Citation Nr: A21016363 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 191212-51136 DATE: October 5, 2021 ORDER Service connection for nicotine dependency, for purposes of accrued benefits, is denied. Service connection for a thyroid disorder, characterized as thyroid disease, for purposes of accrued benefits, is denied. Service connection for a kidney disorder, characterized as decreased kidney function, and claimed as chronic kidney disease, for purposes of accrued benefits, is denied. Service connection for gastroesophageal reflux disease (GERD), for purposes of accrued benefits, is denied. Service connection for diabetes mellitus, type II, for purposes of accrued benefits, is denied. Service connection for hepatitis C and its residuals, for purposes of accrued benefits, is denied. Service connection for peripheral artery disease, for purposes of accrued benefits, is denied. Service connection for high blood pressure, also claimed as hypertension, for purposes of accrued benefits, is denied. Service connection for chronic obstructive pulmonary disease (COPD), for purposes of accrued benefits, is denied. Service connection for multiple myeloma, for purposes of accrued benefits, is denied. Service connection for chronic anemia, for purposes of accrued benefits, is denied. Service connection for coronary arteriosclerosis disease, for purposes of accrued benefits, is denied. Service connection for erectile dysfunction, for purposes of accrued benefits, is denied. Service connection for a back disorder, characterized as a chronic back condition, to include as secondary to multiple myeloma, for purposes of accrued benefits, is denied. Service connection for opioid dependency, for purposes of accrued benefits, is denied. Special monthly compensation (SMC) based on a need for aid and attendance, for purposes of accrued benefits, is denied. SMC on account of being housebound, for purposes of accrued benefits, is denied. FINDINGS OF FACT 1. Tobacco use is not a disability for which service connection may be granted. 2. The preponderance of the evidence of record is against finding that the Veteran had a diagnosis of a thyroid disorder at any time during the appeal for VA disability compensation purposes. 3. The Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction were not shown in service or for many years thereafter and were not otherwise etiologically related to active duty service, including exposure to toxic herbicide agents. 4. The Veteran's back disorder was not shown in service or for many years thereafter, and was not otherwise etiologically related to active duty service, including exposure to toxic herbicide agents, and was caused by, proximately due to, or the result of a service-connected disability, including multiple myeloma. 5. Opioid dependency is not a disability for which service connection may be granted, and the Veteran's opioid abuse was not related to a service-connected disease or disability. 6. The Veteran does not have any service-connected disabilities to support a claim of entitlement to SMC based on a need for aid and attendance or entitlement to SMC on account of being housebound. CONCLUSIONS OF LAW 1. The Veteran's claim of service connection for nicotine dependence lacks legal merit and entitlement under the law. 38 U.S.C. § 1103; 38 C.F.R. § 3.300. 2. The criteria for service connection for a thyroid disorder, characterized as thyroid disease, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for service connection for a kidney disorder, characterized as decreased kidney function, and claimed as chronic kidney disease, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. 4. The criteria for service connection for GERD, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 5. The criteria for service connection for diabetes mellitus, type II, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 6. The criteria for service connection for hepatitis C and its residuals, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 7. The criteria for service connection for peripheral artery disease, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 8. The criteria for service connection for high blood pressure, also claimed as hypertension, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 9. The criteria for service connection for COPD, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 10. The criteria for service connection for multiple myeloma, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 11. The criteria for service connection for chronic anemia, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 12. The criteria for service connection for coronary arteriosclerosis disease, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 13. The criteria for service connection for erectile dysfunction, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 14. The criteria for service connection for a back disorder, characterized as a chronic back condition, to include as secondary to multiple myeloma, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 15. The criteria for service connection for opioid dependency, for purposes of accrued benefits have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303. 16. The criteria for SMC based on a need for aid and attendance, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.351, 3.352, 4.2, 4.3, 4.6, 4.10, 4.40, 4.45, 4.59. 17. The criteria for SMC on account of being housebound, for purposes of accrued benefits, have not been met. 38 U.S.C. §§ 1114, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.351, 3.352, 4.2, 4.3, 4.6, 4.10, 4.40, 4.45, 4.59. