Citation Nr: 21014735 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 15-42 770A DATE: March 15, 2021 REMANDED Entitlement to service connection for kidney disease, to include cysts and stones, is remanded. Entitlement to service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1981 to September 2001. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented testimony before the Board in October 2019; a transcript is in the record. In November 2019, the Board remanded these and other issues for additional development. In an October 2020 rating decision, the RO granted service connection for left hip and right and left knee disabilities. The awards of service connection on those issues are considered full grants of the benefits sought and those issues are no longer before the Board. 1. Entitlement to service connection for kidney disease, to include cysts and stones, is remanded. 2. Entitlement to service connection for diabetes mellitus is remanded. The November 2019 Board remand instructed the RO to provide the Veteran VA examinations to determine whether the Veteran’s disabilities are related to his service, to include confirmed exposure to torpedo (Otto) fuel, or manifested within a year following his discharge from service in 2001. The examiner was also to address whether either disability caused or aggravated the other disability. The Board finds parts of the February 2020 VA examination inadequate. As an initial matter, the examiner determined that the Veteran does not have a diagnosis of kidney disease; however, private treatment records include a diagnosis of chronic kidney disease. See undated private treatment record noting diagnosis of diabetes mellitus due to underlying condition with chronic kidney disease; June and July 2017 Normal Regional treatment records noting same. Another medical opinion is required to reconcile this discrepancy. Also, while concluding that the Veteran does not have kidney disease, the February 2020 VA examiner failed to address whether the Veteran’s diabetes mellitus could be proximately due to or aggravated by kidney cysts and stones and/or whether the Veteran’s kidney cysts and stones could be proximately due to or aggravated by his diabetes mellitus. In light of the medical questions that remain outstanding, the Board finds that another VA opinion is warranted. The Veteran’s representative has requested that an independent medical opinion be obtained. On review, it is determined that an opinion from a specialist is warranted. As such, remand is required for a medical opinion by a nephrologist and/or endocrinologist, pursuant to 38 U.S.C. § 5109, as to whether the Veteran’s diabetes mellitus and kidney disease, to include cysts and stones, are related to his active service. Additionally, the Veteran submitted private medical records in support of his claim. It is unclear if all private medical records have been submitted. As this claim is being remanded anyway, the RO should confirm with the Veteran whether there are any outstanding private treatment records. The matters are REMANDED for the following action: 1. Obtain copies of any VA treatment records from September 2020 to the present. 2. Obtain, if possible, records of relevant private evaluations and treatment the Veteran has received for the disabilities on appeal. The Veteran must assist in the matter by identifying his private healthcare providers and by submitting releases for VA to obtain any private records identified. 3. After the above development is completed, obtain an independent medical opinion from a nephrologist and/or endocrinologist to determine the nature and likely cause of any diabetes mellitus and chronic kidney disease, to include cysts and stones. Based on review of the record (to include this remand), provide an opinion with detailed rationale that responds to the following: (a) Does the Veteran currently have, or at any time during the appeal period has he had, a diagnosis of chronic kidney disease? If the answer is no, reconcile your conclusion with the diagnosis of chronic kidney disease found in an undated private treatment record and June and July 2017 Normal Regional treatment records noting same. (b) Is at least as likely as not (50% or greater probability) that any diabetes mellitus and chronic kidney disease, including cysts and stones, are related to an in-service injury, event, or disease, including confirmed exposure to torpedo (Otto) fuel? (c) Is it at least as likely as not (50% or greater probability) that the Veteran’s diabetes mellitus was either caused or aggravated by his kidney disease, to include cysts or stones? Please explain why. The opinion must address whether the disability increased in severity beyond its natural progression (i.e., was aggravated). If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. (d) Is it at least as likely as not (50% or greater probability) that the Veteran’s kidney disease, to include cysts or stones, was either caused or aggravated by his diabetes mellitus? Please explain why. The opinion must address whether the disability increased in severity beyond its natural progression (i.e., was aggravated). If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. 4. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Matta, 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.