Citation Nr: 21008705 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 14-14 434 DATE: February 17, 2021 REMANDED Entitlement to service connection for kidney stones, to include as secondary to service-connected hypertension and diabetes, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to May 1971. He had additional service in the National Guard. This matter originally came to the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded by the Board in October 2018 and July 2020. Although the Board sincerely regrets additional delay, another remand is necessary to afford the Veteran full consideration of his claim on appeal. The Veteran seeks entitlement to service connection for kidney stones through multiple theories of entitlement, to specifically include as secondary to service-connected hypertension, diabetes, and/or the effects of both disabilities. Following the July 2020 Board remand, the RO obtained a VA addendum medical opinion in August 2020. The August 2020 VA examiner provided a negative nexus opinion regarding whether the Veteran’s kidney stones incurred during active service due to the Veteran’s service treatment records (STRs) documenting normal urinalysis and no notations of symptoms of kidney stones, as well as the 13-years post-service before kidney stones were reported. Additionally, the August 2020 VA examiner provided a negative nexus opinion regarding whether the Veteran’s kidney stones are due to his service-connected hypertension or the combined effects of hypertension and diabetes due, mostly in part, to documented kidney stones in 1984, but the Veteran not being diagnosed with hypertension until 1992 and diabetes in 2010. Furthermore, the August 2020 VA examiner concluded that the Veteran’s kidney stones were not at least as likely as not aggravated by service-connected hypertension or the combined effects of hypertension and diabetes because there is “no mechanism of action for cause or permanent aggravation beyond natural progression of the Veteran’s kidney stones” due to his service-connected disabilities. However, this opinion is merely a conclusory statement without thorough rationale supported by the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007). Although the August 2020 addendum opinion “notes” medical evidence from the claims file, it does not provide the Board with sufficient rationale to adjudicate the claim, especially in consideration of the October 2019 opinion, which noted that hypertension can complicate diabetes and contribute to kidney disease. It is also noted that a “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). Ward v. Wilkie, 31 Vet. App. 233 (2019). Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). Accordingly, the Board finds that a remand is necessary to obtain a new addendum medical opinion. Furthermore, the Board notes that in September 2020, the Veteran reported that he had additional private treatment records to submit in support of his claim, and no additional records have been associated with the claims file. As the matter is being remanded, the Veteran should be provided another opportunity to submit any outstanding private treatment records. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Contact the Veteran and afford him the opportunity to identify any relevant, outstanding private treatment records. After obtaining any necessary authorization from the appellant, all outstanding records should be obtained. If, after at least two attempts, such record cannot be obtained, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. 3. Obtain an addendum opinion for the Veteran’s claim for service connection for kidney stones by an examiner who has not yet provided an opinion regarding the Veteran’s claim. The record, to include a copy of this Remand, should be made available to, and be reviewed by, the examiner. The need for an additional examination of the Veteran is left to the discretion of the clinician. The examiner is asked to answer the following questions: (a.) Whether the Veteran’s kidney stones are at least as likely as not due to service-connected hypertension, diabetes, or the combined effects of both disabilities; (b.) Whether the Veteran’s kidney stones are at least as likely as not aggravated (worsened) by service-connected hypertension, diabetes, or the combined effects of both disabilities. i. If aggravation is found, provide a baseline level of disability prior to aggravation, if possible. ii. When addressing aggravation, the examiner must consider and address the October 2019 opinion noting that hypertension can complicate diabetes and contribute to kidney disease. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, the examiner should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, Associate 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.