Citation Nr: 20043796 Decision Date: 06/29/20 Archive Date: 06/29/20 DOCKET NO. 14-09 347 DATE: June 29, 2020 ORDER Service connection for a renal disorder is denied. Service connection for diabetes mellitus (DM) is denied. Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran had National Guard service from September 1987 to September 1993, with a period of active duty for training ACDUTRA) from June to August 1989 and active service from November 1990 to May 1991. 2. A renal disorder was noted at induction; however, renal failure was not aggravated by service. 3. DM was not shown in service or for many years thereafter, is not etiologically or causally related to service, and cannot be presumed to have been incurred in service. 4. Hypertension was not shown in service or for many years thereafter, is not etiologically or causally related to service, and cannot be presumed to have been incurred in service. CONCLUSIONS OF LAW 1. A pre-existing renal disorder was not aggravated in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2019). 2. DM was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). 3. Hypertension was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a current 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. DM and hypertension are entitled to presumptive service connection. Renal Disorder In addition to the laws and regulations outlined above, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). If a disorder is noted, the question is whether it was aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any “increase in disability [was] due to the natural progress of the” preexisting condition. 38 U.S.C. § 1153. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Moreover, “temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened.” Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). However, the increase need not be so severe as to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). In the Veteran’s 1989 National Guard enlistment examination, high levels of protein, glucose, and white blood cells were noted, indicating that he had a kidney problem. While the severity of a renal disorder was not characterized at induction, question is whether there was in increase in service and whether it was due to the natural progress of the preexisting condition. To that end, in a November 2018 VA examination, the examiner opined that a renal disorder was not aggravated by service. She reasoned that service treatment records (STRs) did not show insult or injury to kidney in service and that there was no evidence of permanent aggravation beyond the natural progression of the disorder. There is no contradictory opinion. Therefore, the medical evidence does not support the claim of service connection on the basis of aggravation.   DM Turning first to direct service connection, in a March 2017 clinical record, the Veteran reported that he had been a type II diabetic for three years; however, in a November 2018 VA examination, he contended that he was diagnosed with DM in 1990. In this case, the Board places more weight to the clinical records which showed the earliest diagnosis of DM in 2017. Nevertheless, as he has been diagnosed with DM, a current disorder has been shown, and the first element of direct service connection is met. As to an in-service incurrence, STRs are absent of any complaints, diagnoses, or treatment of DM. Specifically, the Veteran sought treatment for urethral discharge in service, but DM was not noted. To the extent that the Veteran asserts that DM began in service, in a November 2018 VA examination, the examiner opined that DM was less likely than not incurred in service. She reasoned that STRs were absent of complaints, diagnoses, or treatment for DM. There is no contradictory opinion. Therefore, the medical evidence does not support the claim of direct service connection. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran was discharged from active service in 1991 and was not diagnosed with DM until 2017. As he was discharged in 1991 and symptoms were not identified until 2017, 26 years later, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1991 but did not note symptoms until 2014 at the earliest. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence.   Hypertension Turning first to direct service connection, hypertension was first noted in 2017. Therefore, a current disorder is shown, and the first element of direct service connection is met. As to an in-service incurrence, STRs are absent of any complaints, diagnoses, or treatment of hypertension or high blood pressure. Specifically, the Veteran sought treatment for urethral discharge in service, but hypertension or high blood pressure was not noted. To the extent that the Veteran asserts that hypertension began in service, in a November 2018 VA examination, the examiner opined that hypertension was less likely than not incurred in service. She reasoned that STRs were absent of complaints, diagnoses, or treatment for hypertension. There is no contradictory opinion. Therefore, the medical evidence does not support the claim of direct service connection. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran was discharged from active service in 1991 and was not diagnosed with hypertension until 2017. As he was discharged in 1991 and symptoms were not identified until 2017, 26 years later, the medical evidence does not support service connection on a “continuity of symptomatology” basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1991 but did not note symptoms until 2017 at the earliest. This evidence does not support presumptive service connection on a “manifest within one-year from separation” basis. Therefore, presumptive service connection on any basis is not supported by the medical evidence. The Board has considered the Veteran’s lay statements that a renal disorder was aggravated in service and that DM and hypertension began in service. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to offer etiologies of these disorders. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.