Citation Nr: 21003173 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 20-24 990 DATE: January 19, 2021 ORDER Entitlement to service connection for a nasal disability, claimed as allergic rhinitis, is denied. Entitlement to service connection for a respiratory disability, claimed as asthma with history of pneumonia, is denied. Entitlement to service connection for a bilateral foot disability, claimed as plantar fasciitis with left foot pes planus, is denied. Entitlement to service connection for hypertension is granted. REMANDED Entitlement to service connection for a kidney disability, claimed as loss of kidney function, is remanded. FINDINGS OF FACT 1. The Veteran had military service in Vietnam, and his exposure to herbicides is presumed. 2. A current nasal disability, to include rhinitis and/or sinusitis, was not incurred in service and is not due to an in-service disease, injury, or other incident of service. 3. A current respiratory disability, to include asthma and/or pneumonia, was not incurred in service and is not due to an in-service disease, injury, or other incident of service. 4. A current bilateral foot disability, claimed as plantar fasciitis with left foot pes planus, was not incurred in service and is not due to an in-service disease, injury, or other incident of service. 5. The Veteran has a current diagnosis of hypertension resulting from herbicide exposure in service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a nasal disability, claimed as allergic rhinitis, have not been met. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 1132, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to service connection for a respiratory disability, claimed as asthma with a history of pneumonia, have not been met. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 1132, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 3. The criteria for entitlement to service connection for a bilateral foot disability, claimed as plantar fasciitis with left foot pes planus, have not been met. 38 U.S.C. §§ 1110, 1111, 1112, 1113, 1132, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 4. The criteria for entitlement to service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1965 to January 1968, and from April 1974 to July 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2018 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran subsequently initiated and perfected appeals of these issues within the VA legacy appeals system. In a September 2020 statement, the Veteran’s representative waived any pending request for a hearing before a Veterans Law Judge. In an August 2018 decision, the RO denied the Veteran’s claim for service connection for diabetes mellitus. The Veteran initiated and perfected an appeal of this denial to the Board. Prior to certification of the appeal to the Board and any action by the Board, the RO issued a subsequent September 2020 rating decision which granted service connection for diabetes mellitus. See Bailey v. Wilkie, No. 19-2661, 2021 U.S. App. Vet. Claims LEXIS 13, *34–*38 (Vet. App. Jan. 6, 2021). As this constitutes a full grant of the benefits sought on appeal, the claim for service connection for diabetes mellitus is no longer on appeal. Ab v. Brown, 6 Vet. App. 35 (1993). The Board is cognizant that the Veteran and his representative have asserted an earlier effective date is warranted for this grant of service connection. The question of the assigned effective date is a unique and separate issue, however, and the Veteran must initiate an appeal of this matter before the Board may have jurisdiction over it. See Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. For the showing of “chronic” disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. For purposes of establishing service connection for a disability resulting from exposure to a herbicide agent (including Agent Orange), a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam between January 1962 and May 1975, shall be presumed to have been exposed during such service to a herbicide agent, absent affirmative evidence to the contrary demonstrating that the Veteran was not exposed to any such agent during service. 38 U.S.C. § 1116(f). “Service in the Republic of Vietnam” means actual service in country in Vietnam from January 9, 1962, to May 7, 1975, and includes service in the waters offshore or service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307(a)(6)(iii); see Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008) (VA’s requirement that a Veteran must have “stepped foot” on landmass of Vietnam or the inland waters of Vietnam for agent orange/herbicide exposure presumption is a valid interpretation of the statute); VAOPGCPREC 7-93 (holding that service in Vietnam does not include service of a Vietnam-era Veteran whose only contact with Vietnam was flying high-altitude missions in Vietnamese airspace); VAOPGCPREC 27-97 (holding that mere service on a deep-water naval vessel in waters off- shore of the Republic of Vietnam is not qualifying service in Vietnam). In the present case, the Veteran’s DD-214 reflects service in Vietnam. For such veterans, exposure to herbicides is presumed. 