Citation Nr: 21076942 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-40 946A DATE: December 28, 2021 REMANDED Entitlement to service connection for kidney stones is remanded. Entitlement to service connection for residuals of kidney stone surgery (including scarring) is remanded. Entitlement to a temporary total evaluation for convalescence from kidney stone surgery is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1971 to May 1974. In August 2019, a videoconference hearing was held before the undersigned Veterans Law Judge, and a transcript of the hearing is associated with the record. From the date of the hearing, the record was held open for 60 days in order to allow for the submission of additional evidence for consideration. In January 2020 and December 2020, the case was remanded for additional development. 1. Entitlement to service connection for kidney stones. The Veteran contends that his kidney stones (for which he underwent surgery in August 2015) were either caused by or aggravated beyond their natural progression by: (1) his service-connected splenectomy; (2) his service-connected gunshot wound residuals of the abdomen and chest (to include medication he takes for such); (3) his service-connected scarring associated with his gunshot wound residuals of the abdomen and chest; and/or (4) his service-connected posttraumatic stress disorder (PTSD) (to include medication he takes for such). As an initial matter, the evidence of record indicates that the Veteran has continued to see a private provider (Dr. K.A.) since records were last obtained from that provider in 2014, including as noted in an August 2019 statement from Dr. K.A. (noting an appointment with the Veteran on June 20, 2019), an August 2019 VA treatment record (noting that an August 12, 2019 prescription from Dr. K.A. had been scanned into VistA Imaging), and an October 2020 VA treatment record (noting that an October 15, 2020 office visit report from Dr. K.A. had been scanned into VistA Imaging). On remand, all outstanding treatment records should be obtained and associated with the claims file. The evidence of record currently includes medical opinions weighing against the finding of both causation and aggravation of the Veteran's kidney stones by his service-connected gunshot wound residuals of the abdomen and chest (including opinions provided by VA medical providers in March 2020 and July 2021), and by his service-connected scarring associated with his gunshot wound residuals of the abdomen and chest (including opinions provided by VA medical providers in November 2015 and July 2021). The evidence of record also includes medical opinions weighing against the finding of causation of the Veteran's kidney stones by the medication he takes for his service-connected gunshot wound residuals of the abdomen and chest (including an opinion provided by a VA medical provider in July 2021) and by his service-connected PTSD (including an opinion provided by a VA medical provider in July 2021). The evidence also includes a medical opinion weighing against aggravation of the Veteran's kidney stones by his service-connected splenectomy (including an opinion provided by a VA medical provider in March 2020). However, the evidence of record does not currently include any medical opinions addressing causation of the Veteran's kidney stones by the Veteran's splenectomy or by medication he takes for his service-connected PTSD. Furthermore, the evidence of record does not currently include any medical opinions addressing aggravation of the Veteran's kidney stones by the medication he takes for his service-connected gunshot wound residuals of the abdomen and chest, by his service-connected PTSD, or by the medication he takes for his service-connected PTSD. Because the Board's December 2020 remand specifically requested some of these opinions, another remand is needed for corrective action. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not substantially complied with, the Board errs as a matter of law when it fails to ensure substantial compliance). 2. Entitlement to service connection for residuals of kidney stone surgery (including scarring). 3. Entitlement to a temporary total evaluation for convalescence from kidney stone surgery. Because a decision on the kidney stones service connection issue could significantly impact a decision on the claim seeking service connection for residuals of kidney stone surgery and the temporary total evaluation issue, the issues are inextricably intertwined. A remand of the residuals of kidney stone surgery claim and the temporary total evaluation claim is required. See Harris v. Derwinski, 1 Vet. App. 181 (1991). The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all private providers who have treated him for his claimed disabilities during the appeal period (including Dr. K.A. for all pertinent treatment since 2014). Make two requests for the authorized records from each identified provider, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA treatment records for the period from June 2021 to the present, as well as viewable copies of the non-VA treatment records scanned into VistA Imaging (as referenced in the VA treatment records outlined in detail above). Any negative search result should be noted in the record and communicated to the Veteran. 3. After all requested records have been associated with the claims file, obtain a medical opinion from an appropriate clinician, after review of the electronic claims file, in order to address the following questions: (a) Whether it is at least as likely as not that the Veteran's kidney stones were caused by the Veteran's service-connected splenectomy or by the medication he takes for his service-connected PTSD; and (b) Whether it is at least as likely as not that the Veteran's kidney stones were aggravated beyond their natural progression (i.e., any increase in severity beyond the natural progression of the condition) by the medication he takes for his service-connected gunshot wound residuals of the abdomen and chest, by his service-connected PTSD, or by the medication he takes for his service-connected PTSD. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. If the clinician determines that an examination is necessary to respond to any of the above questions, then the Veteran should be scheduled for such (or a telehealth interview if an in-person examination is not feasible). M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. B. Yantz, Counsel The Board's decision in this case is binding only with respect to the instant matter(s) decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.