Citation Nr: 22014277 Decision Date: 03/12/22 Archive Date: 03/12/22 DOCKET NO. 17-50 689 DATE: March 12, 2022 REMANDED Entitlement to service connection for a right kidney disability, including nonfunctioning right kidney and hydronephrosis, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1980 to September 1983. This case is before the Board of Veterans' Appeals (Board) on appeal from a June 2013 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for a right kidney disability. The Veteran's notice of disagreement (NOD) was received in July 2013. The RO issued the statement of the case (SOC) in August 2017, and the Veteran's VA Form 9, substantive appeal was received in September 2017. In October 2021, the Veteran testified at a video conference hearing at the RO before the undersigned Veterans Law Judge (VLJ). A transcript of that testimony is of record. 1. Entitlement to service connection for a right kidney disability, to include nonfunctioning right kidney and hydronephrosis. The Veteran contends that he is entitled to service connection for a right kidney disability, which he believes began during service. Alternatively, he contends that his right kidney disability is secondary to his service-connected schizophrenia. Id. The Veteran specifically contends that his right kidney disability is due to bad water, heavy lifting, and/or bad food that he consumed during service, which caused him to have to use the restroom "constantly." See July 2017 Decision Review Officer hearing transcript, p. 2-3; see also February 2019 Appellate Brief. Alternatively, he asserts that his right kidney disability is related to medications he took for service-connected schizophrenia (i) during service, including Cogentin, Navane, and Haldol; and/or (ii) after service, to include Cogentin, Haldol, Olanzapine, and Klonopin. See generally, February 1994 VA mental health clinic discharge note; VA internal medicine and mental health notes from October 2015 to February 2019. The Veteran has current kidney diagnoses of acute kidney injury and hydronephrosis, as noted in the May 2013 VA kidney conditions Disability Benefits Questionnaire (DBQ). According to the DBQ, these kidney disorders were initially diagnosed in 2009. Service Treatment Records (STRs) from March 1983 show that the Veteran was started on Haldol and Cogentin. A March 1983 physical evaluation board shows that the Veteran urinated in his pants during a military formation. In June 1983, his Haldol prescription was discontinued, but he continued to be treated with Navane and Cogentin. A May 1997 VA psychiatry discharge note states "[the Veteran] reported some urgency of urination. He has a history of urinating in public places when he cannot wait to use the bathroom for example at MARTA station." Current medications included olanzapine and temazepam. VA internal medicine and mental health notes from October 2015 to February 2019 show that the Veteran receives Haldol 50 mg shots, and is prescribed Olanzapine and Cogentin (benztropine). He also reported taking "water pills," or diuretics. The Veteran was afforded a VA examination in May 2013 to determine whether his right kidney disability was related to psychiatric medications taken for service-connected schizophrenia. The examiner diagnosed acute kidney injury and hydronephrosis, with a diagnosis date for each of 2009. The 2009 date was based on a renal ultrasound showing right hydronephrosis and compensatory left hypertrophy. A CT scan of the abdomen and pelvis showed that right hydronephrosis and hydroureter were chronic. Based on those findings, and after an examination of the Veteran, the examiner remarked as follows: [The Veteran] has a nonfunctioning right kidney based on testing done in 2009. At this time, his GFR is >60, he does not have persistent proteinuria. I did a literature search to review whether his psychiatric medications (Cogentin, Thiothixene [i.e., Navane] or Olanzapine) can cause unilateral obstruction and loss of renal function on one side; I could not find any literature reporting this association. Therefore, it is less likely than it is not that the nonfunctional right kidney is related to psychiatric medication use. [sic] A review of the STRs and the post-service medical records demonstrates that the examiner did not discuss the STRs and post-service medical records which show a history of urinary problems; and the examiner did not obtain a history from the Veteran as to the onset, continuity, and frequency of his symptoms, including urinary issues, which he believes are attributable to his right kidney disability. Lastly, the examiner's opinion did not address each of the medications that the Veteran takes for schizophreniaspecifically, Haldol, which the Veteran has taken both during service as well as post-service. A remand is necessary to obtain an adequate opinion which addresses that evidence. In addition, The Veteran has not been afforded a VA examination to determine whether his right kidney disability is related to service on a direct basisi.e., as due to bad water, heavy lifting, and/or bad food that he consumed during service, which he reports caused him to have to use the restroom "constantly." A remand is necessary to obtain an opinion on that theory of entitlement. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA kidney examination with a nephrologist, if possible, to determine the nature and etiology of any right kidney disabilities. The examiner should identify all current right kidney disabilities, and for each disability, opine as to whether it is at least as likely as not (i.e., a 50 percent likelihood or greater) that each disability is related to disease or injury in service, to include consideration of whether the reports of bad water, heavy lifting, and/or bad food that he consumed during service, which caused him to have to use the restroom "constantly." The examiner should also opine as to whether it is at least as likely as not (i.e., a 50 percent likelihood or greater) that each disability is caused by, or aggravated (worsened beyond natural progression by, any of the medications that the Veteran takes, or has taken, for his service-connected schizophrenia, to include during service as well as after service. These medications include Haldol, Olanzapine, Cogentin, Thiothixene, and Olazapine. In so opining, the examiner should consider the Veteran's lay statements concerning in-service urinary difficulties, including having to make constant trips to the restroom. The examiner should also consider the post-service treatment records which show that the Veteran has continued to have difficulty urinating, and which show that he has continued to take many of the same medications for schizophrenia which he was prescribed during service (including Cogentin, Navane, Haldol). Importantly, by remanding this matter, no finding is made, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The entire claims file, including a copy of this remand, must be made available to, and reviewed by, the examiner. A thorough rationale must accompany all opinions formed and conclusions drawn. L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. KAYS HUKILL 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.