38 C.F.R. § 3.307(a)(6)(iii). If the Veteran was exposed to an herbicide agent during service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there was no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied; chloracne or other acneform disease consistent with chloracne, Type II diabetes (also known as Type II diabetes colitis or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease, multiple myeloma, non-Hodgkin’s lymphoma, acute and subacute peripheral neuropathy, porphyria cutaneous tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchitis, laryngitis or trachea) and soft tissue sarcomas, other than osteosarcoma, chondrosarcoma Kaposi’s sarcoma, or mesothelioma. 38 C.F.R. § 3.309(e). While ischemic heart disease is noted to be a presumptive disorder under 38 C.F.R. § 3.309(e), this term does not include hypertension. 38 C.F.R. § 3.309(e), Note 3. The availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Stefl v. Nicholson, 21 Vet. App. 120 (2007). 1. Entitlement to service connection for a nasal disability. The Veteran seeks service connection for a nasal disability, claimed as allergic rhinitis. He asserts such a disability began during a period of active duty service, and service connection is therefore warranted. As noted in the introduction above, the Veteran had two periods of service. Upon entry into his first period of service, the Veteran underwent a June 1965 service entrance examination which noted no abnormalities of the nose, throat, or sinuses. On a concurrent report of medical history, he noted a history of productive cough, asthma, and shortness of breath. The service treatment records for this period are otherwise negative for any diagnosis of or treatment for a disability of the nose, throat, or sinuses. He was afforded a November 1967 service separation examination which was negative for any abnormalities of the sinuses, nose, mouth, throat, or lungs. On a concurrent report of medical history, the Veteran reported a history of hay fever. A history of asthma and hay fever, both existing prior to service, was noted. Prior to his second period of service, the Veteran underwent a March 1974 physical examination which was negative for any noted abnormalities of the nose, sinuses, or throat. On a concurrent report of medical history, the Veteran denied any history of nose or throat trouble, sinusitis, hay fever, or chronic cough. An April 1977 service separation examination was negative for any abnormalities of nose, sinuses, mouth, throat, or lungs. On a concurrent report of medical history, the Veteran reported a history of ear, nose, or throat trouble, described as asthma and hay fever as a child. A veteran who served after December 31, 1946, is presumed to be in sound condition when he or she entered into military service, except for conditions noted on the entrance examination, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1132. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304 (b). History provided by a veteran of the pre-service existence of conditions recorded at the time of the entrance examination does not, in itself, constitute a notation of a preexisting condition. 38 C.F.R. § 3.304 (b)(1); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). When no preexisting condition is noted upon entry into service, a veteran is presumed to have been sound upon entry, and the presumption of soundness arises. The burden then shifts to VA to rebut the presumption of soundness by clear and unmistakable evidence that a veteran’s disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). Thus, based on the above, while the Veteran reported a history of asthma and hay fever prior to his initial entrance into service in 1965, neither his 1965 nor 1974 service entrance examinations noted any current abnormalities of the throat, nose, or sinuses. Thus, based on these reports, the Board finds the presumption of soundness attaches for both periods of the Veteran’s service. The Board also finds, however, that a nasal or sinus disability was not incurred in service, as the service treatment records for both periods are negative for any diagnosis of or treatment for a sinus or nasal disability, and both the 1967 and 1977 service separation examinations are negative for any abnormalities of the nose, throat, and sinuses. Post-service, he did not report or seek treatment for such a disability until approximately 2017, more than 30 years after his most recent period of service. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the Board may consider a lack of notation of a medical condition or symptoms where such notation would normally be expected). In the absence of any competent evidence that a current nasal disability was incurred in service, service connection for a nasal disability must be denied. Additionally, competent evidence has not been presented linking any current nasal disability to a disease, injury, or other incident of service. A September 2017 VA clinical notation indicated the Veteran’s allergic rhinitis was exacerbated by his ongoing post-service tobacco use. To the extent that the Veteran used tobacco during his period of service, service connection cannot be granted for a disability or injury resulting from in-service tobacco use as a matter of law. 