Citation Nr: 21001674 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 18-37 439 DATE: January 11, 2021 REMANDED Entitlement to service connection for kidney condition, claimed also as renal dysfunction, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1967. This matter is before the Board of Veterans’ Appeals (Board) on appeal from May 2014 and January 2016 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was most recently before the Board in January 2020, at which time it was remanded for further development, as discussed below. Due to recent actions by the RO, the Board finds additional development is necessary before adjudicating this matter on the merits. Entitlement to service connection for kidney condition, claimed also as renal dysfunction, is remanded. A May 2020 Board decision noted that the Veteran is presumed to have been exposed to chemical contaminants in the water at Camp Lejeune. The Board also found a December 2015 VA examination to be incomplete, as the VA examiner did not address the entirety of the Veteran’s contentions regarding his kidney condition, to include herbicide agents while serving in Vietnam, as well as exposure to TriChloroethylene as part of his in-service duties as a machinist. The Board remanded the claim of service connection for a kidney condition and directed the Agency of Original Jurisdiction (AOJ), in relevant part, to schedule the Veteran for a VA examination to determine the nature and etiology of the kidney condition. The examiner was directed to provide an opinion as to whether any current kidney condition is at least as likely as not related to an in-service injury, event, or disease, to include contaminated water at Camp Lejeune, and/or exposure to herbicide agents while serving in Vietnam, and/or exposure to Trichloroethylene. 01/23/2020, BVA Decision. Subsequently, a June 2020 VA examiner opined that the Veteran’s chronic kidney disease is less likely than not caused by a result of exposure to contaminated water at Camp Lejeune, herbicides, or Trichloroethylene. The examiner noted that the Veteran’s risk factors for chronic kidney disease include hypertension. 07/15/2020, C&P Exam. An October 2020 VA examination noted a diagnosis of focal segmental glomerulosclerosis (FSGS). However, the examiner opined that the Veteran’s FSGS is less likely than not related to exposure during active service. Specifically, the examiner remarked that FSGS most frequently occurs without a known cause. 10/10/2020, C&P Exam; 10/10/2020, C&P Exam (medical opinion). Shortly thereafter, a November 2020 rating decision granted service connection for coronary artery disease, effective March 2, 2020. 11/06/2020, Rating Decision. The Board finds that the June 2020 and October 2020 VA examinations are incomplete. Specifically, the June 2020 VA examiner noted that the Veteran’s risk factors for chronic kidney disease include hypertension. However, neither examiner had the opportunity to opine as to whether the Veteran’s kidney condition is proximately due to or aggravated by his now service-connected coronary artery disease per a November 2020 rating decision.   Based on the foregoing, the Board finds that an addendum opinion is necessary to adjudicate this issue, to include an opinion on whether the Veteran’s kidney condition is proximate due to, the result of, or aggravated by the Veteran’s service-connected disabilities, to include coronary artery disease. This matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. Additionally, request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After completing directive # 1, obtain an addendum opinion from an appropriate clinician regarding nature and etiology of the Veteran’s kidney condition. An in-person examination is not required unless deemed necessary by the clinician. The clinician should review the virtual file, including a copy of this Remand. The examiner is to address: (a.) Whether it is at least as likely as not (probability of 50 percent or more) that the Veteran’s kidney condition is proximately due to or the result of a service-connected disability, to include but not limited to his service-connected coronary artery disease? (b.) If the answer to (a.) is negative, is it as likely as not that the Veteran’s kidney condition is aggravated (increased in severity beyond the natural progression) by a service-connected disability, to include but not limited to his service-connected coronary artery disease? If yes, can a baseline in severity of the kidney condition prior to aggravation be determined? If a baseline can be determined, describe the symptomatology associated with that baseline. A comprehensive rationale for all opinions must be provided. The sole reason for any negative opinion cannot be the lack of evidence of treatment during service. If any portion of the opinion cannot be provided without resort to mere speculation, the examiner should identify any outstanding evidence that might enable the opinion to be provided. The Veteran’s statements as well as the other lay statements must be addressed. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.