Citation Nr: 21031435 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 14-31 828 DATE: May 21, 2021 ORDER Entitlement to service connection for combined variable immunodeficiency ("CVID"), to include as due to Camp Lejeune contaminated water exposure, is denied. FINDING OF FACT The Veteran's CVID was not aggravated by service. CONCLUSION OF LAW The criteria for service connection for a CVID disability 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 served on active duty from April 1975 to January 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in June 2018. The claim was remanded for the RO to obtain an addendum opinion. In November 2019 an addendum was added to the file. Thus, the Board finds that the RO substantially complied with the June 2018 Board remand directive and that the matter has been properly returned to the Board for appellate consideration. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran claims he suffers from a CVID related to service. Specifically, during the November 2017 Board hearing he alleged in-service manifestations of skin disease, sinusitis, cold symptoms, and problems with his lymph nodes were manifestations of his CVID. For the reasons discussed below, the Board finds that a medical nexus between the claimed disability and active service has not been demonstrated, and that service connection is not warranted. Service treatment records (STRs) do not reflect any symptoms, diagnosis, or treatment for a CVID disability. The March 1975 enlistment examination reflects lymph nodes surgery as a preexisting procedure. In August 1976 the Veteran indicated he was seen for a sore throat he had for two days. He had a fever and chills too. In October 1975 he was seen for a rash on his upper torso. In November 1975 he was seen for a cold. The January 1977 separation examination did not identify any CVID pathology. Post-service, in June 2008 private treatment records, it was noted the Veteran has common variable hypogammalobinemia, which has been present since infancy. In November 2010 VA treatment records the Veteran had a consultation for CVID. He reported sinus and bronchila infections began around age 17, however, they were more severe during his time at Camp Lejeune. He also began experiencing skin infections while at Camp Lejeune. During a November 2010 VA hematology consultation, the doctor found the Veteran's CVID is a genetic disorder that can be sporadic in nature. It was noted the disease is not related to service at Camp Lejeune. The dermatologist opined it is not possible to determine causation or linkage with regard to exposure at Camp Lejeune. The hematologist opined that the partial CVID is not due to exposure at Camp Lejeune. A September 2019 VA examination report indicated review of the Veteran's claims file, recounted the Veteran's history, and recited his complaints. It was noted, the distinction between a congenital or developmental defect, and a congenital or developmental disease, is not a distinction not generally made in clinical medical practice but the importance of the distinction for adjudication purpose is clear. CVID generally manifests after childhood and often the diagnosis is not made until the third or fourth decade. However, it is an inherited disorder, not a disorder that develops after birth. For VA purposes, it is probably best to consider CVID to be a congenital or developmental disease because the immune globulin deficiencies may worsen with advancing age, as do other aspects of the immune system. The examiner opined it is at least as likely as not that the CVID did not manifest prior to active duty service. It was reasoned, "such delayed manifestation is very much in keeping with the late onset of manifestation..." Also, it was opined it is of negligible likelihood that the Veteran's CVID was incurred or caused by his service, and it is less likely than not that it was aggravated beyond natural progression by exposures or events during service. There are no generally accepted factors that worsen CVID; the natural history is one of general stability with the superimposition of immune senescence caused by advancing age. The Board has reviewed all of the lay and medical evidence of record in conjunction with the applicable laws and regulations and finds the current disability is not related to service. In this regard the Board finds the September 2019 VA examination discussed above, is the most probative evidence of record. The examiner found the disability was not related to service. It is supported by an adequate rationale, noting there are no generally accepted factors that worsen CVID; the natural history is one of general stability with the superimposition of immune senescence caused by advancing age. There are no contrary medical opinions of record. Therefore, the Board finds the September 2019 VA opinion is the most probative evidence. To the extent that the Veteran argues the in-service skin condition, sinusitis, cold symptoms, and problems with his lymph nodes were manifestations of his CVID, the Board finds the Veteran is not competent to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, the Veteran is receiving compensation for the skin condition, as the RO has awarded a 30 percent evaluation. The Board acknowledges the June 2020 correspondence from the Veteran's attorney. The attorney requested a copy of the September 2019 VA examination, which VA provided to him in April 2021. Also, the attorney argued the September 2019 VA examiner relied on a 9-year-old opinion and did not render an independent opinion. The United States Court of Appeals for Veterans Claims (Court) has ruled that there is a "presumption of regularity" under which it is presumed that VA examiners and other government employees have properly discharged their official duties. Ashley v. Derwinski, 2 Vet. App. 307, 308 (1992) (citing United States v. Chemical Foundation, Inc., 272 U.S. 1, 14-15 (1926)). Clear evidence to the contrary is required to rebut the presumption of regularity. As noted above, the Board has found the September 2019 VA opinion probative. Furthermore, the Board has reviewed the VA examination report and finds no clear evidence that the VA examiner did not provide an independent opinion based on the evidence available. The examiner indicated the available records and VA e-folder were reviewed. The attorney's statements alone do not constitute clear evidence showing that the examination was not conducted in the regular manner appropriate for an CVID opinion. Accordingly, service connection for a CVID disability is denied. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable. See 38 U.S.C.§5107(b); 38 C.F.R.§ 3.102; see also Gilbert, 1 Vet. App.at 53-56. [SIGNATURE ON NEXT PAGE] JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jackman, 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.