38 C.F.R. § 3.300(a). A VA medical examination was afforded the Veteran in January 2018. The claims file was reviewed in conjunction with the examination. The Veteran reported a history of allergic rhinitis since childhood. A current diagnosis of rhinitis was confirmed; the examiner did not, however, suggest an etiological nexus with service. In the absence of any such competent evidence of a nexus, service connection for a nasal disability is denied. As noted above, the Veteran had service in Vietnam and is presumed to have had herbicide exposure. Sinusitis and rhinitis are not, however, on the list of disabilities for which service connection is presumed in such veterans. The Veteran has also not presented competent evidence establishing a nexus between his herbicide agent exposure in service and his rhinitis and sinusitis. Thus, service connection is not warranted on that basis. The Veteran himself asserts a current nasal disability results from an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id. However, nasal disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the award of service connection for a nasal disability, as such a disability was not incurred in service and is not due to an in-service disease, injury, or other incident of service. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 2. Entitlement to service connection for a respiratory disability. The Veteran seeks service connection for a respiratory disability, to include asthma and/or pneumonia. He asserts such a disability was incurred in service, and service connection is therefore warranted. As noted in the introduction above, the Veteran had two periods of service. Upon entry into his first period of service, the Veteran underwent a June 1965 service entrance examination which noted no abnormalities of the lungs or respiratory system. On a concurrent report of medical history, he noted a history of productive cough, asthma, and shortness of breath. The service treatment records for this period are otherwise negative for any diagnosis of or treatment for a disability of the throat or lungs. The Veteran was afforded a November 1967 service separation examination which was negative for any abnormalities of the throat, or lungs. On a concurrent report of medical history, the Veteran reported a history of hay fever. A history of asthma and hay fever, both existing prior to service, was noted. Prior to his second period of service, the Veteran underwent a March 1974 physical examination, which was negative for any noted abnormalities of the lungs or respiratory system. On a concurrent report of medical history, the Veteran denied any history of asthma, shortness of breath, or chronic cough. In December 1975, the Veteran was treated for chest congestion and a productive cough. An upper respiratory infection was diagnosed and he was given medication. The Veteran again sought treatment in March 1976 for shortness of breath and a productive cough. An upper respiratory infection was again diagnosed and he was given medication. In November 1976, the Veteran sought treatment for asthma and shortness of breath following a flu shot. He reported a history of asthma as a child. The assessment was of asthma versus a flu shot reaction. He was given medication and told to return if symptoms persisted. An April 1977 service separation examination was negative for any abnormalities of nose, sinuses, mouth, throat, or lungs. On a concurrent report of medical history, the Veteran reported a history of asthma and shortness of breath. He further described a history of asthma and hay fever as a child. As discussed with respect to the claim for a nasal disability above, a veteran is presumed to be in sound condition when he or she entered into military service, except for conditions noted on the entrance examination, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. §§ 1111, 1132. While the Veteran in the present case reported a history of asthma and hay fever since childhood and prior to his initial entrance into service in 1965, neither his 1965 nor 1974 service entrance examinations noted any current abnormalities of the lungs or respiratory system. Thus, based on these reports, the Board finds the presumption of soundness attaches for both periods of the Veteran’s service. The Board also finds, however, that a current respiratory disability was not incurred in service, as the service treatment records for both periods are negative for any diagnosis of or treatment for a chronic respiratory disability. Although the Veteran was treated for upper respiratory infections and shortness of breath during his second period of service, the 1977 service separation examination was negative for any abnormalities of the lungs or respiratory system. Post-service, he did not report or seek treatment for a respiratory disability until approximately 2014, more than 30 years after his most recent period of service. