Citation Nr: 21041124 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-54 737 DATE: July 8, 2021 ORDER Service connection for chronic renal disease and renal cyst disease is granted. A compensable rating for hypertension is denied. FINDINGS OF FACT 1. The Veteran's chronic renal disease and renal cyst disease are secondary to his service-connected hypertension. However, it is less likely than not, that the Veteran's neoplasm of the kidney or right benign neoplasm of the kidney were incurred in or caused by his active military service. 2. The Veteran takes continuous medication for the control of his hypertension; however, he has not been shown to have a history of diastolic pressure of predominantly 100 or more. Additionally, during the course of the appeal he has not been shown to have either a diastolic pressure of predominantly 100 or more, or a systolic pressure of predominantly 160 or more. CONCLUSIONS OF LAW 1. The criteria for service connection for chronic renal disease and renal cyst disease have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310(a). 2. The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.104, Diagnostic Code (DC) 7101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from August 1966 to August 1968. The matter is on appeal before the Board from a May 2015 rating decision. The Board previously remanded the issues for further development in June 2019. The development has been completed, and the issues have returned to the Board for further adjudication. The Board notes that during the pendency of the appeal, the Veteran was granted service connection for a left foot disability, a right foot disability, a left knee disability, and a right knee disability in a June 2020 rating decision. The granting of service connection for these four issues, is a grant of the full benefit sought on appeal, and as such these issues are no longer before the Board. 1. Service Connection Renal Disease and Renal Cyst Applicable Law Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (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. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disability which is aggravated by a service-connected disability. In order 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) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998). Analysis The Veteran asserts that he has a kidney disability that is secondary to his service-connected hypertension. The Veteran underwent a VA examination pertaining to kidney conditions in January 2020, at which the examiner noted diagnoses of right benign neoplasm of the kidney from 2008, renal cyst disease status-post removal from 2008, neoplasm of the kidney from 2015, and chronic renal disease from 2015. The examiner opined that it is at least as likely as not that the Veteran's chronic renal disease and renal cyst disease are at least as likely as not caused by his service-connected hypertension. The examiner provided a citation, and explained that when blood vessels become damaged, the nephrons that filter your blood do not receive the oxygen and nutrients that they need to function well. However, the examiner also found that there was no evidence to support that the Veteran's neoplasm of the kidney and right benign neoplasm of the kidney were related to hypertension. Based upon the foregoing, service connection for chronic renal disease and renal cyst disease are warranted as secondary to the Veteran's service-connected hypertension. However, service connection for the Veteran's neoplasm of the kidney and right benign neoplasm of the kidney are not warranted as secondary to the Veteran's service-connected hypertension. On a direct basis, the examiner opined that it was less likely than not that the Veteran's claimed kidney disability was incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that there are no medical records that support that the Veteran's neoplasm of the kidney or right benign neoplasm of the kidney were incurred in or caused by his service. Additionally, a review of the Veteran's service treatment records (STRs) does not reflect any diagnoses for neoplasm of the kidney or right benign neoplasm of the kidney, nor do they show any complaints or treatments that may be related to either neoplasm of the kidney or right benign neoplasm of the kidney. A further review of the Veteran's medical treatment records does not provide any findings of any greater significance than those relayed above. As such, service connection for neoplasm of the kidney and right benign neoplasm of the kidney is not warranted on a direct basis either. Consideration is given to the Veteran's contentions that his claimed kidney conditions of neoplasm of the kidney and right benign neoplasm of the kidney were either incurred in or caused by his military service, or secondary to his service-connected hypertension. While lay persons are competent to provide opinions pertaining to certain medical issues, the etiology of neoplasm of the kidney and right benign neoplasm of the kidney, as is specific to this case, is outside the realm of common knowledge for someone, such as the Veteran, who does not possess medical training, specialized expertise, or experience. Jandreau v. Nicholson, 492. F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, probative value shall not be applied to the Veteran's assertions. Accordingly, service connection for chronic renal disease and renal cyst disease as secondary to service-connected hypertension is granted. However, service connection for neoplasm of the kidney and right benign neoplasm of the kidney is denied. 