KIDNEY DISEASE OF

Summary

The veteran, who served from July 1974 to January 1978, September 1978 to September 1981, and August 1984 to August 1987, appeals the denial of service connection for a kidney condition. The veteran contended the condition was due to active service or secondary to hypertension or diabetes, but the Board noted these latter conditions were not service-connected. The Board found the first element of service connection (a present disability) was met due to diagnoses of chronic kidney disease and acute renal failure. The second element (in-service incurrence) was also met, giving the veteran the benefit of the doubt, based on his testimony of symptoms appearing months after service separation, despite no in-service treatment records. However, the Board found no nexus between the claimed in-service incurrence and the current kidney condition. Multiple VA medical opinions were reviewed, with the Board affording low probative value to opinions from April 2021, April 2022, and October 2022, citing lack of rationale, reliance on absence of records, and failure to consider lay evidence. A March 2025 opinion was also discounted for failing to consider lay evidence and relying on inaccurate factual premises. A subsequent August 2025 opinion was discounted for failing to consider lay evidence. A November 2025 opinion with addenda in December 2025 and January 2026 was afforded high probative value, concluding the chronic kidney disease was related to hypertension and diabetes, not service, and had resolved. The Board found the evidence weighed against service connection, and thus the benefit-of-the-doubt doctrine did not apply. Service connection for the kidney condition was denied.

Rationale

No in-service diagnosis or treatment for kidney condition.; Veteran's testimony of symptoms post-service considered.; Multiple VA opinions reviewed; most afforded low probative value.; November 2025 opinion afforded high probative value, linking condition to comorbidities, not service.

Full Decision Text

Citation Nr: 26002713
Decision Date: 02/26/26	Archive Date: 02/26/26

DOCKET NO. 14-33 669
DATE: February 26, 2026

ORDER

Entitlement to service connection for a kidney condition is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's kidney condition was caused by or incurred in service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a kidney condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1974 to January 1978, from September 1978 to September 1981, and from August 1984 to August 1987.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified before the Board in a May 2019 video conference hearing, and a transcript of that testimony is of record. This hearing was before a Veterans Law Judge who is no longer available to participate in the appeal. In a September 2024 correspondence, the Veteran was given the opportunity to request another hearing. The Veteran and his representative did not request a new hearing.

This matter was previously before the Board in October 2019, January 2022, August 2023, October 2024, and July 2025.

The Board denied the claim in August 2023, and the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court) contesting the Board's August 2023 decision denying, in pertinent part, service connection for a kidney condition. In May 2024, the Court granted a Joint Motion for Partial Remand (JMPR) filed by representatives for both parties and remanded the claim to the Board for compliance with the JMPR.

This matter was last before the Board in October 2025, where it was remanded for further development. The claim has since been returned to the Board for appellate review.

The Board finds that there has been substantial compliance with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998).

Service Connection

Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Determinations as to service connection will be based on a review of all the evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a).

In determining whether service connection is warranted, the Board shall consider the benefit-of-the-doubt doctrine. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

Entitlement to service connection for a kidney condition.

The Veteran contends his kidney condition is due to active service, or in the alternative secondary to his hypertension or diabetes. See October 2025 Appellate Brief. The Board notes the Veteran is not service connected for hypertension or diabetes, and as such, secondary service connection will not be discussed further.

As discussed below, the Board finds that service connection for a kidney condition is not warranted.

As an initial matter, the Veteran has had diagnoses of chronic kidney disease and acute renal failure during the pendency of the appeal. See February 2015 Medical Treatment Record - Non-Government Facility. Thus, the first element of service connection has been met.

With respect to in-service incurrence, there appears to be no documentation of a diagnosis or treatment for any kidney conditions. However, the Veteran's service treatment records (STRs) indicate he had vomiting in August 1985. The Veteran asserted that his kidney disorder began within a few months of service separation. He reported that he started noticing symptoms six or seven months after separation but did not seek treatment
As discussed below, the Board finds that service connection for a kidney condition is not warranted.

As an initial matter, the Veteran has had diagnoses of chronic kidney disease and acute renal failure during the pendency of the appeal. See February 2015 Medical Treatment Record - Non-Government Facility. Thus, the first element of service connection has been met.

With respect to in-service incurrence, there appears to be no documentation of a diagnosis or treatment for any kidney conditions. However, the Veteran's service treatment records (STRs) indicate he had vomiting in August 1985. The Veteran asserted that his kidney disorder began within a few months of service separation. He reported that he started noticing symptoms six or seven months after separation but did not seek treatment. See May 2019 Correspondence (hearing transcript). Accordingly, in giving the Veteran the benefit of the doubt, the Board finds that the second element of the Shedden analysis has been met.

