BVA9503475 DOCKET NO. 93-06 766 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for claimed residuals of recurrent streptococcal infections of the throat, to include a kidney transplant due to glomerulonephritis with hematuria and proteinuria. 2. Entitlement to service connection for residuals of a tonsillectomy. 3. Entitlement to service connection for residuals of carcinoma of the skin of the left ear. 4. Entitlement to service connection for peripheral vascular disease. REPRESENTATION Appellant represented by: Joseph I. Carter, Esquire ATTORNEY FOR THE BOARD L. B. Wirt, Associate Counsel INTRODUCTION The veteran served on active duty from January 1952 to January 1955. This appeal arises from a February 1992 rating decision of the Department of Veterans Affairs (VA) Atlanta, Georgia, Regional Office (RO), which denied the veteran entitlement to service connection for residuals of recurrent streptococcal infections of the throat (to include a kidney transplant due to glomerulonephritis with hematuria and proteinuria), residuals of a tonsillectomy, residuals of carcinoma of the skin, and peripheral vascular disease. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he suffered from recurrent streptococcal infections of the throat in service, and that these infections caused him to develop glomerulonephritis, for which he eventually required a kidney transplant. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the grant of entitlement to service connection for residuals of recurrent streptococcal infections of the throat, to include a kidney transplant due to glomerulonephritis with hematuria and proteinuria. The preponderance of the evidence is also against the grant of entitlement to service connection for residuals of a tonsillectomy, residuals of carcinoma of the skin, and peripheral vascular disease. FINDINGS OF FACT 1. The evidence does not show that the veteran suffered from a kidney condition, including glomerulonephritis with hematuria and proteinuria, in service, or from chronic nephritis within one year of discharge. 2. Any episodes of streptococcal infection of the throat from which the veteran may have suffered in service were acute and transitory in nature, and no residuals of any such undocumented infections are shown. 3. The evidence does not show that the veteran currently suffers from any residuals of a tonsillectomy. 4. The evidence does not show that skin carcinoma of the left ear had its onset in service or within one year of discharge. 5. The evidence does not show that peripheral vascular disease had its onset in service or that arteriosclerotic occlusive disease was manifested within one year of service discharge. CONCLUSIONS OF LAW 1. A chronic kidney condition, including glomerulonephritis with hematuria and proteinuria, was not incurred in or aggravated by service, and nor may chronic nephritis such be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110 (West 1991); 38 C.F.R. §§ 3.303, 3.307 (1993). 2. Chronic residuals of streptococcal infections of the throat were not incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. 3. Chronic residuals of a tonsillectomy were not incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. 4. Carcinoma of the skin of the left ear was not incurred in or aggravated by service, and nor may it be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110; 38 C.F.R. §§ 3.303, 3.307. 5. Peripheral vascular disease was not incurred in or aggravated by service, and nor may arteriosclerotic occlusive disease be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110; 38 C.F.R. §§ 3.303, 3.307. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the statutory duty to assist mandated by 38 U.S.C.A. § 5107(a). I. Service Connection for Claimed Residuals of Streptococcal Infections of the Throat, to Include a Kidney Condition The veteran contends that he had recurrent streptococcal infections of the throat in service and that those infections caused him to develop glomerulonephritis with hematuria and proteinuria, and that he eventually required a kidney transplant as a result. Service connection may be established for disabilities resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In addition, certain chronic diseases, including nephritis (renal disease), will be presumed service connected, absent affirmative evidence to the contrary, if manifested to a degree of 10 percent within one year from the veteran's separation from service. 38 U.S.C.A. §§ 1101(3), 1112(a)(1), 1113(a); 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The veteran's available service medical records consist of two documents entitled "Clinical Record Cover Sheet," dated in May and June 1952, respectively, and a separation examination dated in January 1955. The first two documents pertain to chronic osteomyelitis of the right humerus, with the June 1952 document indicating that the veteran underwent a sequestrectomy of the right humerus to alleviate that problem. According to the reported history, this condition existed prior to service, and was incurred as a result of compound fractures of the right humerus which the veteran had sustained in 1950 when a tractor had rolled over him. The January 1955 separation examination indicates that his mouth, throat and genitourinary system were normal. Urinalysis revealed negative albumin and sugar, and was also negative microscopically. Blood pressure was 100 systolic, 50 diastolic. There