Citation Nr: 21025121 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-45 783 DATE: April 27, 2021 REMANDED Entitlement to an initial disability rating in excess of 30 percent for chronic kidney disease with renal artery stenosis and hypertension prior to November 29, 2013. REASONS FOR REMAND The Veteran had active service from September 1980 to August 1984 and September 1986 to May 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a decision of the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In October 2009, the AOJ (the VA Regional Office (RO) in this case) granted service connection for chronic kidney disease and renal artery stenosis with hypertension with an evaluation of 30 percent, effective November 20, 2008. In February 2010, the Veteran subsequently filed a notice of disagreement of his rating. In September 2010, the AOJ issued a Statement of the Case (SOC); the Veteran then filed a timely substantive appeal to the Board. The AOJ issued another rating decision in July 2016 in which the AOJ granted a 60 percent rating for the Veteran’s service-connected disability effective November 29, 2013, representing a partial grant of the benefits sought on appeal. At the May 2017 Board hearing the Veteran clearly and unequivocally stated that he was satisfied with the assigned 60 percent rating effective November 29, 2013. Therefore, the issue that remains before the Board is the whether the Veteran is entitled to an initial rating in excess to 30 percent prior to November 29, 2013. In May 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Board previously remanded this matter, in pertinent part, in September 2017 in order to obtain an addendum medical examination to determine the severity of the Veteran’s renal disability prior to November 29, 2013. On remand and in a November 2018 rating decision, the AOJ granted service connection for adjustment disorder with mixed disturbance of emotions and conduct with a 30 percent disability rating assigned effective November 20, 2008. As this represents a full grant of benefits sought on appeal, this matter is no longer on appeal before the Board. 1. Entitlement to an initial disability rating in excess of 30 percent for chronic kidney disease with renal artery stenosis and hypertension prior to November 29, 2013, is remanded. The Veteran contends his chronic kidney disease with renal artery stenosis and hypertension is more severe than initially rated prior to November 29, 2013. Prior to November 29, 2013, the Veteran’s chronic kidney disease had a disability rating of 30 percent. The next higher rating of 60 percent is warranted for constant albuminuria with some edema; or, definite decrease in kidney function; or hypertension at least 40 percent disabling under Diagnostic Code 7101. See 38 C.F.R. § 4.115a; 38 C.F.R. § 4.115b, Diagnostic Code 7534. (instructing atherosclerotic renal disease (renal artery stenosis or atherosclerotic renal disease) to be rated as renal dysfunction under 38 C.F.R. § 4.115a). The September 2017 Board remand requested the AOJ to obtain a medical opinion regarding the Veteran’s kidney disease prior to November 29, 2013. Specifically, the Board requested a VA opinion as to whether it is at least likely as not that prior to November 29, 2013 the Veteran had a definite decrease in kidney function; and whether it is at least likely as not that prior to November 29, 2013 the Veteran had constant albuminuria with some edema. In November 2017, the Veteran underwent a VA contracted examination. In the examination report the examiner listed the medical treatment related to Veteran’s kidney disease prior to November 29, 2013. The examiner provided a service connection medical opinion and provided a summary of the relevant medical evidence. However, the examiner failed to provide an opinion regarding the severity of the Veteran’s renal disease prior to November 29, 2013. Notably, the examiner failed to address the Board’s specific instructions relating any apparent symptoms prior to November 29, 2013. Therefore, the Board finds another remand is required for the AOJ to obtain a retrospective examination regarding the Veteran’s chronic kidney disease with renal artery stenosis and hypertension. The matters are REMANDED for the following action: 1. Obtain an addendum retrospective medical opinion from an appropriate clinician regarding the Veteran’s kidney disease prior to November 29, 2013. The examiner must opine as to: (a.) Whether it is at least likely as not that prior to November 29, 2013 the Veteran had a definite decrease in kidney function. (b.) Whether it is at least likely as not that prior to November 29, 2013 the Veteran had constant albuminuria with some edema. i. The examiner should address the Veteran’s competent and credible testimony that he had swelling in his legs in 2008 or 2009. The examiner should also address the January 2007 laboratory report that the Veteran had higher than normal albumin in his system. (c.) The examiner must provide a complete rationale for the opinions stated. If the examiner cannot provide any of the requested opinions without resorting to speculation, the examiner should indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert Batten 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.