Citation Nr: 18139841
Decision Date: 10/01/18	Archive Date: 10/01/18

DOCKET NO. 15-39 585
DATE:	October 1, 2018
REMANDED
Service connection for chronic kidney disease, to include as due to herbicide exposure, is remanded.
REASONS FOR REMAND
This case comes on appeal from a March 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran served honorably in the U.S. Army from July 1965 to April 1967, including 13 months in the Republic of Vietnam.
1. Entitlement to service connection for chronic kidney disease, to include as due to herbicide exposure, is remanded.
Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, the evidence must show: (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. 38 C.F.R. § 3.303(a); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).
Service connection may be established on a presumptive basis for a disability resulting from exposure to an herbicide agent. Applicable regulations provide that a Veteran who served on active duty in Vietnam during the Vietnam era is presumed to have been exposed to Agent Orange or similar herbicide. 38 C.F.R. § 3.307(a)(1)(6)(iii).
The Veteran’s DD Form 214, certificate of release or discharge from service, notes his service in the Republic of Vietnam. Accordingly, he is presumed to have been exposed to herbicide agents, including Agent Orange. 38 C.F.R. § 3.307(a)(1)(6). 
The Veteran directly attributes his chronic kidney disease to his in-service exposure to herbicide agents, including Agent Orange. He notes that there is no family history of chronic kidney disease. The Veteran has submitted a medical report, dated September 4, 2013, which reflects a diagnosis of chronic kidney disease stage III in April 2013. No opinion was given as to the etiology of the kidney disease at that time.
The Board notes that if a veteran is not entitled to presumptive service connection for a disability as due to herbicide exposure, service connection on a direct basis also must be considered. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, an opinion should be obtained regarding the nature and etiology of the Veteran’s chronic kidney disease, to include whether it was directly related to the Veteran’s conceded in-service exposure to herbicide agents, including Agent Orange. 
The matter is REMANDED for the following action:
Provide the Veteran an examination to determine the likely etiology of any chronic kidney disease. The entire claims file should be made available to and be reviewed by the examiner, and it should be confirmed that such records were available for review. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. Any explanation for all opinions expressed must be provided. 
Based on the examination and review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any chronic kidney disease is related to the Veteran’s service, specifically his exposure to herbicide agents, such as Agent Orange. 
The examiner must consider the Veteran’s lay statements and contentions in the context of any negative opinion.
 
CAROLINE B. FLEMING
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Stuedemann, Associate Counsel