Citation Nr: 21065841 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 16-29 489 DATE: October 27, 2021 REMANDED Entitlement to service connection for nephritis with pyelonephritis (kidney infections) is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1984 to December 2004. This matter comes before the Board of Veterans' Appeals (Board) from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This issue was previously remanded by the Board in June 2021 and has since been returned for further adjudication. 1. Entitlement to service connection for nephritis with pyelonephritis (kidney infections) is remanded. Although the Board regrets additional delay, remand is necessary to obtain an adequate opinion based on the evidence of record. In July 2021, the Veteran underwent a VA examination. The examiner stated that the Veteran does not have a diagnosis of nephritis or pyelonephritis. The initial diagnoses in 1988 was not located. There were no located medical records with the documentation of a kidney complication or recurrent pyelonephritis in service. Service treatment records demonstrate that the Veteran was diagnosed with pyelonephritis in February 1988, had a history of kidney infections in June 1992, and had suspected nephritis in June 1992. Post-service treatment records demonstrate that the Veteran most recently had an infection of pyelonephritis in August 2015. As the record does reflect that the Veteran suffered from pyelonephritis in service along with a history of kidney infections and had a diagnosis of pyelonephritis during the appeal period, a new opinion is necessary to determine if the Veteran's current pyelonephritis is related to her infections in service. 2. Entitlement to service connection for hypertension is remanded. In July 2021, the Veteran underwent a VA examination. The examiner stated that the Veteran contends that she had an initial episode of hypertension in 1988 while pregnant which was not located. There were no located medical records with documentation of hypertension. Service treatment records demonstrate that the Veteran had pregnancy induced hypertension in January 1989. Additionally, records demonstrate that the Veteran suffered from incidents of high blood pressure in August 1996, April 1997, April 1998, September 1998, November 1999, February 2000, and February 2001. As there is a documentation of pregnancy induced hypertension and there are notations of levels of high blood pressure in service, remand is necessary to obtain a new opinion to determine if the Veteran's current hypertension is related to her military service. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to treatment for kidney conditions and hypertension. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current pyelonephritis or other kidney condition onset during service or is otherwise related to an in-service injury, event, or disease, to include the in-service documentations of kidney infections. THE EXAMINER MUST CONSIDER AND EXPLAIN WHETHER THE VETERAN'S ACCOUNT OF THE DEVELOPMENT OF HER CLAIMED KIDNEYDISORDER IS CONSISTENT WITH THE MEDICAL EVIDENCE AND THE EXAMINER'S KNOWLEDGE AND PRACTICE EXPERIENCE, ACCOUNTING FOR FACTS AND CIRCUMSTANCES SPECIFIC TO THE VETERAN. As indicated above, the examiner must review the record in conjunction with rendering the requested opinion; however, his/her attention is drawn to the following: *A STR documents that the Veteran experienced pyelonephritis in February 1988 and the condition resolved in March 1988. *June 1992 STRs reflect that the Veteran had a history of kidney infections; she received treatment for nephritis. *An August 2015 treatment record documents diagnosis of pyelonephritis. *A September 2015 treatment record documents that the Veteran was diagnosed with pyelonephritis 3 weeks earlier but had severe pain on examination. The examiner was concerned that the infection had not cleared despite 3 weeks of antibiotic treatment The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. 3. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current hypertension onset during service or is otherwise related to an in-service injury, event, or disease, to include the in-service pregnancy-induced hypertension and incidents of high blood pressure. THE EXAMINER MUST CONSIDER AND EXPLAIN WHETHER THE VETERAN'S ACCOUNT OF THE DEVELOPMENT OF HER CLAIMED HYPERTENSIONIS CONSISTENT WITH THE MEDICAL EVIDENCE AND THE EXAMINER'S KNOWLEDGE AND PRACTICE EXPERIENCE, ACCOUNTING FOR FACTS AND CIRCUMSTANCES SPECIFIC TO THE VETERAN. As indicated above, the examiner must review the record in conjunction with rendering the requested opinion; however, his/her attention is drawn to the following: *A September 1990 eye clinic STR and December 1989 Naval Hospital STR reflect the Veteran had a family history of hypertension (mother). *An August 1996 STR documents the Veteran's blood pressure readings were 130/80 and 130/98; the assessment, in pertinent part, was r/o hypertension. *A June 2012 VA treatment record documents an assessment of hypertension. *A November 2014 treatment record documents diagnosis of essential hypertension. *A January 2015 treatment record documents diagnosis of systemic hypertension. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hofmeister 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.