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Buczynski, 24 Vet. App. at 224. In the absence of any competent evidence that a current respiratory disability was incurred in service, service connection for a respiratory disability must be denied. Additionally, competent evidence has not been presented linking any current respiratory disability to a disease, injury, or other incident of service. Numerous VA clinical notations establish the Veteran’s cough and other respiratory complaints are the result of his post-service and continuing tobacco use. To the extent that the Veteran used tobacco in service, service connection cannot be granted for a disability or injury resulting from in-service tobacco use as a matter of law. 38 C.F.R. § 3.300(a). No private or VA health care provider has suggested an etiological nexus between any current respiratory disability and service. In the absence of any such competent evidence of a nexus, service connection for a respiratory disability is denied. As noted above, the Veteran had service in Vietnam and is presumed to have herbicide exposure. Asthma and pneumonia are not, however, on the list of disabilities for which service connection is presumed in such veterans. The Veteran has also not presented competent evidence establishing a nexus between his Agent Orange exposure in service and his asthma and pneumonia. Thus, service connection is not warranted on that basis. The Veteran himself asserts a current respiratory disability results from an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id. However, respiratory disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the award of service connection for a respiratory disability, as such a disability was not incurred in service and is not due to an in-service disease, injury, or other incident of service. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 3. Entitlement to service connection for a bilateral foot disability. The Veteran seeks service connection for disabilities of the bilateral feet. He asserts the rigors of military service, to include airborne training, resulted in chronic disabilities of the feet, and service connection is therefore warranted. Upon entry into his first period of active duty service, the Veteran was without any noted abnormalities of the feet on service entrance examination in June 1965. In July 1965, he was treated for athlete’s foot and an ingrown toenail. He was given topical ointments and powders and returned to duty. On examination for service separation in November 1967, he was again without any noted abnormalities of the feet, and on a concurrent report of medical history, he denied any history of foot trouble. Considering next the service treatment records for the Veteran’s second service period, these reflect a March 1974 service entrance examination which was negative for any abnormalities of the feet. However, he reported of bilateral foot pain in September 1975. On objective examination of his feet, no abnormalities were noted. He was told to use a heating pad to address his symptoms. Later that month, he was diagnosed with tinea pedis of the feet. He was given medication. The Veteran sought treatment for pain of the right great toe in April 1976, after striking his toe. An X-ray of the right toe indicated a nondisplaced spiral fracture. The Veteran sought treatment in March 1977 of bilateral foot pain due to ingrown toenails of the great toes. He was provided padding to place under his toenails. An April 1977 service separation examination was negative for any abnormalities of either foot. On a concurrent report of medical history, the Veteran reported a history of foot trouble. He stated he broke the large toe of the right foot, and had a history of recurrent athlete’s foot since high school. The Board notes first that the Veteran has already been granted service connection for residuals of a right great toe fracture. As such, this disability need not be further considered as part of the pending claim. As for any other current disability of the feet, the preponderance of the evidence is against a finding that any current disability of either foot was incurred in or is otherwise related to any period of service. While he was treated on several occasions during both periods of service for athlete’s foot and ingrown toenails, these episodes appear to have been acute and transitory, as neither a skin disorder of the feet nor ingrown toenails were noted at service separation or for many years thereafter. Post-service, he did not report or seek treatment for a respiratory disability until approximately 2016, when he was diagnosed with bilateral pes planus by a VA examiner, more than 30 years after his most recent period of service. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. See Buczynski, 24 Vet. App. 221, 224 (2011). In the absence of any competent evidence that a current disability of either foot was incurred in service, service connection for a bilateral foot disability must be denied. The preponderance of the evidence is also against a finding of an etiological nexus between service and any current foot disability. The Veteran was afforded a January 2018 VA examination of his feet. On presenting to the examiner, the Veteran denied making any claim involving his feet and stated he did not wish to be examined. Thus, the examiner did not complete the examination report. The examiner described the Veteran as “adamant” that he was not claiming service connection for disabilities of the feet, and did not wish to be examined. The remainder of the record is likewise negative for a nexus between service and any current foot disability. The Veteran had previously asserted a current bilateral foot disability resulted from an in-service disease or injury. