11-16 741
11-16 741
| Board of Vet. App. | Jan 31, 2017Background
- Veteran served on active duty Feb 1966–Dec 1968; claim arose from July 2009 filing for service connection for diabetes and related nephropathy.
- VA awarded service connection for diabetes mellitus, type II, effective July 29, 2008; Veteran seeks service connection for nephropathy (direct and secondary to diabetes).
- VA obtained service and VA medical records, provided VA exams in Feb 2010 (with May 2010 addendum) and a remand-ordered October 2015 medical opinion; Board found VA satisfied duty to notify and assist.
- Medical records show long-standing hypertension (documented as early as 1982 and reportedly beginning 1969), diabetes diagnosed circa 1998–1999, episodic renal function abnormalities, and treatment notes indicating progressive renal dysfunction.
- VA examiners (May 2010 and Oct 2015) concluded nephropathy was less likely due to diabetes and more likely related to long-standing hypertension, obesity, and dyslipidemia; no competent evidence ties nephropathy to service or to service-connected diabetes.
- August 2012 denial of service connection for hypertension is final; no pending reopened claim for hypertension, which precludes secondary service connection for nephropathy predicated on hypertension.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for nephropathy (secondary to diabetes) | Nephropathy was caused or aggravated by service‑connected diabetes mellitus, type II | Most probative medical opinions and records show nephropathy is more likely due to long‑standing hypertension, obesity, dyslipidemia predating diabetes | Denied — preponderance against nexus to diabetes; no secondary service connection granted |
| Direct service connection for nephropathy | Nephropathy began in or is related to active service | Service records are silent for kidney disease at separation and no competent evidence links nephropathy to service | Denied — no nexus to in‑service events established |
| Adequacy of VA development/examinations | VA should obtain further development or relied‑on evidence supports nexus | VA provided examinations (2010, 2015), reviewed records, and gave reasoned opinions; remand directive satisfied | Board finds duty to assist and remand compliance satisfied; opinions adequate |
| Application of benefit‑of‑the‑doubt rule | Veteran entitled to doubt benefit given some treatment notes suggesting diabetic nephropathy | Preponderance of evidence is against claim, so doubt rule does not apply | Benefit of the doubt not invoked; claim denied |
Key Cases Cited
- Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.) (elements for direct service connection)
- Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir.) (VA duties under VCAA)
- Barr v. Nicholson, 21 Vet. App. 303 (Vet. App.) (requirements for medical nexus opinions)
- Romanowsky v. Shinseki, 26 Vet. App. 289 (Vet. App.) (evaluating post‑service evidence of onset)
- Stegall v. West, 11 Vet. App. 268 (Vet. App.) (requirement to comply with remand directives)
- Colvin v. Derwinski, 1 Vet. App. 171 (Vet. App.) (Board cannot substitute its medical judgment)
- Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App.) (preponderance standard and benefit‑of‑the‑doubt rule)
- Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir.) (lay competence limits on medical causation testimony)
- Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir.) (when lay testimony may be competent)