2. Compensable Rating Hypertension Procedurally, the Veteran was granted service connection for hypertension in a February 1970 rating decision with a 10 percent evaluation effective August 22, 1968. In a December 1974 rating decision, the Veteran's 10 percent evaluation for his hypertension was decreased to noncompensable effective March 1, 1975. The Veteran filed a claim for a compensable rating for his hypertension in December 2014. In a May 2015 rating decision, the Veteran was denied a compensable rating for his hypertension. The Veteran filed a Notice of Disagreement in May 2016, in which he disagreed with the noncompensable evaluation and noted that his blood pressure can only be controlled with medications. After the issuance of a Statement of the Case in September 2016, the Veteran filed a Form 9 Appeal to the Board in October 2016. In June 2019, the Board remanded the issue to try and obtain the Veteran's private treatment records and to provide the Veteran with an additional VA examination. In November 2019, a letter was sent to the Veteran requesting that he fill out and return VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA). The purpose of the request was to be able to assist the Veteran in obtaining his private treatment records pertaining to the treatment of his hypertension. The letter also noted that the Veteran could also obtain and submit his private treatment records himself, if possible. Unfortunately, the Veteran did not fill out and return the requested forms, nor did he submit his private treatment records. The duty to assist is not a one-way street, and it is important that a Veteran make efforts to assist VA in gathering evidence relevant to his claim. See Woods v. Gober, 14 Vet. App. 214, 224 (2000). VA tried to assist the Veteran in obtaining his private treatment records, however, the Veteran failed to complete and return the requested forms. Neither did he submit his private treatment records himself. As such, the Board finds the development pertaining to obtaining the Veteran's private treatment records to be sufficient, and therefore it has been completed. Applicable Law Disability ratings are assigned under a schedule for rating disabilities and based on a comparison of the veteran's symptoms to the criteria in the rating schedule. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Disability evaluations are determined by assessing the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the ratings schedule. Individual disabilities are assigned separate Diagnostic Codes, and ratings are based on the average impairment of earning capacity. See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2. If there is a question as to which evaluation should be applied to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran's service-connected hypertension is rated under DC 7101. A 10 percent evaluation is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. A 20 percent evaluation is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent evaluation is warranted for diastolic pressure predominantly 120 or more. A 60 percent evaluation is warranted for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101. Analysis Over the course of the appeal, the Veteran has undergone two VA examinations pertaining to his hypertension. He first underwent a VA examination in April 2015. The Veteran was noted to take continuous medication for the treatment of his hypertension. The examiner did not report the Veteran to have a history of diastolic blood pressure elevation to predominantly 100 or more. Three blood pressure readings were taken, which were 121/74, 118/76, and 123/78. No other pertinent physical findings, complications, conditions, signs and/or symptoms were identified. The Veteran next underwent a VA examination in January 2020, at which it was noted that the course of the Veteran's hypertension had remained the same since its onset in 1968. The Veteran reported his current symptoms to include occasional headaches and dizziness at times. The Veteran was noted to take continuous medication for the treatment of his hypertension. The Veteran did not have a history of a diastolic blood pressure elevation to predominantly 100 or more. Three blood pressure readings were taken, which were 140/82, 140/84, and 138/80. No other pertinent physical findings, complications, conditions, signs and/or symptoms were identified. A review of the Veteran's available treatment records does not provide any findings of any greater significance than those relayed above. As previously noted, the Board remanded the issue in June 2019 to try and obtain the Veteran's private treatment records, as they may have contained information pertinent to the evaluation of his hypertension. However, as previously explained, the duty to assist is not a one-way street. As the Veteran failed to provide information that may be pertinent to supporting his claim, the Board's ability to fully assess the case for a compensable rating for service-connected hypertension is frustrated. As such, based upon the evidence of record, a compensable evaluation for hypertension is not warranted. A 10 percent evaluation for hypertension requires diastolic pressure of predominantly 100 or more, or systolic pressure of predominantly 160 or more, or a history of diastolic pressure of predominantly 100 or more that requires continuous medication for control. While the Veteran was reported to take continuous medication for his hypertension at both VA examinations, neither examination found him to have a history of diastolic pressure of predominantly 100 or more. Additionally, his blood pressure readings did not show a diastolic pressure of predominantly 100 or more or a systolic pressure of predominantly 160 or more. Also, there have been no treatment records or findings submitted that negate these findings. Accordingly, a compensable rating for hypertension is denied. L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Lutgens-Staley, 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.