Citation Nr: 21005334 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 15-31 407A DATE: February 1, 2021 ORDER Entitlement to service connection for monoclonal gammopathy (claimed as monoclonal paraproteinemia) is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has or has had at any time during the pendency of the appeal, a current diagnosis of a disabling condition related to his monoclonal gammopathy (claimed as monoclonal paraproteinemia). CONCLUSION OF LAW The criteria for service connection for monoclonal gammopathy (claimed as monoclonal paraproteinemia) are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service with the Navy from February 1979 to September 1995. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the Board remanded the claim for further development. It was unclear if monoclonal gammopathy was a laboratory finding that manifested itself only in laboratory test results or was a disability for which service connection could be granted. The Board remanded the claim for a medical opinion to answer this question. An opinion from a Disability Benefits Questionnaire (DBQ) physician was received in June 2019. Therefore, there was substantial compliance with the August 2018 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that since the issuance of the April 2020 SSOC additional records were added to the claims file. CAPRI records were received in August and September 2020 and a VA examination regarding an increased rating for hearing loss and tinnitus was received October 2020. These records were either cumulative of the facts previously established or not pertinent to the issue discussed below. Therefore, the Board has concluded that it may proceed with appellate consideration of the monoclonal gammopathy (claimed as monoclonal paraproteinemia) claim without prejudice to the Veteran. See 38 C.F.R. § 19.31. Applicable Law and Regulations Entitlement to VA compensation may be granted for a disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability, (2) an 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. 38 U.S.C. § 1110; Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Due consideration must be given to all pertinent medical and lay evidence in evaluating a claim for service connection for any disability. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Competent lay evidence is any evidence that does not require the proponent to have specialized education, training, or experience. 38 C.F.R. § 3.159(a)(2); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Lay statements can be considered competent to establish a diagnosis when the layperson is competent to identify the medical condition, reports a contemporaneous medical diagnosis, or describes symptoms which support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Once evidence is deemed competent, the Board must determine whether such evidence is also credible. Layno v. Brown, 6 Vet. App. 465 (1994). When there is a proximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Analysis The Veteran contends his oncologist told him that he had multiple myeloma due to too much protein in his blood, which caused him to lose weight and have painful diarrhea. He reported while serving on the USS Eisenhower from 1979 to 1982 he was required to wear a dosimeter that measured radiation exposure. He stated crewmembers of the ship were exposed to various levels of radiation and never informed. He reported asking his oncologist if radiation exposure could lead to developing paraproteinemia. Per his oncologist, if an individual was exposed to various levels of nuclear radiation it would take many years for paraproteinemia to appear. The Veteran’s service treatment records showed normal clinical findings during his September 1978 enlistment examination. He reported being in good health. In his April 1992 reenlistment examination, it was noted that he was status post otoplasty, status post hernia repair, and that he required hearing aids. The Veteran reported issues with swollen/painful joints; ear, nose, and throat trouble; hearing loss; hernia; and arthritis, rheumatism, and/or bursitis. Despite noting these issues, he reported being in overall good health. In August 2012, the Veteran was diagnosed with low level monoclonal gammopathy of undetermined significance (MGUS) in the absence of skeletal, renal, or hematologic involvement; hypercalcemia; and clinical evidence of immunosuppression. His doctors noted that an April 2012 serum immunofixation test found the monoclonal IgG-kappa protein. In May 2012, he underwent a urine protein electrophoresis (UPEP), which detected no abnormal protein in part because it was conducted in a random urine specimen and the overall protein levels were below the detection threshold of the instrument. A serum protein electrophoresis (SPEP) was also done and revealed a 0.3 gr/dL IgG-kappa monoclonal protein. The Veteran complained that his right leg would give way resulting in falls and a knee injury. This prompted an extensive work up, which discovered monoclonal gammopathy. In July 2012, he had a skeletal survey, LDH and beta-2 microglobulin measurements, and a 24-hour UPEP test as well as a urine immunofixation test. In the absence of other manifestations or organ damage consistent with myeloma, a bone marrow biopsy was not recommended. In January 2013, the Veteran underwent magnetic resonance imaging (MRI) of the brain. He was being evaluated for evidence of demyelinating disease. However, the MRI showed normal findings. Reported diarrhea led to a colonoscopy in February 2013. The colorectal screening was negative. In February 2014 and August 2015, his doctors noted a low-level gamma spike with normal kappa and lambda levels as well as normal serum immunoglobulins. In August 2015, his doctors also noted that a bone scan found no lucent or suspicious osseous lesions. By May 2016, hematology and oncology treatment records noted his SPEP had a small M-spike in January 2015 and his last M-spike in serum was 0.6 mg in August 2015. He continued to have no calcium elevation, renal dysfunction, anemia, or bone disease (CRAB features) present. In February 2017, the Veteran’s colonoscopy biopsy results were normal. In June 2019, a DBQ physician reviewed the available records using the acceptable clinical evidence (ACE) process. The examiner opined the Veteran did not have a disabling condition from this laboratory abnormality. He was diagnosed with paraproteinemia or monoclonal gammopathy in 2012. This is most often associated with an immunoproliferative disorder or hematologic neoplasm, especially multiple myeloma. In the more than six years since his diagnosis, no myeloma or other immunoproliferative disorder had been diagnosed. He had no symptoms from his laboratory abnormality and did not have any blood cell abnormalities such as anemia or thrombocytopenia. The June 2019 VA opinion was highly probative evidence, as it relied on sufficient facts and data, and provided a rationale for the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Therefore, the probative evidence weighed against finding the Veteran had a current disabling condition related to his monoclonal gammopathy. While the Veteran believes he has a current disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The Board concludes that the Veteran does not have a current diagnosed disabling condition related to his monoclonal gammopathy and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1131, 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). (Continued on the next page)   Based on the evidence of record, the Board finds that entitlement to service connection for monoclonal gammopathy (claimed as monoclonal paraproteinemia) is not warranted. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.L. Byers 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.