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1965 to November 1968. He died in December 2019. The appellant is his widow, who has been substituted as the claimant. The rating decision on appeal was issued in August 2019 and constitute initial decisions. Therefore, the modernized review system, also known as the Appeals Modernization Act, applies. In December 2019 the Veteran submitted a notice of disagreement, where he elected the Direct Review option. Accordingly, the Board may only consider the evidence of record at the time of the AOJ decisions on appeal. 38 C.F.R. § 20.301. In this case, after the August 2019 rating decision was issued, the Veteran submitted an article regarding herbicide exposure and multiple myeloma and high blood pressure. Because Direct Review of the December 2019 rating decision was selected, this evidence will not be considered by the Board. Service Connection The appellant contends that service connection is warranted for the Veteran's nicotine dependency, thyroid disorder, kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, back disorder, and opioid dependency. In support of the claims, the appellant states that the Veteran was treated for multiple myeloma between March 2018 and December 2019, and that he was treated for nicotine dependency, thyroid disorder, kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, back disorder, and opioid dependency for more than 20 years. The appellant also relies on the arguments put forth by the Veteran. The Veteran argued that his claims of service connection should have been granted because they were all related to his exposure to toxic herbicide agents during service in the Republic of Vietnam. With respect to hepatitis C, he contended that he incurred hepatitis C as a result of his exposure to contaminated blood or contaminated blood instruments while working in the medic unit during his active duty service. With respect to his kidney disorder and erectile dysfunction, he contended that service connection was also warranted because those disorders were secondary to his hypertension or diabetes mellitus, type II. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present 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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). "In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Certain chronic diseases may be presumed to have been incurred during service if they become manifested to a compensable degree within one year from separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. Id. Moreover, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). 1. Entitlement to service connection for nicotine dependency, for purposes of accrued benefits The appellant contends that service connection for the Veteran's nicotine dependence is warranted. The Board acknowledges that the Veteran's treatment records, including a June 2013 treatment record, note nicotine dependence. However, there is no express basis on which to award service connection for tobacco use itself. See generally 38 C.F.R. Part 4 (VA Schedule for Rating Disabilities) (does not contemplate a separate disability rating for tobacco use). Further, for claims filed after June 9, 1998, as in the instant case, service connection may not be granted on the basis that a disability resulted from disease or injury attributable to the use of tobacco products during active service. 38 U.S.C. § 1103(a); 38 C.F.R. § 3.300. Insofar as the appellant claims, and the Veteran claimed, that his use of tobacco (nicotine dependence) is itself a disability stemming from usage during service, service connection cannot be granted under these provisions. Given that the claim of service connection for nicotine dependence, the claim is denied. See Sabonis v. Brown, 6 Vet. App. 426 (1994) (explaining that where the law is dispositive, the claim must be denied due to a lack of legal merit); see also 38 U.S.C. § 1103; 38 C.F.R. § 3.300. 2. Entitlement to service connection for a thyroid disorder, characterized as thyroid disease, for purposes of accrued benefits The appellant contends that service connection for a thyroid disorder is warranted. The Board finds that after a thorough review of the evidence of record, the evidence does not reflect that the Veteran had a diagnosed thyroid disorder at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). Here, no service treatment records reflect that he ever sought treatment for, reported signs or symptoms of, or was diagnosed with a thyroid disorder. Indeed, the report from his November 1968 separation examination was normal and did not reflect that he had any issues related to his thyroid or a thyroid disorder. Similarly, the Veteran did not report signs or symptoms of a thyroid disorder in his September 1968 report of medical history. The post-service treatment records also fail to show that he ever sought treatment for, reported signs or symptoms of, or was been diagnosed with a thyroid disorder. In fact, various treatment records, including a June 2011 treatment record reflect that his thyroid was normal. The Board acknowledges the assertions by the appellant and the Veteran, and their belief that he had a thyroid disorder, however, they are not competent to provide a diagnosis in this case. The issue is medically complex and requires specialized medical education and knowledge of the interaction between multiple systems in the body, as well as the ability to interpret complicated diagnostic medical testing. Jandreau, v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, the statements by the appellant and the Veteran regarding a thyroid disorder are found to lack competency. Accordingly, because the preponderance of the evidence is against a finding that the Veteran had a thyroid disorder at any point during the period on appeal, service connection is not warranted. See 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). 