The remaining question is whether there is a nexus between the Veteran's in-service incurrence and his kidney condition.

The Veteran's service treatment records do not indicate a diagnosis or treatment for any kidney conditions. The Board notes that the Veteran did not participate in toxic exposure risk activity (TERA). See April 2023 other (TERA memorandum).

The Veteran was afforded a VA examination and medical opinion in April 2021. The examiner provided a negative nexus opinion. In doing so, the examiner provided no medical rationale. Instead, the examiner simply stated that there was no diagnosed kidney disorder during service. The examiner provided no explanation as to how this piece of evidence informed their ultimate conclusion. Moreover, the examiner did not address the Veteran's competent observations regarding symptoms that may be related to his condition. As such, the Board finds the April 2021 opinion is afforded low probative value. See Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (stating that a medical opinion must support its conclusion with an analysis that the Board can weigh, and a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision).

The Veteran was afforded a VA medical opinion in April 2022. The clinician provided a negative nexus opinion. The clinician provided, "no chronic diagnosis is made for renal disease on active duty. Urinating difficulties and kidney disease are not medically related. Kidney disease does not cause urination difficulties. He reports subjectively his urination issues date back to active duty inferring kidney issues present on active duty. In this case, a kidney condition- an objective finding with labs would have to be present on active duty. There is no abnormal lab finding for a kidney issue until 2019. No record shows chronic proteinuria. Labs prior to this as noted in evidence were normal. A nexus has not been established." The Board finds the April 2022 opinion is afforded low probative value as the VA clinician relied on the absence of treatment records during and after service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). Moreover, the clinician failed to cite the medical literature used for her conclusions.

The Veteran was afforded a VA medical opinion in October 2022. The clinician provided a negative nexus opinion. The clinician provided, "after reviewing medical records to include the remand letter, it is less likely than not that the Veteran's kidney disorder is related to military service as there are no medical records showing diagnosis, treatment for the kidney disorder condition during active duty. Although the Veteran stated that he began experiencing symptoms of difficulty urinating while on active duty, it was likely an acute process." The Board finds the October 2022 opinion is afforded low probative value as the VA clinician relied on the absence of treatment records during and after service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). Moreover, the clinician failed to cite the medical literature used for her conclusions.

The Veteran was afforded a VA medical examination, direct service connection opinion, and conflicting medical evidence opinion in March 2025. The examiner provided negative nexus opinions. For direct service connection, the examiner opined, "there are no records to support any claim or treatment to support that chronic kidney disease was diagnosed or was due to service. He was diagnosed with acute renal failure due to chronic kidney disease in 2015 per records and this was 29 years after his last active-duty discharge in 1986. Records reveal that the acute renal failure was resolved." The Board finds the March 2025 direct service connection opinion is afforded low probative value, as the examiner failed to consider the Veteran's statements and contentions regarding the onset and
 conclusions.

The Veteran was afforded a VA medical examination, direct service connection opinion, and conflicting medical evidence opinion in March 2025. The examiner provided negative nexus opinions. For direct service connection, the examiner opined, "there are no records to support any claim or treatment to support that chronic kidney disease was diagnosed or was due to service. He was diagnosed with acute renal failure due to chronic kidney disease in 2015 per records and this was 29 years after his last active-duty discharge in 1986. Records reveal that the acute renal failure was resolved." The Board finds the March 2025 direct service connection opinion is afforded low probative value, as the examiner failed to consider the Veteran's statements and contentions regarding the onset and continuity of his symptoms. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (an adequate and thorough examination must consider all other relevant evidence of record, including lay statements). As to the conflicting medical evidence, the examiner opined, "the Veteran required a hospital encounter in 2015 due to acute renal failure due to chronic kidney disease, where he did have vomiting. Records reveal that the acute renal failure did resolve. There is no evidence that I am able to locate that the Veteran complained of a vomiting condition while in service. There is also no evidence that I am able to locate that a symptom of vomiting is a cause of chronic kidney disease." The Board finds the March 2025 VA conflicting medical evidence opinion is afforded low probative value, as the opinion relies on an inaccurate factual premise, as the Veteran's service treatment records indicate he had vomiting in August 1985. See Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If [an] opinion is based on an inaccurate factual premise, then it is correct to discount it entirely." (citing Reonal v. Brown, 5 Vet. App. 458, 461 (1993)); see also Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) ("[A]n adequate medical report must rest on correct facts and reasoned medical judgment so as [to] inform the Board on a medical question and facilitate the Board's consideration and weighing of the report against any contrary reports.").

