Citation Nr: 18157928 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-46 577 DATE: December 13, 2018 REMANDED The claim of entitlement to an evaluation in excess of 30 percent for renal cell carcinoma, status post right nephrectomy, is remanded. The claim of entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Coast Guard from June 1969 to June 1973. This matter is before the Board of Veteran’s Appeals (Board) from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The claim of entitlement to an evaluation in excess of 30 percent for renal cell carcinoma, status post right nephrectomy is remanded. The Veteran contends that his currently 30 percent rated renal cell carcinoma, status post right nephrectomy (claimed as kidney cancer) has worsened and should receive an increased rating. The VA examination and blood test results of March 2017 found that there was a progression in the Veteran’s symptoms but not enough for the RO to determine an increased evaluation applicable. There were abnormal blood and urine diagnostic results noted in the VA treatment records of the Veteran in 2017, and the Veteran, in a letter dated January 2018, indicated that his service-connected kidney cancer had worsened since his last VA examination in 2017. The Veteran indicated that he is now being monitored for kidney function in his remaining kidney and that his oncologist is concerned about the Veteran being able to process the contrast dye needed for his scans. Considering the progression of the Veteran’s symptoms noted in 2017 and 2018, a new VA examination is warranted on remand. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The claim of entitlement to an evaluation of individual unemployability (TDIU) is remanded. The Board finds that the Veteran’s claim for TDIU is inextricably intertwined with the issue remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Therefore, adjudication of the TDIU claim would be premature at this juncture. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file any outstanding VA treatment records. Specifically, any referrals to specialists or concerns of the primary care physician (PCP) of the Veteran regarding the left kidney’s functioning capabilities since the last VA examination in 2017. Obtain a new VA medical examination to assess the current level of severity of the Veteran’s renal cell carcinoma, status post right nephrectomy, including whether the Veteran’s remaining left kidney has any renal dysfunction causing generalized poor health including but not limited to: increased levels of creatinine, constant albuminuria with some edema, definite decrease in kidney function, hypertension with a diastolic pressure predominantly 120 or more. The examiner must review the claims file and copy of this remand, and indicate as such. The rationale for all opinions expressed must be provided. If the examiner is unable to provide any required opinions, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information that he or she has exhausted the limits of current medical knowledge in providing an answer to the particular questions presented. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record, perform any necessary development, and readjudicate the claims on appeal. If the appeal is denied, the AOJ should issue an appropriate SSOC, afford the Veteran an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C.A. Teich, Associate Counsel