3. Entitlement to service connection for a kidney disorder, characterized as decreased kidney function, and claimed as chronic kidney disease, for purposes of accrued benefits 4. Entitlement to service connection for GERD, for purposes of accrued benefits 5. Entitlement to service connection for diabetes mellitus, type II, for purposes of accrued benefits 6. Entitlement to service connection for hepatitis C and its residuals, for purposes of accrued benefits 7. Entitlement to service connection for peripheral artery disease, for purposes of accrued benefits 8. Entitlement to service connection for high blood pressure, also claimed as hypertension, for purposes of accrued benefits 9. Entitlement to service connection for COPD, for purposes of accrued benefits 10. Entitlement to service connection for multiple myeloma, for purposes of accrued benefits 11. Entitlement to service connection for chronic anemia, for purposes of accrued benefits 12. Entitlement to service connection for coronary arteriosclerosis disease, for purposes of accrued benefits 13. Entitlement to service connection for erectile dysfunction, for purposes of accrued benefits 14. Entitlement to service connection for a back disorder, characterized as a chronic back condition, to include as secondary to multiple myeloma, for purposes of accrued benefits The appellant contends that service connection is warranted for the Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder. Based upon the evidence of record, the Board determines that service connection is not warranted for the Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder because the preponderance of the evidence weighs against finding that they began during service or are otherwise etiologically related to service. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), (d), 3.304, 3.307, 3.309, 3.310. As a preliminary matter, to the extent that the Veteran asserted that service connection for his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder was warranted based upon exposure to toxic herbicide agents during service in the republic of Vietnam, the Board finds that this argument is without merit. VA regulations state that a veteran who served in the Republic of Vietnam during the period from January 9, 1962 to May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, 2,4-Dichlorophenoxyacetic acid or 2,4,5-Trichlorophenoxyacetic acid, and may be presumed to have been exposed during such service to any other chemical compound in an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). Notably, these were the key compounds found in the tactical herbicide agents used during that time, with "Agent Orange" being the most common. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307(a)(6)(iii). Service connection is warranted for a Veteran who has been exposed to toxic herbicide agents during active military service (subject to the requirements of 38 C.F.R. § 3.307 (a)) for diseases such as chloracne or other acneform diseases consistent with chloracne, diabetes mellitus, Hodgkin's disease, non-Hodgkin's lymphoma, early onset peripheral neuropathy, porphyria cutanea tarda, multiple myeloma, respiratory cancers (cancer of the lungs, bronchus, larynx, or trachea), soft-tissue sarcomas, ischemic heart disease, Parkinson's disease, B-cell leukemias and prostate cancer. In fact, service connection is warranted even if these disorders were not shown during active duty. 38 C.F.R. § 3.309(e). In this case, service connection for the Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder is not warranted on a presumptive basis due to exposure to herbicide agents. Although the Veteran served from 1965 to 1968, and diabetes mellitus, hypertension, and multiple myeloma are disorders that may be presumed to be related to exposure to herbicide agents, the Veteran's service did not include service in Vietnam pursuant to 38 C.F.R. § 3.307(a)(6)(iii). Indeed, there is no evidence showing that he served in the Republic of Vietnam or had nautical service during the Vietnam era. Next, although the Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder are not entitled to presumptive service connection under 38 C.F.R. §§ 3.307 and 3.309, the appellant is not precluded from establishing service connection for them with proof of actual direct causation as due to active duty service. See Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). However, as discussed below, the Board concludes that service connection is not warranted. Initially, the Board finds that the Veteran's service treatment records fail to establish that his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder were incurred in or were related to his active duty service. Specifically, his service treatment records do not reflect that he reported symptoms of, received treatment for, or was diagnosed with a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, or a back disorder. In fact, the report from his September 1968 separation examination reflects that the examining physician found that all of his systems and body parts were "normal," that he had normal blood pressure. Moreover, in his September 1968 report of medical history, he denied shortness of breath, palpitation or pounding heart, high blood pressure, frequent indigestion, a tumor, growth, cyst, or cancer, arthritis or rheumatism, and recurrent back pain, indicated that his health was "good," and did not report any signs or symptoms that could be attributed to any of the claimed disorders. The post-service evidence also does not indicate that the Veteran experienced continuous symptoms related to a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, or a back disorder. In this case, the clinical evidence of record shows significant gaps between the Veteran's separation from service and when he first sought treatment for these disorders after his separation from service in November 1968: