Citation Nr: 18154154
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 17-38 255
DATE:	November 29, 2018
ORDER
Service connection for chronic kidney disease is granted.
FINDINGS OF FACT
1. The Veteran was exposed to herbicide agents coincident with his service in the Republic of Vietnam.
2. Resolving all doubt in his favor, the Veteran’s currently diagnosed chronic kidney disease is related to his acknowledged in-service exposure to herbicide agents.
CONCLUSION OF LAW
The criteria for service connection for chronic kidney disease have been met.  38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307.
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Veteran served on active duty from August 1966 to August 1968.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).  
Entitlement to service connection for chronic kidney disease, to include as due to exposure to herbicide agents.
The Veteran contends that his chronic kidney disease is related to his exposure to herbicide agents coincident with his service in the Republic of Vietnam.
Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection may also be granted for any disease diagnosed after discharge, when all 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).  
Veterans who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, are presumed to have been exposed to herbicide agents.  See 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6).  For purposes of the presumption, “herbicide agents” are 2,4-D, 2,4,5-T, and its contaminant TCDD, cacodylic acid, and picloram.  38 C.F.R. § 3.307(a)(6)(i).  
When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).
As an initial matter, the Board notes that the Veteran has a current diagnosis of chronic kidney disease, which has been attributed to idiopathic membranous glomerulonephritis.  In this regard, such was first diagnosed on an August 2011 biopsy as noted in a November 2011 private treatment record, and he has had continuing treatment since such diagnosis.  Additionally, the Veteran is presumed to have been exposed to herbicide agents coincident with his service in Vietnam from January 1967 to January 1968 as documented in his service personnel records.  Further, while chronic kidney disease is not a disease presumptively related to exposure to herbicide agents, the Board finds that service connection is warranted on a direct basis.  See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).
In this regard, the Veteran submitted a May 2015 letter from his treating physician, S.M., M.D.  In such letter, Dr. S.M. noted that while the Veteran was stationed in Vietnam he was exposed to Agent Orange, an herbicide agent, and now has renal disease due to such exposure.  Notably, Dr. S.M. did not provide any supporting rationale for his opinion.  Accordingly, the Board affords such opinion no probative weight.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions).
In contrast, the Board finds another letter from Dr. S.M., submitted by the Veteran in April 2016, to be highly probative.  In such letter, Dr. S.M. again noted the Veteran’s service in Vietnam with resulting exposure to Agent Orange, an herbicide agent, and opined that he has a number of problems that can be associated either directly or indirectly to such exposure, including his membranous glomerulonephritis, which, as noted above, is the root cause of his chronic kidney disease.  Dr. S.M. supported his opinion by noting the medical literature that relates Agent Orange to such problems, and included such literature in an attachment to his letter.  Medical treatise evidence supporting such proposition was also cited by the Veteran and his representative.  Further, Dr. S.M. noted specific chemicals, which are contained in herbicide agents, that are directly related to the development of glomerulonephritis, and noted that Agent Orange and dioxins cause problems with numerous body systems, which also indirectly affect the renal system.  Notably, much of the research included concerned the endocrine system, to specifically include a notation regarding the effect on a hormone which stimulates water absorption by the kidney tubules.
The Board finds the above opinion to be highly probative as to the question of a nexus between the Veteran’s chronic kidney disease and his in-service exposure to herbicide agents.  In this regard, while the opinion does not provide a wealth of supporting data and rationale, it did provide a sufficient basis for the opinion proffered.  See Nieves-Rodriguez, supra; Stefl, supra.  Further, as his treating physician, Dr. S.M. was fully aware of the Veterans medical history and there is no indication that a detailed review of the claims file would have changed his opinion.  See Prejean v. West, 13 Vet. App. 444, 448-9 (2000); Snuffer v. Gober, 10 Vet. App. 400, 403-04 (1997) (review of claims file not required where it would not change the objective and dispositive findings made during a medical examination).  Notably, there is no medical opinion to the contrary.
Therefore, the Board resolves all doubt in the Veteran’s favor and finds that his chronic kidney disease is related to his acknowledged in-service exposure to herbicide agents.  Consequently, service connection for such disorder is warranted.  38 U.S.C. 5107; 38 C.F.R. § 3.102; Gilbert, supra.
 
A. JAEGER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Jonathan M. Estes, Associate Counsel 

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