Citation Nr: 21015308 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-30 596 DATE: March 17, 2021 REMANDED Entitlement to service connection for kidney disease, to include as secondary to the service-connected gastroesophageal reflux disease, otherwise known as GERD, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1965 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided testimony at an August 2020 videoconference hearing before the undersigned Veterans Law Judge at the RO. A transcript of the hearing is associated with the claims folder. In March 2016 K.D., M.D., noted the Veteran took non-steroidal medication for almost 20 years and continues to be on proton pump inhibitors, both of which can cause interstitial nephritis. Specifically, the doctor found the Veteran “most likely has some baseline chronic kidney disease with a creatinine of 1.1-1, 2 from long-term non-steroidal medication intake. The acute rise is probably prerenal from the furosemide which was stopped in January.” In October 2016 the Veteran was afforded a VA examination. He was diagnosed with interstitial nephritis and nephrolithiasis (Kidney Stones). The examiner opined the claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected condition. It was reasoned, although the Veteran has a complicated medical history, nephrology consultant, K.D. M.D., has stated in multiple evaluations that intestinal nephritis and mild chronic renal failure is secondary to long standing recurrent kidney stones. It was noted that the kidney stone history dates back more than 30 years. The Board finds the October 2016 VA opinion is inadequate or incomplete as it does not address direct service connection. The examiner acknowledges the Veteran’s kidney stone history dates back more than 30 years, which would indicate the kidney stones began in service. However, the opinion rendered only discussed secondary service connection. The March 2016 treatment records from K.D., M.D. provided an indication that the kidney disease is related to medication and treatment the Veteran has received during active duty service. When VA undertakes to provide a VA opinion, it must ensure that the opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, an addendum opinion on the nature and etiology of the kidney disease as directly related to service is warranted. See McLendon v. Nicholson, 20 Vet App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Obtain any ongoing VA treatment records. Should they exist, associate them with the claims file. 2. Forward the claims file to the examiner who conducted the October 2016 VA examination for an addendum opinion and rationale based on direct service connection. If the examiner is unavailable, the claims file should be forwarded to another appropriate examiner to provide the requested opinion and rationale. If the requested opinion cannot be provided without another examination of the Veteran, schedule him for a VA examination with an appropriate examiner. The examiner shall provide an opinion as to the following question: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s current kidney disease was incurred in or as a result of his period of active duty service? A detailed rationale supporting the examiner’s opinions should be provided. The rationale for any opinion expressed must be provided. Note that the lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. Note: The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. 3. Conduct any other development deemed necessary and then readjudicate the Veteran’s claim. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. To the extent that telehealth technology permits an alternative to an in-person examination, such opportunity is fully acceptable in lieu of an in-person examination. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or United States Court of Appeals for Veterans Claims must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jackman, 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.