The Veteran was afforded a VA examination and medical opinion in August 2025. The examiner provided a negative nexus opinion. The examiner opined, "the Veteran has claimed kidney condition as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of acute renal failure in 2015 (resolved) and CKD stage 3 in June 2022 (resolved) and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. STRs are silent for any evidence of kidney conditions while in service. The evidence in the STRs show the Veteran was no longer service connected when the first kidney episode was diagnosed. Most recent test results show Veteran's kidney function as normal." The Board finds the August 2025 opinion is afforded low probative value, as the examiner failed to consider the Veteran's statements and contentions regarding the onset and continuity of his symptoms. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (an adequate and thorough examination must consider all other relevant evidence of record, including lay statements).

The Veteran was afforded a VA examination and medical opinion in November 2025, and addendum opinions in December 2025 and January 2026. The RO found the November 2025 opinion inadequate for rating purposes. The December 2025 addendum opinion noted, "the Veteran was seen during service for acute vomiting and was treated for suspected flu. There is no indication that this caused any kidney disease or is related to the kidney disease that the Veteran developed years later. The C-file shows that the Veteran's later kidney disease was caused by his hypertension and diabetes and has since resolved." The January 2026 addendum opinion noted, "the STRs show no record of a kidney condition during service. Post-service records show that in February 2015 the Veteran was hospitalized with acute kidney injury vs acute on chronic kidney disease as the Veteran had several risk factors for kidney disease including hypertension, diabetes, medication use related to hypertension and diabetes that can cause kidney injury, and NSAID use. This was likely compounded by volume depletion due to acute nausea, vomiting, and diarrhea, leading to acute kidney injury. Nephrology records from August 2023 further confirm a history of chronic kidney disease
 Veteran developed years later. The C-file shows that the Veteran's later kidney disease was caused by his hypertension and diabetes and has since resolved." The January 2026 addendum opinion noted, "the STRs show no record of a kidney condition during service. Post-service records show that in February 2015 the Veteran was hospitalized with acute kidney injury vs acute on chronic kidney disease as the Veteran had several risk factors for kidney disease including hypertension, diabetes, medication use related to hypertension and diabetes that can cause kidney injury, and NSAID use. This was likely compounded by volume depletion due to acute nausea, vomiting, and diarrhea, leading to acute kidney injury. Nephrology records from August 2023 further confirm a history of chronic kidney disease directly related to chronic diabetes mellitus type II and hypertension. Records show, however, that the condition (chronic kidney disease) has since resolved with normal kidney function as shown on labs from January 2025. Both diabetes and hypertension are known causes for chronic kidney disease. Although the Veteran contends that his kidney disease and the associated subjective symptoms began during service, this is not supported by the C-file or the medical literature. An STR dated August 1985 shows that the Veteran was seen and evaluated for acute nausea and vomiting. He was suspected to have a viral flu illness. Although the Veteran had acute kidney injury related to nausea/vomiting and diarrhea many years later in 2015, this was due to already existing kidney dysfunction as related to his diabetes and hypertension. Furthermore, the Veteran is deemed competent to provide a history of symptoms, which have been reviewed and taken into consideration. The lay statements regarding the Veteran's condition/symptoms were also reviewed and considered. While the Veteran is deemed credible to report symptoms, he is not qualified to ascribe the symptoms to an etiology. After review and consideration of the available evidence, a nexus has not been established. The Veteran's chronic kidney disease (resolved) is directly related to his co-morbidities that developed many years following service and could not have been caused by or is related to in any way the acute vomiting that occurred during service." The Board finds the December 2025 and January 2026 addendum opinions are afforded high probative value, as the examiner provided opinions that were well-reasoned, contained supporting rationales and medical literature, and addressed the Veteran's specific conditions and symptoms. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

The Board recognizes the Veteran's assertion that his kidney condition is related to service, including as related to his in-service vomiting. However, although the Veteran is competent to report lay-observable symptoms, he is not competent to establish a nexus between a disability and military service. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

In conclusion, as the evidence of record persuasively weighs against a finding that the Veteran's kidney condition was incurred in or is otherwise related to active service, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 777-79. The appeal is denied.

 

 

D. SMART

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K.A. Murphy

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.