was no mention of any streptococcal or other infections of the throat. No other defects were noted either. Post-service medical records from Dr. F. M. Davis have been associated with the file and are dated from November 1958 to July 1989. An entry dated in February 1969 indicates that the veteran was seen for a cough and cold, and complained of pain over his right kidney. He was noted to have many rales in his lungs. He was seen again several days later, complaining of right flank pain. His blood pressure was recorded as 120 systolic, 70 diastolic in March 1976. In April 1982, he was seen again with a complaint of feeling tired all the time. Blood pressure was 140 systolic, 70 diastolic. There was apparently pus, blood and albumin in his urine. It was recommended that he have an intravenous pyelogram (IVP) and a complete blood count. The veteran was seen shortly thereafter for evaluation of microscopic hematuria and a general complaint of not feeling well at Palmyra Park Hospital in Albany, Georgia, by Carl V. Hancock, Jr., M.D. An IVP did not reveal a specific abnormality, although there was incomplete filling of the right renal pelvis. The relevant final diagnoses were microscopic hematuria, etiology undetermined; and small parapelvic cyst of the left kidney. In June 1988, the veteran was hospitalized for excision of a skin lesion at the VA Medical Center (VAMC) in Gainesville, Florida. The hospital summary indicates that he carried a diagnosis at that time of end-stage renal disease secondary to membranoproliferative glomerular nephritis. The summary states that this condition was diagnosed by biopsy in 1983, and had resulted in progressively deteriorating renal function. He was reportedly about to start hemodialysis. It was also noted that he had developed hypertension secondary to his renal disease, but that it was controlled with medication. No past history of streptococcal throat infections was noted. In February 1990, the veteran underwent a kidney transplant at Shands Hospital at the University of Florida in Gainesville. The discharge summary indicates that the veteran had end-stage renal disease secondary to membranoproliferative glomerulonephritis type I. His past medical history was noted as significant for hypertension, a history of brucellosis, excision of a benign right epididymal mass in July 1989 and for a tonsillectomy as a child. No mention of any past streptococcal infections was made. The veteran underwent a VA examination in October 1991. He gave a history of having had several streptococcal throat infections in service, but did not recall being treated for them apart from a tonsillectomy which he said he had in service. On physical examination, his mouth and throat were normal. His genitourinary system was also described as normal, with reference to his history. The relevant diagnoses were history of tonsillitis with tonsillectomy, history of chronic glomerulonephritis with uremia and hemodialysis, kidney transplant due to the glomerulonephritis, and mild hematuria and proteinuria due to the glomerulonephritis. The examiner also made these comments: Chronic glomerulonephritis does follow episodes of streptococci pharyngitis. If there is evidence of recurrent sore throats due to streptococcus while in service, then [the] veteran[']s current problem can be attributed to this. As mentioned previously, the veteran's available service medical records are negative for any mention of recurrent streptococcal throat infections, hypertension or a kidney condition. There is also no evidence of any hypertension or kidney condition within one year from discharge. In addition, although the VA examiner commented that glomerulonephritis can result from streptococcal pharyngitis, records from the veteran's post-service treatment, with the exception of the October 1991 VA examination, are negative for any reported history of, treatment for, or diagnosis of a streptococcal infection at any time. The veteran's glomerulonephritis is identified in his records as being the membranoproliferative type, and there is no mention by the physicians who have treated him for the condition of any possible connection between that condition and any past streptococcal infections. Despite the VA examiner's general statement regarding possible causes of glomerulonephritis, there is no evidence, beyond the veteran's own assertions, which shows that he had streptococcal infections in service, and that these infections caused him to develop glomerulonephritis some 30 years later. The veteran is not competent to offer evidence as to medical causation. Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). Therefore, service connection for residuals of streptococcal throat infections, to include a kidney transplant due to glomerulonephritis with hematuria and proteinuria cannot be granted. II. Service Connection for Residuals of a Tonsillectomy The veteran has also appealed a denial of service connection for residuals of a tonsillectomy. As noted previously, service connection may be established for disabilities resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). The veteran's available service medical records are negative for any evidence of his having had a tonsillectomy in service. The February 1990 records from Shands Hospital at the University of Florida (pertaining to the veteran's kidney transplant), mention a history of a tonsillectomy "as a child," but is not more specific as to the date. The report from the October 1991 VA examination contains a history of a tonsillectomy in approximately 1953. Regardless of when the veteran's tonsillectomy was performed, however, there is no evidence that he currently has any residual disability in his throat. At his October 1991 VA examination, his throat was described as normal. Other post-service medical records are likewise negative for any reported throat problem. It is not sufficient merely that the veteran had his tonsils removed in service; he must have a current disability resulting from the procedure in order to establish entitlement to service connection. