GALLBLADDER DISEASE

Summary

The veteran, who served in the United States Air Force from August 1990 to August 1994, appeals the denial of service connection for six conditions: gallbladder disease, gastroesophageal reflux disease (GERD), hypertension, peripheral neuropathy, cirrhosis, and kidney disease. The veteran claimed these conditions as secondary to PTSD. However, the Board noted that the veteran is not service-connected for PTSD, thus precluding secondary service connection for these conditions as a matter of law. For gallbladder disease, GERD, hypertension, and peripheral neuropathy, the Board found that while the conditions were noted in the veteran's post-service medical records, the service treatment records were silent regarding any complaints, treatment, or diagnoses related to these conditions. The Board concluded that the evidence persuasively weighed against a finding that these conditions began during active service or were otherwise related to service. For cirrhosis and kidney disease, the Board acknowledged the veteran's diagnoses and noted that these conditions could potentially be attributed to his in-service alcoholism. However, direct service connection was precluded due to the willful misconduct exclusion related to alcohol abuse. The Board found no evidence connecting these conditions to service apart from the alcoholism. In all instances, the Board determined that VA examinations were not necessary as the requirements for direct service connection were not met. Consequently, service connection for all six claimed conditions was denied.

Rationale

Not service connected for PTSD, precluding secondary claim.; Service treatment records silent for gallbladder disease.; No nexus established between gallbladder disease and service.

Full Decision Text

Citation Nr: A24086296
Decision Date: 12/27/24	Archive Date: 12/27/24

DOCKET NO. 230130-318884
DATE: December 27, 2024

ORDER

Entitlement to service connection for gallbladder disease is denied. 

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.  

Entitlement to service connection for hypertension is denied. 

Entitlement to service connection for peripheral neuropathy is denied. 

Entitlement to service connection for cirrhosis is denied.

Entitlement to service connection for kidney disease is denied.  

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that gallbladder disease began during active service or is otherwise related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that GERD began during active service or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that hypertension began during active service or is otherwise related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that peripheral neuropathy began during active service or is otherwise related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that cirrhosis began during active service or is otherwise related to an in-service injury or disease.

6. The evidence of record persuasively weighs against finding that kidney failure began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for gallbladder disease are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for hypertension are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for GERD are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for peripheral neuropathy are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for cirrhosis are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for kidney failure are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from August 1990 to August 1994. 

This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2022 Appeals Modernization Act (AMA) rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2022 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.?38 U.S.C. §§ 1110, 1131;?38 C.F.R. § 3.303?(a). Service connection
 to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.?38 U.S.C. §§ 1110, 1131;?38 C.F.R. § 3.303?(a). Service connection may also be granted for any disease diagnosed after discharge, when all?of?the?evidence, including that pertinent to service, establishes that the disease was incurred in service.?38 C.F.R. § 3.303?(d). Direct service connection may not be granted without?evidence?of?a current disability; in-service incurrence or aggravation?of?a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.?Id.; see also Caluza v. Brown,?7 Vet. App. 498, 506?(1995) aff'd,?78 F.3d 604?(Fed. Cir. 1996). 

Secondary service connection may be granted for a disability that is due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11?Vet. App.?509, 512 (1998). 

1. Entitlement to service connection for gallbladder disease as secondary to PTSD. 

The Veteran claims that his gallbladder disease should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ. 

As a preliminary matter, while the Veteran has advanced the theories that his gallbladder diagnosis is secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for gallbladder as secondary to PTSD is precluded as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994).

In the December 2022 rating decision, the RO made a favorable finding that gallbladder disease was reported in the Veteran's medical history in September 2020. See September 2020 Gainesville and West Palm Beach VAMC records. 

However, the Veteran's service treatment records show no complaints, treatment, or diagnosis of a gallbladder problem. There is nothing in the record that makes a connection between the Veteran's gallbladder disease and service. 

As such, although no VA examination for gallbladder disease was conducted, one was not necessary because the requirements of McLendon have not been met. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).  

As the evidence of record persuasively weighs against finding that the Veteran's gallbladder disease began during active service or is otherwise related to an in-service injury or disease, service connection for gallbladder disease is not warranted.  

2. Entitlement to service connection for GERD as secondary to PTSD. 

The Veteran claims that his GERD should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ.

As an initial matter, while the Veteran has advanced the theory that his GERD diagnosis is secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for GERD as secondary to PTSD is precluded as a matter of law. Sabonis, supra.

In the December 2022 rating decision, the RO made a favorable finding that a GERD diagnosis was reported in the Veteran's September 2020 medical record. See September 2020 Gainesville and West Palm Beach VAMC records. 

The Veteran was afforded a VA examination for GERD in October 2022. The examiner confirmed the diagnosis of GERD. The examiner opined that the Veteran's GERD was less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner's rationale was that the Veteran was never deployed to Southwest Asia and that the Veteran reported that he attributed the GERD symptoms to the NSAIDs used for his motor vehicle accident-induced back pain. See October 2022 Gulf War Opinion. 

Additionally, the record does not indicate a connection between the Veteran's GER
 was reported in the Veteran's September 2020 medical record. See September 2020 Gainesville and West Palm Beach VAMC records. 

The Veteran was afforded a VA examination for GERD in October 2022. The examiner confirmed the diagnosis of GERD. The examiner opined that the Veteran's GERD was less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner's rationale was that the Veteran was never deployed to Southwest Asia and that the Veteran reported that he attributed the GERD symptoms to the NSAIDs used for his motor vehicle accident-induced back pain. See October 2022 Gulf War Opinion. 

