Citation Nr: 21032023 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 17-04 461 DATE: May 25, 2021 REMANDED Entitlement to an initial rating in excess of 80 percent for the Veteran's service-connected kidney condition associated with diabetes mellitus type 1 with mild diabetic retinopathy (kidney condition) is remanded. REASONS FOR REMAND The Veteran's active duty service in the U.S. Army includes January 1961 to July 1961, February 1964 to October 1964, and October 1968 to April 1987. He died in February 2013. The appellant is his widow. In an August 2020 notice, the AOJ recognized the appellant as the Veteran's surviving spouse and a substituted appellant for appeals pending at the time of the Veteran's death. Thus, she is recognized as a substituted appellant for purposes of the present appeal. This appeal arises from an April 2014 rating decision, granting service connection for a kidney condition, characterized by the AOJ as "kidney condition associated with diabetes mellitus type 1 with mild diabetic retinopathy", and assigned an initial 30 percent rating, effective from June 28, 2011. In a December 2016 rating decision, the AOJ increased the rating for the Veteran's kidney condition from 30 to 80 percent, retroactively effective from June 28, 2011, the date service connection was established. The appellant continued the appeal. In August 2019, the Board dismissed the appellant's increased rating claim in excess of 80 percent for the Veteran's chronic kidney disease associated with diabetes mellitus. The appellant appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC/Court). In an October 2020 Order, the Court vacated the Board's decision and remanded this case to the Board for readjudication. The increased rating claim for a kidney condition is again before the Board for consideration. Entitlement to an initial rating in excess of 80 percent for the Veteran's kidney condition. The appellant contends that the Veteran's kidney condition warranted the maximum 100 percent rating, as he needed daily dialysis. See April 2015 notice of disagreement. She also indicated that the Veteran had increased heart problems. See VA Form 9, January 2017. The Veteran's kidney condition is assigned a 100 percent initial rating under 38 C.F.R. § 4.115a (genitourinary system dysfunctions), DC 7541, for Renal Involvement in Diabetes Mellitus, which is rated as renal dysfunction. Per 38 C.F.R. § 4.115a, renal dysfunction warrants a 100 percent rating if requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80 mg percent; or, creatinine more than 8 mg percent; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. The Veteran, in an August 2012 Report of General Information, reported that his medical records include relevant treatment at Landhuthl Army Hospital on Ramstein Army Base, Germany, and Heidelberg Army Hospital, Germany. Although the AOJ referenced that these records are associated with the claims file, it is not entirely clear that all relevant records have been obtained and/or associated with the claims file. On remand, the AOJ should attempt to obtain any outstanding records from Landhuthl Army Hospital on Ramstein Army Base, Germany, and Heidelberg Army Hospital, Germany. A retrospective medical opinion is also necessary to assist the Board in determining the severity of the Veteran's kidney condition during the period it was service-connected from June 28, 2011 to February 25, 2013. The matters are REMANDED for the following action: 1. Ask the appellant to provide the names and addresses of any medical provider, VA or private, who had treated the Veteran for kidney problems. Obtain outstanding federal records from: (a) Landhuthl Army Hospital on Ramstein Army Base, Germany; and (b) Heidelberg Army Hospital, Germany; and associate these records with the claims file. Obtain outstanding VA treatment records, if any. If any requested records are unavailable, the claims file should be annotated as such and the appellant and her representative notified of such. 2. After associating any additional medical records with the claims file, obtain a retrospective medical opinion from a qualified VA clinician to determine the severity of the Veteran's kidney disease preceding his death in February 2013. After reviewing the record, the examiner should comment whether there was any increased functional impairment due to his kidney disease from June 28, 2011 to February 25, 2013. Specifically comment on whether the Veteran's renal dysfunction required regular dialysis during this period, or precluded more than sedentary activity from one of the following: persistent edema and albuminuria; or, BUN more than 80 mg percent; or, creatinine more than 8 mg percent; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. A complete rationale should be provided for all opinions rendered. 3. Thereafter readjudicate the claim. If any benefit sought on appeal remains denied, issue a supplemental statement of the case to the appellant and her representative. The appropriate time period to respond should be provided. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Biswajit Chatterjee, 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.