Citation Nr: 21040668 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 19-15 953A DATE: July 6, 2021 REMANDED Entitlement to service connection for a kidney disability is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Marine Corps from August 1958 to September 1962. This matter comes before the Board of Veterans' Appeals (Board) from a July 2017 rating decision. In July 2020, the Board denied the Veteran's appeal. The Veteran then appealed the Board's decision to the Court of Appeals for Veterans Claims (Court). While his appeal was pending before the Court, the Veteran and VA's General Counsel filed a joint motion for remand (JMR), agreeing that the Board erred when it failed to ensure VA satisfied its duty to assist and failed to provide an adequate statement of reasons or bases for its denial. In March 2021, the Court granted the parties' JMR, vacated the Board's July 2020 decision, and remanded the matter to the Board for actions consistent with the JMR. The matter has returned to the Board for appellate consideration. Given the findings in the JMR and the Court's order, the Board finds remand necessary to obtain an adequate medical opinion concerning the Veteran's claim. See Stegall v. West, 11 Vet. App. 268 (1998). This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2) and 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for a kidney disability is remanded. The Veteran contends that his current kidney disability is related to his active service. Specifically, he contends it is related to his exposure to contaminated water at Camp Lejeune. See July 2017 Correspondence. The Veteran's current kidney disability and in-service exposure to contaminated water has already been established. The Veteran has a current diagnosis of kidney stones, also known as nephrolithiasis. See February 2019 VA Medical Opinion Disability Benefits Questionnaire. The Veteran's service personnel records confirm that he was stationed at Camp Lejeune from at least November 1958 through January 1960 and was presumptively exposed to water contaminants there. As outlined in the JMR, the existing medical opinion evidence of record is inadequate as it fails to sufficiently address lay evidence and fails to provide an adequate nexus rationale specific to the Veteran. Additionally, clarification is needed to determine whether the Veteran has any additional kidney disability in addition to kidney stones. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA medical examination by an appropriate clinician regarding the Veteran's claimed kidney condition, to include whether any current kidney disability is at least as likely as not related to his active service, and to include as directly due to his exposure to contaminated water at Camp Lejeune. All pertinent evidence of record, including the entire claims file, and record of all statements made in support of the Veteran's claim, must be made available to and reviewed by the clinician. All indicated diagnostic tests should be completed. If the Veteran declines an in-person examination, an addendum medical opinion must still be obtained. 2. Following completion of the above, the clinician shall do the following: (a.) List all kidney conditions present during the period on appeal (from January 2017 to the present). Attention is drawn to the Veteran's assertion that he has stage two kidney disease and five kidney related surgeries. (b.) For each identified kidney condition, state an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the condition originated during or is otherwise etiologically related to the Veteran's service, including as directly related to the Veteran's conceded exposure to contaminated water at Camp Lejeune. The opinion for each identified condition shall address the Veteran's January 2019 lay statements, specifically that the Veteran began experiencing kidney problems and symptoms by 2001 or 2002. For purposes of these opinions, the clinician shall assume that the Veteran is a credible historian. Additionally, the opinion for each identified condition must be specific to the Veteran. In other words, to be adequate, the clinician's opinions must address whether in this particular case, there is a medical nexus between the Veteran's kidney condition(s) and his service (given the Veteran's known exposure to contaminated water at Camp Lejeune, his lay evidence of symptomatology, and the medical evidence pertaining to his kidney function. The fact that nephrolithiasis or another identified condition is not listed as a presumptive condition for Camp Lejeune contaminates does not relieve the clinician of providing the requested direct medical opinions. In rendering the opinion, as indicated by the JMR, the examiner should identify whether this Veteran had risk factors for nephrolithiasis, such as higher urine calcium, higher urine oxalate, and lower urine citrate and dietary risk factors such as a lower calcium intake, higher oxalate intake, higher animal protein intake, lower potassium intake, higher sodium intake, or lower fluid intake. A complete rationale must be provided for all opinions offered, and if the examiner cannot offer an opinion without resorting to mere speculation, the examiner should fully explain why this is the case and identify what additional evidence/information, if any, would allow for a more definitive opinion. Continued on next page 3. Following completion of the foregoing, the Agency of Original Jurisdiction (AOJ) should review the record and readjudicate the claim on appeal. If the claim remains denied, the AOJ should issue an appropriate supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. S. Sorathia Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, Associate 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.