Citation Nr: 21002365 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 12-14 844 DATE: January 13, 2021 ORDER Entitlement to service connection for left kidney disability, to include as due to an in-service motor vehicle accident (MVA) or secondary to service-connected aortic valve replacement (AVR), is denied. Entitlement to service connection for genitourinary system disability, to include as due to an in-service MVA or secondary to service connected AVR, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran’s kidney disability had its onset in active service or was proximately caused or aggravated by his service-connected aortic valve replacement. 2. The preponderance of the evidence is against a finding that the Veteran’s genitourinary system disability had its onset in active service or was proximately caused or aggravated by his service-connected aortic valve replacement. CONCLUSIONS OF LAW 1. The criteria for service connection for a kidney disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a genitourinary system disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § § 3.102, 3.303, 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1963 to January 1991. The Veteran passed away in March 2014. The Appellant is his surviving spouse and has been substituted as the claimant. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this claim for additional development in July 2018 and June 2020. In April 2015, the Appellant submitted a statement requesting that her appeal be expedited due to financial hardship with supporting documentation. The Board finds that good cause to advance the case on the docket has been demonstrated. Thus, the Motion to Advance on the Docket (AOD) is granted and the appeal is advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2), 38 C.F.R. § 20.900(c). Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires the following: (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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). To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) evidence that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service connected disability. 1. Entitlement to service connection for a kidney disability is denied. 2. Entitlement to a service connection for a genitourinary system disability is denied. The Appellant contends that the Veteran’s kidney disability and genitourinary system disability were related to his service. Specifically, that they were secondary to his service-connected AVR or related to an in-service MVA. The Veteran’s initial claim for a genitourinary system disorder was for an elevated prostate-specific antigen (PSA) test from December 1998. See October 2008 Statement in support of claim. A PSA level is a laboratory finding, not a disability, and although doctors might have told the Veteran that his PSA levels indicated a pre-cancerous condition, prior to his death, no medical professional diagnosed the Veteran with a prostate cancer. However, the Veteran’s claim also referenced kidney stones and this was adjudicated in the June 2009 rating decision that was appealed to the Board. The record shows that the Veteran had nephrolithiasis (kidney stones) and an erectile dysfunction diagnosis during the appeal period. Therefore, current disabilities have been demonstrated. With respect to evidence of an in-service incurrence, the record reflects that the Veteran was in an MVA in September 1969 that caused a right kidney contusion. Thus, an in-service injury has been established. Subsequent treatment records report that the Veteran made a complete recovery with no complications or “sequelae” (meaning aftereffects or residual complications). See January 1975 examination. The record also contains a June 1990 medical note reporting kidney stones in 1970. A review of the service treatment record did not reveal any treatment for kidney stones in service. Treatment for bilateral parotid gland swelling in which no parotid stones were found; however, the record did not demonstrate any treatment for kidney stones. See August 1966 Service treatment records. With respect to evidence of a service-connected disability, the record reflects that the Veteran was granted service connection for AVR (specifically, aortic valve replacement status post bacterial endocarditis with renal insufficiency and hypertension) effective February 1, 1991. Thus, the service-connected disability element for secondary service connection has been established. The Board has carefully and sympathetically reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for a kidney disability or other genitourinary system disorder on either a direct or secondary basis. A March 2009 VA examiner concluded that the Veteran’s kidney stones were less likely than not related to his AVR because kidney stones have no relationship to AVR. The examiner reasoned that kidney stones are due to a metabolic process, which is a different phenomenon than what occurs with AVR. Regarding the genitourinary system, the examiner reported that the Veteran had erectile dysfunction but did not have any treatment for his genitourinary tract disorder. The Veteran’s PSA level was tested at the examination and found to be in the normal range. See March 2009 VA examination. However, as the examiner did not address In September 2019 a VA examiner reviewed the file and concluded that it was less likely than not