vet. App. 488, 496–97(1997)); see 38 C.F.R. § 3.303(b). Service connection may be granted, on a secondary basis, for a disability which is proximately due to, or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Similarly, any increase in severity of a non-service-connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease, will be service connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the non-service-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. Service connection for hepatitis C Based on the evidence, the Board concludes that service connection is warranted for the Veteran's current hepatitis C disability, shown through medical records of record as early as 2013, as at least a relative equipoise of the evidence indicates that it is related to service. The Veteran feels that he contracted hepatitis in service, including as indicated below. A VA examiner in September 2015 opined that the Veteran's hepatitis C is less likely than not due to service, but his rationale was that other risk factors which he felt the Veteran had “would place him in as much (emphasis added) potential risk as his claim for the potential intraservice exposures”. This formulation, in our judgment, raises reasonable doubt as to service incurrence. Moreover, the examiner understood the Veteran to have prison as a risk factor, as reported in an earlier medical record, but the Veteran indicated in October 2017 that he had never been in prison. The VA examination report indicates that the Veteran had performed a tattoo on himself at age 12 and had 1 pierced ear. He denied alcoholism, multiple sexual partners, indiscrete sexual activities, and that sexual or intimate friends or family members had hepatitis C. He also denied intravenous drug use and internasal cocaine use. The examiner noted that the Veteran had worked in a development center with a high-risk population of mental health clients from 1987-90, and that he had marijuana use as a risk factor. According to the VA examination report, the Veteran felt he was potentially exposed to hepatitis C in service by air guns for immunizations during induction and then later with immunization updates at Ft. Jackson. He had also had wisdom tooth extraction at Ft. Lewis and medical treatment including surgery for an open wound on his right forearm in service, caused by a broken garlic jar according to a service personnel record. He indicated in October 2017 that when he was inducted in 1975, he was inoculated with multi use nozzle jet injection, the use of which was later discontinued due to blood spray causing cross contamination. He noted that Hepatitis C can go undetected for decades, and that there was no testing for it until the early 1990s. He had also been a food service specialist/cook in service, according to his DD Form 214. The Veteran’s in service hepatitis C risk factors appear, at least as likely as not, to be the etiology of his hepatitis C, including as indicated by the information provided by the VA examiner in September 2015. Reasonable doubt as to service incurrence is resolved in the Veteran's favor. Service connection for renal failure Based on the evidence, the Board concludes that service connection is warranted for the Veteran's renal failure, as secondary to his service connected hepatitis C disability. The VA examiner in September 2015 indicated that it is probably multifactorial in nature, including from the Veteran's long-standing service connected hepatitis C. The Board will accept this to establish secondary service connection for the Veteran's renal failure as secondary to his service connected hepatitis C. Service connection for diabetes mellitus Based on the evidence, the Board concludes that service connection is not warranted for the Veteran's diabetes mellitus. VA medical records, including from October 2014, show he has diabetes mellitus. The preponderance of the evidence indicates that diabetes mellitus was not manifest in service or to a degree of 10 percent within 1 year of separation, and that it is unrelated to service and was not caused or aggravated by his service connected hepatitis C or renal failure. Service treatment records are silent for reference to diabetes mellitus. The Veteran denied pertinent symptomatology and his urinalysis was normal on service discharge examination in August 1980. His current diabetes mellitus was not shown until many years after service. There is no competent evidence of record relating diabetes to service or to his service connected hepatitis C or renal failure. The Board acknowledges that the Veteran was not provided with a VA nexus examination/opinion as regards his diabetes mellitus but finds that an examination is not required in order to make a final adjudication. Absent any competent evidence indicating that the Veteran's type II diabetes mellitus may have been associated with his service or a service-connected disability, a medical nexus opinion is not warranted, as even the low standard in McLendon v. Nicholson, 20 Vet. App. 27 (2006), is not met. See 38 C.F.R. § 3.159(c)(4); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010) (a conclusory lay nexus statement is not sufficient to trigger VA's duty to provide an examination). Service connection for macular disability (claimed as macular degeneration) Based on the evidence, the Board concludes that service connection is not warranted for the Veteran's current macular disability. VA medical records from October 2014 show macular edema. The preponderance of the evidence is against a finding that macular edema or any other macular disability was manifest in service or is related to service. Service treatment records are silent for reference to macular issues, the Veteran's eyes were normal on service discharge examination in August 1980, and his current macular edema is not shown until many years after service. VA medical records show that it is due to his non-service connected diabetes mellitus. While he claims service connection for diabetes mellitus and for macular edema as secondary to it, service connection is not warranted for his diabetes mellitus. Accordingly, service connection cannot be granted for his macular edema as secondary to his diabetes mellitus. As for the claimed macular degeneration, the preponderance of the evidence indicates that he does not have macular degeneration. Further, the preponderance of the evidence is against finding that macular degeneration was manifest in service or is related to service. While the Veteran reported treatment for macular degeneration in December 2014, it is mentioned numerous times in his medical records that he does not have macular degeneration. In April 2015, he was reported to have no macular degeneration, and in October 2015, a VA eye clinic record again noted “no” regarding the existence of macular degeneration. Service connection for hypertension Based on the evidence, the Board concludes that service connection is not warranted for the Veteran's current hypertension disability. Current VA medical records shows he has hypertension. The preponderance of the evidence is against a finding that hypertension was manifest in service or to a degree of 10 percent within 1 year of separation, that it is related to service, or that it was caused or aggravated by his service connected hepatitis C or renal failure. Service treatment records are silent for reference to hypertension, and the Veteran denied pertinent symptomatology and his blood pressure was normal on service discharge examination in August 1980. His current hypertension is not shown until many years after service. There is no evidence of renal or portal hypertension to tie it to his renal failure or hepatitis C. To the contrary, his VA medical records indicate that it is essential/benign hypertension, and no competent evidence relates it to service or to the service connected hepatitis C or renal failure. While the Veteran may feel that service connection is warranted for the disabilities for which service connection has been denied, his opinions on these complex matters of medical causation are not competent as he is a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The preponderance of the evidence   is against granting service connection for such disabilities. However, we would like to thank the Veteran for his 6 years of honorable service. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lawson The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.