Citation Nr: 21009771 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-20 139 DATE: February 23, 2021 REMANDED Entitlement to service connection for a kidney disability other than diabetic nephropathy, to include tumor and removal of the left kidney, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1967 to August 1970 and from June 1973 to June 1975 and July 1975 to August 1980. The Veteran had a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in September 2017. 1. Kidney disability other than diabetic nephropathy The Veteran has been service connected for diabetes mellitus and diabetic nephropathy with hypertension. He has contended kidney disability, including oncocytoma, as due to service-connected disease or injury. As noted in the prior April 2018 Board remand, the Veteran contends that he has a kidney disability other than diabetic nephropathy that was caused or aggravated by a service-connected disease. Treatment records document diagnoses that include a history of a left oncocytoma, status post nephrectomy, and hypertensive chronic kidney disease. The Veteran has been service connected for diabetes mellitus and diabetic nephropathy with hypertension. The Board remanded for an opinion on this matter. Specifically, whether it is as at least as likely as not (50 percent probability or more) that any current kidney disability other than diabetic nephropathy (specifically to include a history of a left oncocytoma, status post nephrectomy) is the result of in-service exposure to herbicide agents or was caused or aggravated by a service-connected disability (specifically to include his diabetic nephropathy with hypertension). The opinion addressed direct service connection (noting there was no evidence of in-service oncocytoma) – which also included a statement regarding aggravation – but not herbicide agent exposure or causal relationship to a service-connected disease or injury. The opinion states: renal oncocytomas are uncommon and consist of a pure population of oncocytes. Given their rarity there is no clear medical research evidence that hypertension or diabetes affects oncocytoma growth. Most of the current research on oncocytomas revolves around genetic susceptibility. However, there was no opinion given regarding aggravation, as the opinion itself (as opposed to the rationale) only addressed direct service connection. The rationale itself is unclear, as it may suggest that some, possibly uncertain, research shows oncocytoma is aggravated by hypertension or diabetes. It also did not address whether nephropathy (as opposed to diabetes itself) may cause or aggravate oncocytoma. Given the opinion did not fully address the remand directives, an additional remand is necessary The matters are REMANDED for the following action: Obtain a medical opinion from a qualified professional as to the Veteran’s kidney disorder claim. If the reviewer determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. The medical professional is asked to provide an opinion regarding whether it is as at least as likely as not (50 percent probability or more) that any current kidney disability – other than diabetic nephropathy – (including a history of a left oncocytoma, status post nephrectomy) is the result of in-service exposure to herbicide agents or was caused OR aggravated by a service-connected disability (specifically to include his diabetic nephropathy with hypertension). Aggravation means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. In providing an opinion regarding aggravation, if the examiner means to state some medical research supports a finding of aggravation, the examiner should so state. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Yoffe, 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.