Additionally, the record does not indicate a connection between the Veteran's GERD and service. The Veteran's service treatment records are silent for GERD and there are no lay statements connecting the Veteran's GERD to service. Although no VA opinion for direct service connection of GERD was provided, one was not necessary as the requirements of McLendon have not been met. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).  

As the evidence of record persuasively weighs against finding that the Veteran's GERD began during active service or is otherwise related to an in-service injury or disease, service connection for GERD is not warranted.  

3. Entitlement to service connection for hypertension as secondary to PTSD. 

The Veteran claims that his hypertension should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ.

As an initial matter, while the Veteran has advanced the theory that his hypertension diagnosis is secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for hypertension as secondary to PTSD is precluded as a matter of law. Sabonis, supra.

In the December 2022 rating decision, the RO made a favorable finding that the Veteran had been diagnosed with portal hypertension in December 2020. See December 2020 West Palm Beach VAMC records. 

The Veteran's service treatment records show no complaints, treatment, or diagnosis of high blood pressure or hypertension. There is nothing in the record that makes a connection between the Veteran's hypertension and service. 

Although no VA examination for hypertension was conducted, one was not necessary as the requirements of McLendon have not been met. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).  

As the evidence of record persuasively weighs against finding that the Veteran's hypertension began during active service or is otherwise related to an in-service injury or disease, service connection for hypertension is not warranted.  

4. Entitlement to service connection for peripheral neuropathy as secondary to PTSD. 

The Veteran claims that his peripheral neuropathy should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ.

As an initial matter, while the Veteran has advanced the theories that his peripheral neuropathy diagnosis is secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for peripheral neuropathy as secondary to PTSD is precluded as a matter of law. Sabonis, supra.

In the December 2022 rating decision, the RO made a favorable finding that the Veteran had been diagnosed with neuropathy in September 2020. See September 2020 West Palm Beach VAMC records. 

The Veteran's service treatment records show no complaints, treatment, or diagnosis of neuropathy. There is nothing in the record that makes a connection between the Veteran's neuropathy and service. 

Although no VA examination for neuropathy was conducted, one was not necessary because the requirements of McLendon have not been met. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).

As the evidence of record persuasively weighs against finding that the Veteran's neuropathy began during active service or is otherwise related to an in-service injury or disease, service connection for neuropathy is not warranted.  

5. Entitlement to service connection for cirrhosis as secondary to PTSD. 

6. Entitlement to service connection for kidney disease as secondary to PTSD. 

The Veteran claims that his cirrhosis and kidney disease should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ.

As an initial matter, while the Veteran has advanced the theories that his cirrhosis and kidney disease diagnoses are secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for cirrhosis and kidney disease as secondary to PTSD are precluded as a matter of law. Sabonis, supra.

In the December 2022 rating decision, the RO made a favorable finding that the Veteran was diagnosed with cirrhosis of the liver in September 2020. See September 2020 Gainesville and West Palm Beach VAM
 disease as secondary to PTSD. 

The Veteran claims that his cirrhosis and kidney disease should be service connected secondary to his PTSD. See September 2022 VA Form 21-526EZ.

As an initial matter, while the Veteran has advanced the theories that his cirrhosis and kidney disease diagnoses are secondary to his PTSD, he is not service connected for PTSD. Consequently, service connection for cirrhosis and kidney disease as secondary to PTSD are precluded as a matter of law. Sabonis, supra.

In the December 2022 rating decision, the RO made a favorable finding that the Veteran was diagnosed with cirrhosis of the liver in September 2020. See September 2020 Gainesville and West Palm Beach VAMC records.  In a January 2022 medical record, the provider noted that the Veteran was hospitalized for cirrhosis and alcohol use disorder in 2019. In a September 2022 nephrology note, his disease is described as "alcoholic cirrhosis." 

In the December 2022 rating decision, the RO also made a favorable finding that the Veteran was diagnosed with stage 3 chronic kidney disease in May 2022. See May 2022 Gainesville and West Palm Beach VAMC records. In a January 2022 medical record, the provider noted that the Veteran was hospitalized in the ICU for one week for ascites, jaundice, and encephalopathy with liver and kidney failure in Fall 2019. The provider also noted that the Veteran was hospitalized for cirrhosis and alcohol use disorder in 2019.

Although secondary service connection is precluded, the evidence of record indicates that the Veteran's cirrhosis and/or kidney failure could be attributed to his alcoholism, which was present during service. See the 1992 Alcoholism Rehabilitation Summary. However, direct service connection may be granted only when a disability was incurred or aggravated in the line of duty, and not the result of the Veteran's own willful misconduct or the result of his abuse of alcohol or drugs. 38 U.S.C. §§ 105 (a), 1110; 38 C.F.R. §§ 3.1 (m), 3.301(a). To the extent that the Veteran's cirrhosis and/or kidney failure can be related to his active-duty service though his in-service alcoholism, service connection is precluded as a matter of law. See id.; Sabonis, 6 Vet. App. at 429-30. 

The Veteran's service treatment records show no complaints, treatment, or diagnoses of cirrhosis or kidney failure. There is nothing in the record, other than his alcohol abuse, that makes a connection between the Veteran's diagnoses and service.

Although no VA examinations for cirrhosis and kidney failure were conducted, one was not necessary because the requirements of McLendon have not been met. McLendon v. Nicholson, 20 Vet. App. 79, 81-86 (2006).

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As the evidence of record persuasively weighs against finding that the Veteran's cirrhosis and kidney failure began during active service or is otherwise related to an in-service injury or disease, service connection for cirrhosis and kidney failure is not warranted.  

 

 

Wendy Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Clark, C.

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.