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Inasmuch as such a disability has not been shown, service connection for residuals of a tonsillectomy cannot be granted. III. Service Connection for Residuals of Carcinoma of the Skin The veteran has appealed a denial of entitlement to service connection for residuals of carcinoma of the skin as well. Service connection may be established for disabilities resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In addition, certain chronic diseases, including skin cancer (malignant tumors), will be presumed service connected, absent affirmative evidence to the contrary, if manifested to a degree of 10 percent within one year from the veteran's separation from service. 38 U.S.C.A. §§ 1101(3), 1112(a)(1), 1113(a); 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The veteran's available service medical records are negative for any evidence of carcinoma of the skin. Post-service medical records from Dr. F. M. Davis indicate that he had a skin lesion excised from his arm in May 1960, five years after discharge. Microscopic evaluation of the lesion resulted in a diagnosis of molluscum contagiosum. The pathology report indicates that there was no suggestion of malignant change in the specimen. In June 1988, he was hospitalized at the VAMC in Gainesville for excision of a skin lesion on his left posterior ear. The report notes that the veteran first noticed the lesion six months previously, and reported no other history of cancer. On physical examination, it was reported that the lesion resembled a central ulcer typical of basal cell carcinoma. No other such lesions were found. The lesion was excised without incident, and the diagnosis was skin cancer of the left posterior ear. Medical records from Shands Hospital at the University of Florida in Gainesville indicate that the veteran had basal cell carcinoma lesions removed from the tip of his nose in July 1990, and from his right temple in January 1991. Inasmuch as there is no evidence of carcinoma of the skin until many years after discharge, and no evidence indicating that the disease is attributable to service, service connection for the condition cannot be granted. IV. Service Connection for Peripheral Vascular Disease The veteran has also appealed a denial of service connection for peripheral vascular disease. As noted, service connection may be established for disabilities resulting from injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). In addition, certain chronic diseases, including cardiovascular conditions, will be presumed service connected, absent affirmative evidence to the contrary, if manifested to a degree of 10 percent within one year from the veteran's separation from service. 38 U.S.C.A. §§ 1101(3), 1112(a)(1), 1113(a); 38 C.F.R. §§ 3.307(a)(3), 3.309(a). The veteran's available service medical records are negative for any evidence of peripheral vascular disease. Post-service medical records from Dr. F. M. Davis indicate that he was seen in March 1976 complaining of his right leg giving out, with occasional pain. He was found to have decreased volume of the femoral pulse in the right lower leg. A chest X-ray was negative. The apparent impression was impaired circulation to right femoral artery. Dr. Davis referred the veteran to Mikell B. Karsten, M.D. A letter from Dr. Karsten, dated in March 1976, indicates that examination revealed very attenuated pulses throughout the right lower extremity as compared to the left. Capillary and venous filling were described as "quite good." There was a loud bruit audible over the right lower quadrant of the abdomen, which Dr. Karsten opined was compatible with atherosclerotic occlusive disease of his right iliac vessel. The veteran was seen again by Dr. Davis in April 1982, and it was noted that although he did not report pain in the right leg, the veteran still had a bruit of the right femoral which was louder than it had been previously. As noted above, peripheral vascular disease was not shown to be present in service, and the first evidence of any such condition was in 1976, many years after the veteran's discharge. There is no evidence which relates this condition to any incident in service. Therefore, service connection cannot be granted. ORDER Entitlement to service connection for claimed residuals of recurrent streptococcal infections of the throat, to include a kidney transplant due to glomerulonephritis with hematuria and proteinuria, is denied. Entitlement to service connection for residuals of a tonsillectomy is denied. Entitlement to service connection for residuals of carcinoma of the skin of the left ear is denied. Entitlement to service connection for peripheral vascular disease is also denied. SAMUEL W. WARNER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.