Citation Nr: 21021243 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 13-32 239 DATE: April 12, 2021 REMANDED Entitlement to ratings for renal failure with hypertension (HTN) in excess of 60 percent prior to November 7, 2017 and in excess of 80 percent from that date is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1968 to April 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 Department of Veterans Affairs (VA) rating decision which granted service connection for renal failure with HTN, rated 0 percent, effective November 15, 2006. In January 2015 a videoconference hearing was held before the undersigned; a transcript is in the record. An interim (October 2015) rating decision granted service connection for renal disease with hypertension (noted as encompassing the previously service connected renal failure), rated 60 percent effective August 17, 2015. In October 2017, this matter was remanded for additional development. A January 2018 rating decision increased the rating for the renal disease to 80 percent, effective November 7, 2017. The Board’s October 2017 remand requested an advisory medical opinion by a nephrologist or internist addressing several questions related to the severity of the Veteran’s service-connected renal disease. On review of the November 2017 VA medical opinion received in response, the Board finds that another remand is needed as the Board’s October 2017 remand directives were not substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). Specifically, regarding whether prior to August 27, 2015, there was any clinical indication of constant or recurring albumin with hyaline and granular casts or red blood cells; or, transient or slight edema or HTN at least 10 percent disabling under Code 7101, the November 2017 VA examiner did not address whether the Veteran had HTN at least 10 percent disabling under 7101 prior to that date. Furthermore, when asked prior to August 27, 2015, whether there is any clinical indication of constant albuminuria with some edema, and/or HTN with diastolic pressure predominantly 120 or more, the examiner responded, “No. The [V]eteran has a diagnosis of hypertension and one episode of elevated BP [on March 19, 2004][,] ER visit[,] BP 177/103.” The “no” does not appear responsive to whether there was any clinical indication of constant albuminuria with some edema prior to August 27, 2015. Also, in response to the request to identify the earliest clinical indication of a definite decrease in kidney function, the examiner did not discuss the significance of the 2007 renal clinic records and the January 2013 diabetes mellitus consultation. The matters are REMANDED for the following action: Arrange for the Veteran’s record to be forwarded to an appropriate clinician (nephrologist or internist) for review and an addendum advisory medical opinion. Based on a review of the complete record (to include all pertinent laboratory studies during the evaluation period), the consulting provider should provide an opinion that responds to the following: (a) Prior to August 27, 2015, was there any clinical indication of HTN at least 10 percent disabling under Code 7101? If so, please cite to the examination, study, or occasion of treatment when such finding was made. (b) Prior to August 27, 2015, was there any clinical indication of constant albuminuria with some edema? If so, cite to the occasion. Please identify the earliest clinical indication of a definite decrease in kidney function. Specifically, is there evidence of such prior to August 27, 2015? If so, please identify the earliest clinical data/diagnostic studies that reflect definite decrease in kidney function. The rationale must include discussion of the 2007 renal clinic records and the January 2013 DM consultation (cited above), in particular the significance of the notations of “stage 3” renal disease and the observation that 60 percent of renal function was lost. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Griffith 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.