With respect to a kidney disorder, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to a kidney disorder until January 2019, more than 50 years after his separation from service. Prior to January 2019, other treatment records, including a September 2015 treatment record reflect that he had no kidney disease. With respect to GERD, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to GERD until February 2007, more than 38 years after his separation from service. With respect to diabetes mellitus, type II, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to a kidney disorder until January 2019, more than 50 years after his separation from service. Prior to January 2019, other treatment records, including an April 2018 treatment record, reflect that he did not have diabetes. With respect to hepatitis C and its residuals, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to hepatitis C and its residuals until July 2003, more than 34 years after his separation from service. With respect to peripheral artery disease, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to peripheral artery disease until April 2018, more than 49 years after his separation from service. With respect to high blood pressure, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to high blood pressure until June 1999, more than 30 years after his separation from service. With respect to COPD, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to COPD until August 2017, more than 48 years after his separation from service. Prior to August 2017, other treatment records, including a September 2015 treatment record, reflect that he did not have COPD. With respect to multiple myeloma, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to multiple myeloma until January 2019, more than 50 years after his separation from service. With respect to chronic anemia, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to chronic anemia until January 2019, more than 50 years after his separation from service. Prior to January 2019, other treatment records, including an April 2009 treatment record, reflect that he did not have signs or symptoms of anemia. With respect to coronary arteriosclerosis disease, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to coronary arteriosclerosis until May 2013, when a treatment record noted that his past medical history included it, which was more than 44 years after his separation from service. With respect to erectile dysfunction, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to erectile dysfunction until October 2009, when a treatment record noted that his past medical history included it, which was more than 40 years after his separation from service. With respect to a back disorder, the objective medical evidence does not show any symptoms of or treatment for symptoms that could be attributed to a back disorder until August 2012, more than 43years after his separation from service. Given the significant gaps between his separation from service in November 1968 and when he first sought treatment for these disorders, a continuity of symptoms based upon the clinical evidence is not sufficient to support a direct nexus. The Board acknowledges the Veteran's statements regarding the history of his symptoms of a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and a back disorder. Although he is competent to report that he experienced the symptoms of these disorders, he is not competent to determine that these symptoms were manifestations of a particular disorder. See Jandreau, 492 F.3d at 1377, 1377 n.4. Nevertheless, to the extent that the appellant contends that the Veteran's kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder have persisted since his service because he was treated for them for over twenty years, the Board determines that the reported history of continued symptoms is not credible and does not establish the nexus element because, as discussed above, the evidence shows that he did not seek treatment for these disorders for significant durations after separation from service. The fact that he did not seek treatment for these significant durations after his active duty service weighs against the appellant's credibility to the extent that she asserts continuous symptoms of these disorders. See Kahana v. Shinseki, 24 Vet. App. 428, 439-40 (2011). Moreover, the Veteran's normal September 1968 separation examination and denial of shortness of breath, palpitation or pounding heart, high blood pressure, frequent indigestion, tumor, growth, cyst, or cancer, arthritis or rheumatism, and recurrent back pain, and statement that his present health was "good" in the September 1968 report of medical history, further weighs against her credibility in asserting that he had continuous symptoms of the claimed disorders after his active duty service. Thus, a continuity of symptoms cannot be established based upon the Veteran's assertions. Finally, service connection may be granted when the evidence establishes a medical nexus between active duty service and the current diagnosis. However, there is not sufficient evidence in the medical records to demonstrate a nexus between the Veteran's active duty service and his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder. Indeed, there is no objective medical evidence linking these disorders to his active duty service. Further, the Board notes that neither the appellant nor the Veteran provided sufficient evidence, including private opinions and/or medical evidence, to establish a nexus between his active service and his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder. In arriving at its conclusion, the Board has also considered the statements made by the appellant and the Veteran relating his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder to his active