Citation Nr: 21006881 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 13-25 541A DATE: February 5, 2021 REMANDED Entitlement to service connection for a kidney disorder is remanded. Entitlement to service connection for anemia, to include as due to a kidney disorder, is remanded. Entitlement to service connection for hyperparathyroidism, to include due to a kidney disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1956 to January 1957. In June 2020, the Board remanded the current claims for additional development. 1. Entitlement to service connection for a kidney disorder is remanded. In the June 2020 remand, the Board requested that the Regional Office (RO) obtain a VA medical opinion from an appropriate VA examiner and specifically advised that the Veteran’s reports of symptoms and history must be acknowledged and considered in formulating any opinion. In August 2020, the RO procured VA examinations and medical opinions regarding the Veteran’s kidney disorder, anemia, and hyperparathyroidism. The examiner indicated that the Veteran’s kidney disorder was congenital and clearly and unmistakably existed prior to service. The examiner also indicated that such condition was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner explained that he was unable to find any lab results indicating a kidney condition during the Veteran’s active service and the earliest indication of a kidney condition was in May 1986 with increase creatinine of 1.8. The examiner, however, did not consider and/or discuss the Veteran’s reports that he had only one kidney going into the military and, after advanced training, he started going downhill and was spitting up blood. The Veteran also reported that he was in and out of the military hospital the whole time he was in the military and, after returning home from the Army, he was anemic and had nosebleeds and fainting spells. See February and October 2011 Statement in Support and October 2011 Correspondence. Likewise, the VA examiner did not comply with the Board’s remand directives as indicated above. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board also emphasizes that an opinion based on the absence of documentation in the record is inadequate if it fails to consider the Veteran's reports of symptoms and history. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Accordingly, remand is warranted for a new VA medical opinion consistent with the directives herein. The Veteran’s representative, by and on his behalf, indicated that the Veteran received treatment at the William Beaumont Army Medical Center at Fort Bliss, Texas through January 1957. See January 2021 Appellate Brief. Although the RO appears to have certified that the Veteran’s service treatment records are unavailable and/or do not exist, the record reflects that the RO only sought treatment records from Fort Bliss Hospital from October 1956 through December 1956. See July 2015 Request for Information. Accordingly, additional development is requested to attempt to obtain hospital records from the Fort Bliss William Beaumont Army Medical Center through January 1957. 2. Entitlement to service connection for anemia and hyperparathyroidism as due to a kidney disorder is remanded. The Veteran’s claims for service connection for anemia and hyperparathyroidism are inextricably intertwined with his claim for service connection for a kidney disorder, as they are claimed as secondary. Accordingly, remand for these inextricably intertwined claims is also required. The matters are REMANDED for the following actions: 1. Conduct record development to attempt to obtain hospital records from William Beaumont Army Medical Center at Fort Bliss, Texas from May 1956 to January 1957. 2. Following the development above, obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s kidney disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. If it is determined that the requested opinions may not be provided without an examination of the Veteran, such should be arranged. The examiner should determine whether there is clear and unmistakable (obvious, manifest, or undebatable) evidence that the Veteran’s preexisting kidney disorder was not aggravated beyond the natural progression of the condition by his active duty service? The term “aggravated” in this context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. In rendering the above opinion, the examiner should specifically consider and discuss the Veteran’s reports that after advanced training, he started going downhill and was spitting up blood and that he was in and out of the military hospital the whole time he was in the military and, after returning home from the Army, he was anemic and had nosebleeds and fainting spells. See February and October 2011 Statement in Support and October 2011 Correspondence. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Metzner, Paul 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.