Citation Nr: 21029984 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 18-54 454 DATE: May 17, 2021 REMANDED Entitlement to an initial compensable rating for diabetic nephropathy rated as renal dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from January 1963 to January 1967 and the United States Navy from July 1969 to October 1986. This matter returns to the Board from a November 2020 Board remand. Entitlement to an initial compensable rating for diabetic nephropathy rated as renal dysfunction is remanded. The Veteran was granted service connection for diabetic nephropathy, which was incorporated into his evaluation for diabetes mellitus II in an April 2018 rating decision. In November 2020, the Board remanded for an addendum opinion to determine whether the Veteran has a albumin constant or recurring with hyaline and granular casts or red blood cells associated with his albuminuria, whether the Veteran has a "definite increase in kidney function" including based on eGFR findings, which the medical record indicates has been abnormal, and whether the Veteran has constant albuminuria with some edema. The examiner was instructed to base the opinion on the April 2018 VA examination's findings and other evidence of record. Should the examiner be unable to answer the questions based on the findings of the April 2018 VA examination report and other evidence of record, a new examination and appropriate tests and studies should be conducted. In January' 2021 an addendum opinion was rendered. The examiner relied heavily on the April 2018 examination report to render the opinion. The examiner indicated there was not evidence aside from a one-time lab result indicating microalbuminuria indicative of diabetic granular casts or RCC. The examiner indicated an inability to fully opine on the issue without additional testing, which was not conducted. The examiner further indicated that the evidence of record was insufficient to determine whether there was a definite decrease in kidney function or that there is persistent microalbuminuria or any associated edema. It is clear from the examination report that additional testing and studies were necessary to fully evaluate the Veteran's current disability. As additional testing was directed by the Board in the November 2020 remand should the evidence of record be insufficient, the Board finds the January 2021 examination report to be insufficient to adjudicate the claim at this time. The matter is REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his diabetic nephropathy. The examiner should provide a full description of the disability and report all signs and symptoms. To determine the current severity of the disability, and all its associated symptomatology, relevant testing and labs should be conducted, including, but not limited to, kidney function testing. The examiner must provide a complete rationale for any opinions provided. 2. Then, review the examination report provided to ensure that the requested information was provided. If the report is deficient in any manner, the AOJ must implement corrective procedures. 3. Then, readjudicate the claim. If the decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. T. Blake Carter Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rekowski 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.