Citation Nr: 21024043 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 18-13 874 DATE: April 21, 2021 REMANDED Entitlement to an initial compensable evaluation for renal cancer prior to January 24, 2018, is remanded. Entitlement to a rating in excess of 60 percent for renal cancer from January 24, 2018 to January 31, 2021, is remanded. Entitlement to a compensable rating for renal cancer beginning January 31, 2021, is remanded. REASONS FOR REMAND The Veteran had active military service from February 1962 to October 1966. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matter twice, in March 2019 and June 2020, for additional development. Unfortunately, despite apparent efforts made to comply with the remand directives, the Board finds that another remand is required prior to the adjudication of the issues on appeal. The increased rating claims stem from the original service connection claim that was filed on September 2, 2015. Despite that filing date and the RO’s failure to acknowledge such in the March 2017 rating decision, the effective date assigned was March 14, 2017. The effective date, as explained in the July 2017 rating decision that established service connection, is based on a presumptive basis, and that is the date the law changed regarding Camp Lejeune Water Contamination. A review of the record highlights the lack of clarity as to what the current level of severity is of the Veteran’s renal cancer. The current level of severity includes all times from March 2017 to present. Of note, during the course of the appeal the Agency of Original Jurisdiction (AOJ) reduced the Veteran’s rating for this disability from 60 to 0 percent, effective February 1, 2021. See February 2021 rating decision. In the June 2020 Board remand, the Board detailed as to how and why the October 2019 examination report failed to comply with the March 2019 remand directives. An opinion was provided in July 2020. This opinion failed to comply with the remand directives and as reflected in correspondence dated November 2020, the AOJ recognized this and requested additional information from the provider. The July 2020 VA examiner responded to this request and provided an addendum opinion in November 2020. She responded to the directives, listing the requested records showing various creatinine levels, as well as the December 2018 CT scan. However, she did not discuss the significance of these kidney tests when assessing the Veteran’s severity. She used ambiguous, vague language such as “would not be expected” and “does not seem.” Lastly, she failed to provide detailed, clear rationale to support any of her assessments. For these reasons, an additional remand is needed to obtain an adequate examination and opinion. Also, of note, a letter from a VA examiner was submitted December 2020. The examiner stated that due the Veteran’s partial kidney loss his serum creatinine and “EGFR” is borderline as being classified as having chronic kidney disease. She continued by stating that the Veteran’s renal function must be monitored frequently. This letter does not contain creatinine or BUN levels that illustrate a definite decrease in kidney function, but the information provided is competent and credible and does show that the Veteran’s renal cancer may be more severe than the reduced noncompensable rating currently assigned. The last VA examination performed in person is dated October 2019. Given that specific testing is needed for the rating criteria, the Board will request that the examination be performed in person. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file any outstanding VA treatment records documenting treatment for renal cancer dated from March 2017 to the present. 2. Invite the Veteran to identify and/or submit any outstanding private treatment records, to include any medical readings that document his creatinine levels and BUN levels. 3. The AOJ should schedule the Veteran for an appropriate VA examination, preferably with an examiner who has not previously participated in this case, and preferably with an oncologist or similar medical professional, to determine the current severity and manifestations of the Veteran’s renal cell carcinoma and residuals thereof. The examiner is requested to note in his/her report that a full review of the Veteran’s electronic claims file, to include this remand, was completed. The examiner should provide a full description of the renal cell carcinoma to include any and all residuals of renal cell carcinoma and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should opine as to the level of severity of the Veteran’s renal cell carcinoma and residuals thereof throughout the appeal period, specifically from May 2017 to January 24, 2018, and from February 1, 2021 to present. (a.) In assessing the level of severity of the Veteran’s renal cell carcinoma and residuals thereof, the examiner must discuss the significance of the kidney tests contained in the February 2017, the June 2017, the November 2017 and the December 2017 VA treatment reports and comment on whether these findings support a definite decrease in kidney function (VBMS, document labeled CAPRI, receipt date March 19, 2018, pgs. 52, 57, 69, 127 and 187 of 938). (b.) The examiner must comment on what significance, if any, the December 2018 CT report that showed a cyst in the right kidney has when assessing the level of severity of the Veteran’s renal cell carcinoma and residuals thereof (VBMS, document labeled CAPRI, receipt date March 6, 2018, pgs. 33-34 of 168). (c.) Lastly, the examiner is to acknowledge and discuss the December 2020 letter authored by a VA examiner, wherein she describes the level of severity as borderline for chronic kidney disease (VBMS, document labeled Medical Treatment Record-Government Facility, receipt date December 24, 2020, pg. 3 of 3). All findings should be reported in detail and all opinions must be accompanied by a clear rationale. 4. The AOJ should ensure that the examiner provides all information required for rating purposes, and that the examiner complies with the remand directives. CHRISTOPHER J. O’DONNELL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes, 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.