that the Veteran’s kidney stones, erectile disfunction, or elevated PSA were related to or aggravated by his service-connected AVR. The examiner reasoned that kidney stones have no known relationship with AVR, the Veteran was not taking any medications for his AVR that would increase the likelihood of kidney stones, therefore his kidney stones were less likely than not related to service, to include the 1969 vehicle accident. Regarding his erectile dysfunction, the examiner reasoned that the Veteran’s heart condition was stationary from 2004 to 2009, and the Veteran’s erectile dysfunction presented in 2007 during a period when his heart was stable, thus it was not caused by the AVR. Additionally, the examiner noted that the Veteran’s PSA level was normal in 2009. Pursuant to the June 2020 Board remand, the 2019 VA examiner provided two addendum opinions; the first in June and the second in October 2020. Regarding the Veteran’s kidney stones; the examiner again concluded that it was less likely than not that his kidney disability had its onset during service or manifest withing a year of service, was related to service (to include the 1969 vehicle accident) or was related to or aggravated by his service-connected AVR. The examiner reasoned that, based on imaging studies, the Veteran’s kidney stones manifested in 1998. Imaging studies from December 1990 and April 1991 demonstrated normal findings without evidence of renal stones. The examiner found that the 1969 vehicle accident resulted in a right kidney contusion that resolved with a complete recovery and no sequelae; and the left kidney was not affected by the accident. Finally, the examiner stated that the Veteran’s AVR, hypertension, or the associated treatments would not cause kidney stones. See June 2020 VA examination. The examiner acknowledged the June 1990 medical record that indicated that the Veteran had kidney stones as early as 1970; however, the examiner concluded that the report was an inaccurate historical report of the Veteran’s condition. After a review of the record, the examiner determined that the Veteran was evaluated for his kidney contusion in 1970 and the 1990 medical note made 20 years after the reported kidney stone history was second hand historical information that was not supported by the record. See October 2020 VA examination. Regarding the Veteran’s genitourinary system; in addition to the kidney stones, the examiner noted transiently elevated PSA level, an enlarged prostate, transient erectile disfunction, transient renal insufficiency, nonspecific urethritis and prostatitis. The examiner concluded that none of the above listed genitourinary conditions (with the exception of the right kidney injury that resolved with no sequelae) had their onset in service, were related to service (to include the 1969 vehicle accident), or were related to or aggravated by his service-connected AVR. The examiner reasoned that based on a December 2013 test, the elevated PSA level resolved and was therefore not chronic. The examiner stated the enlarged prostate was diagnosed more than a year after separation and was less likely than not related to a nonspecific urethritis in service because that condition had resolved without any residuals. The examiner noted the January 2014 urology report of transrectal prostate biopsy results that indicated a typical small acinar proliferation in the right prostate gland. The report stated that the Veteran was at high risk for prostate cancer and was currently asymptomatic. The examiner concluded that the prostate changes were more likely than not related to age and less likely than not due to service or the above listed conditions. Regarding the erectile dysfunction – the examiner concluded it was transient and therefore not chronic. A September 2013 urology report found the Veteran’s erectile dysfunction had returned to normal; the examiner reasoned that if the condition its onset in service, was related to service, or caused or aggravated by his service-connected AVR, the condition would not be transient. Similarly, the examiner found that based on several normal diagnostic tests, the renal insufficiency was transient and also resolved. The examiner found the Veteran's nonspecific urethritis was treated in service and resolved without sequelae, as did his instance of prostatitis. The Board finds the VA opinions to be the most probative evidence of record as they provide reasons and bases for the conclusion with citations to the evidence of record. Additionally, the evidence is not otherwise contradicted. While the Appellant believes that the Veteran’s kidney and genitourinary system disabilities are related to service and possibly due to the Veteran’s service-connected AVR, it is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, kidney and genitourinary system disabilities require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s kidney and genitourinary disability is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertions are not competent to establish a nexus. In conclusion, service connection for kidney stones or a genitourinary system disability must be denied, as the preponderance of the evidence is against a finding of service connection on a direct or secondary basis. As the preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.V. Palatt, Associate Counsel 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.