Citation Nr: 19100716 Decision Date: 01/03/19 Archive Date: 01/03/19 DOCKET NO. 08-00 625 DATE: January 3, 2019 REMANDED Service connection for nephrolithiasis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 1996 to June 2000 and from February 2003 to July 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2007 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded in July 2009, January 2014, and September 2015 for additional development. Nephrolithiasis In its September 2015 remand, the Board directed the RO to opine whether there is clear and unmistakable evidence showing the Veteran’s kidney disorder was not aggravated by his periods of service. The April 2016 VA examiner highlighted that there was no evidence that the Veteran’s kidney disorder was aggravated to any degree (beyond its natural progression) by service. As such, the examiner concluded that the Veteran’s kidney disorder was not clearly and unmistakably aggravated during or by his period of service in the military. The Board notes that the Veteran had two distinct periods of active service. As a result, a medical opinion addressing whether aggravation of the Veteran’s kidney disorder occurred during either period is necessary. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The matter is REMANDED for the following action: 1. Obtain all outstanding VA medical records and ask the Veteran to provide authorizations for any private medical records he would like considered in connection with his appeal. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service kidney stone symptomatology. The Veteran should be provided an appropriate amount of time to submit this lay evidence 3. Obtain an addendum opinion addressing whether any identified kidney disorder (1) clearly and unmistakable pre-existed the Veteran’s first period of service (June 1996 to June 2000) and (2) was clearly and unmistakably NOT aggravated by either the Veteran’s first period of service (June 1996 to June 2000) or by his second period of service (February 2003 to July 2004). In reaching his or her conclusions, the examiner should consider the Veteran’s lay statements concerning the onset, recurrence and severity of his symptoms and/or functional impairments both prior to, during and after service. Specifically, the examiner should consider and address: the February 2000 statement from the Veteran that he had kidney stones “once while I was in school and another while on West PAC in 1999, don’t know the cause;” the notation on the May 2003 Pre-Deployment Heath Assessment that the Veteran has a history of renal calculi with history of “IVP x 1 at first episode at age 16 yrs.” The examiner should also consider the November 2013 argument of the Veteran’s representative that the Veteran’s kidney stones were first diagnosed at age 16 prior to entry into service and were not “debilitating” at that time, but that his later recurrence of kidney stones during service were debilitating in nature and thus were aggravated by service. See November 2013 Appellate Brief. For any cited medical treatise, studies, or documents, the examiner should explain the significance of such studies to the facts of this case. (Continued on the next page)   If the opinion requested above cannot be rendered without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). TRACIE N. WESNER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.Ijitimehin, Associate Counsel