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id. However, orthopedic disorders of the feet are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not subsequently been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the award of service connection for a disability of either foot, as such a disability was not incurred in service and is not due to an in-service disease, injury, or other incident of service. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). 4. Entitlement to service connection for hypertension. The Veteran seeks service connection for hypertension, to include as due to herbicide exposure and/or service-connected diabetes. While hypertension is not on the list of disability for which service connection is presumed in veterans with confirmed herbicide exposure, competent evidence of a nexus between a claimed disability and such exposure may still be presented. See Stefl, 21 Vet. App. at 120. In support of his claim, the Veteran submitted the July 2020 statement of M.B.S., M.D., a private physician. Dr. S. noted the Veteran’s history of herbicide exposure and his current diagnosis of hypertension, and concluded it was at least as likely as not his hypertension was due to or the result of his exposure to herbicides in service. Among other factors, Dr. S. noted the National Academy of Sciences, Engineering, and Medicine (NAS) had recently published updated information about the relationship between exposure to Agent Orange and the subsequent development of hypertension. The NAS upgraded the relationship between hypertension and Agent Orange exposure from “limited or suggestive” to “sufficient,” indicating that “there is enough epidemiologic evidence to conclude that there is a positive association” between hypertension and herbicide exposure. See National Academies of Sciences, Engineering, and Medicine 2018, Veterans and Agent Orange: Update 11 (2018) at 10, 487-498. Dr. S. also cited other studies suggesting a link between the dioxin present in herbicides and hypertension, as well as the Veteran’s individual risk factors. The Board notes that the above evidence was rendered by a competent medical expert based on both review of the Veteran’s personal medical history as well as relevant medical treatises and related literature. This evidence is also uncontroverted in the record. As such, and in light of 38 U.S.C. § 5107(b), the Board concludes service connection for hypertension is warranted. REASONS FOR REMAND Entitlement to service connection for a kidney disability. The Veteran seeks service connection for a kidney disability. In denying the Veteran’s initial claim in February 2018, the RO found no evidence of a current kidney disability. However, review of a private February 2014 abdominal CT scan described subcentimeter hypoattenuating foci within the kidneys bilaterally, likely representing renal cysts. Subsequent VA scans likewise identified opacities in the Veteran’s kidneys, but did not indicate if these represent a current disease, injury, or other disability of the kidneys. A remand is required to address this evidence and determine if in fact the Veteran has a current disability of either kidney. Next, the RO determined that the service treatment records were also negative for any diagnosis of or treatment for a kidney disability; thus, service connection on a direct basis was not warranted. During the course of this appeal, however, the Veteran was granted service connection for both diabetes and hypertension, disabilities which can result in impairment to kidney functioning. Thus, a remand is required to determine if the Veteran has a current kidney disability due to or aggravated by a service-connected disability or disabilities. The matters are REMANDED for the following action: 1. Afford the Veteran a VA medical examination and opinion regarding the presence of any current kidney disability. The examiner should answer the following: a) Identify any current disabilities of the Veteran’s kidneys, either at present or at any time since the 2017 initiation of this claim. b) For any identified disability of either kidney, is it at least as likely as not the identified disability is due to a service-connected disability? c) If not, is it at least as likely as not (a fifty percent probability or greater) that the identified disability was aggravated (worsened) by a service-connected disability? The Veteran is service connected for diabetes mellitus, hypertension, posttraumatic stress disorder (PTSD), neurogenic bowel and bladder, thoracolumbar degenerative arthritis, radiculopathy of the bilateral lower extremities, left hip osteoporosis, residuals of bilateral ankle fractures, surgical scars of the low back and left hip, and residuals of a right great toe fracture. A complete medical rationale for any opinion provided is requested. CHRISTOPHER A. WENDELL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Thomas D. Jones, Counsel 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.