duty service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau, 492 F.3d at 1377). In this case, however, the appellant and the Veteran are not competent to provide testimony regarding the etiology of his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder. See Jandreau, 492 F.3d at 1377, n.4. Although they can provide competent testimony regarding symptoms, these disorders are not disorders that can be diagnosed by their unique and identifiable features as they do not involve a simple identification that a layperson is competent to make. In any event, the diagnoses of dysfunctions and disorders, and their respective etiologies, are medical determinations and generally must be established by medical findings and opinion. See id. at 1376-77. Thus, to the extent that the appellant believes and the Veteran believed that his kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and back disorder were related to his active duty service, including that his hepatitis C was the result of exposure to contaminated blood and blood instruments, they are lay persons without appropriate medical training and expertise to provide a medical diagnosis and etiological opinion. With respect to hepatitis C, he contended that he incurred hepatitis C as a result of his exposure to contaminated blood or contaminated blood instruments while working in the medic unit during his active duty service. With respect to his kidney disorder and erectile dysfunction, he contended that service connection was also warranted because those disorders were secondary to his hypertension or diabetes mellitus, type II. To the extent that the appellant contends and the Veteran contended that his kidney disorder and erectile dysfunction were secondary to his high blood pressure and diabetes mellitus, type II, and that his back disorder was secondary to his multiple myeloma, the Board notes that it has determined that service connection for high blood pressure, diabetes mellitus, type II, and multiple myeloma is not warranted. Given that secondary service connection cannot be granted as secondary to a nonservice-connected condition, secondary service connection for his kidney disorder, erectile dysfunction, and back disorder is not warranted on a secondary basis. See 38 C.F.R. § 3.310. By virtue of the foregoing, the Board concludes that the preponderance of the evidence is against the claims seeking service connection for a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and a back disorder, and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 15. Entitlement to service connection for opioid dependency, for purposes of accrued benefits The appellant contends that service connection for opioid dependency should be granted. Although drug dependence may satisfy the requirement of service connection that there is a current disability, the controlling law provides that no compensation shall be paid if the disability was the result of the person's own willful misconduct or abuse of drugs. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Section 8052 of the Omnibus Budget Reconciliation Act (OBRA) of 1990, Public Law No. 101-508, § 8052, 104 Stat. 1388, 1388-351, also prohibits, effective for claims filed after October 31, 1990, the payment of compensation for disability that is the result of a veteran's own drug abuse. See 38 U.S.C. § 1110. Thus, service connection for drug abuse is not permitted under the law. Notwithstanding the aforementioned, service connection for a drug abuse disorder is possible if the abuse of drugs was acquired secondary to, or is a symptom of, a service-connected disability. See Allen v. Principi, 237 F.3d 1368, 1377, 1381 (Fed. Cir. 2001). However, veterans "can only recover if they can adequately establish that their alcohol or drug abuse disability is secondary to or is caused by their primary service-connected disorder . . . such compensation would only result where there is clear medical evidence establishing that the alcohol or drug abuse disability is indeed caused by a Veteran's primary service-connected disability, or the alcohol or drug abuse disability is not due to willful wrongdoing." Id. at 1381. Here, the Board has concluded that service connection for a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, and a back disorder is not warranted, and the Veteran had no other service-connected disabilities. Thus, service connection for opioid dependency cannot be granted as secondary to a service-connected disability. Accordingly, the Board concludes that service connection for opioid dependency is not warranted. SMC 1. Entitlement to SMC based on a need for aid and attendance, for purposes of accrued benefits 2. Entitlement to SMC on account of being housebound, for purposes of accrued benefits SMC based on a need for aid and attendance and SMC on account of being housebound require that entitlement be based on service-connected disabilities. Where there are no service-connected disabilities, SMC is prohibited as a matter of law. In this case, the Veteran has no service-connected disabilities. Accordingly, the claims must be denied as lacking legal merit. Sabonis, 6 Vet. App. at 430. By virtue of the foregoing, the Board concludes that service connection, for purposes of accrued benefits, for nicotine dependency, a thyroid disorder, a kidney disorder, GERD, diabetes mellitus, type II, hepatitis C and its residuals, peripheral artery disease, high blood pressure, COPD, multiple myeloma, chronic anemia, coronary arteriosclerosis disease, erectile dysfunction, a back disorder, and opioid dependency is not warranted, and that SMC based on a need for aid and attendance and on account of being housebound, for purposes of accrued benefits, is not warranted. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Crosnicker, Associate Counsel