KIDNEY DISEASE OF

TRACIE N. WESNER · 2026 · Case ID: 26003161

MIXED

Summary

The Veteran, a National Guard member who served on active duty for training from February 1967 to June 1967, appeals the denial of service connection for several conditions. The Board granted service connection for a renal cyst, finding the evidence in equipoise regarding its secondary connection to service-connected hypertension. Service connection for coronary artery disease with atrial fibrillation, supraventricular arrhythmia, and valvular heart disease was also granted, presumptively due to in-service herbicide exposure. The Board noted that while the Regional Office granted these benefits under the modernized system, the Legacy appeal remains viable for potentially securing an earlier effective date. The Veteran's claims for ulcerative colitis, a spleen cyst, an acquired psychiatric disorder, and headaches were remanded. The remand is necessary due to new evidence received after the last SSOC, including potentially relevant non-VA treatment records from Dr. P.E. and a VA psychiatric evaluation that noted medication prescribed without a clear diagnosis. The Board requires updated opinions on the secondary service connection of the remanded conditions to hypertension, diabetes, tinnitus, and other service-connected disabilities. Additionally, a new psychiatric opinion is needed to clarify the Veteran's diagnosis status and its potential secondary connection to service-connected conditions.

Rationale

Evidence in equipoise; Hypertension as risk factor; Supported by lab findings

Special Benefit

NO SPECIAL BENEFIT

Docket No.

20-25 050

Full Decision Text

Citation Nr: 26003161
Decision Date: 03/10/26 Archive Date: 03/10/26

DOCKET NO. 20-25 050
DATE: March 10, 2026

ORDER

Entitlement to service connection for a renal cyst is granted.

Entitlement to service connection for coronary artery disease with atrial fibrillation, supraventricular arrythmia, and valvular heart disease is granted.

REMANDED

Entitlement to service connection for ulcerative colitis is remanded.

Entitlement to service connection for a cyst on the spleen is remanded.

Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to ulcerative colitis or a service-connected disability, is remanded.

Entitlement to service connection for headaches, to include as secondary to ulcerative colitis or a service-connected disability, is remanded.

FINDINGS OF FACT

1. The Veteran has been granted service connection for hypertension.

2. The evidence is approximately balanced regarding the question of whether a renal cyst is proximately due to the Veteran's service-connected hypertension.

3. The Veteran has been found to have been exposed to an herbicide agent and has a diagnosis of coronary artery disease with atrial fibrillation, supraventricular arrythmia, and valvular heart disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for a renal cyst as secondary to service-connected hypertension are met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for coronary artery disease with atrial fibrillation, supraventricular arrythmia, and valvular heart disease are met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the Louisiana National Guard on Active Duty for Training (ACDUTRA) from February 1967 to June 1967, with additional periods of ACDUTRA and inactive duty for training between October 1966 and October 1972.

This case comes before the Board of Veterans' Appeals (Board) from a December 2014 rating decision of the Regional Office. The appeal was most recently remanded by the Board in a May 2024 decision. At that time, the issue of entitlement to service connection for hypertension on a direct basis was remanded. That issue has since been granted by a Department of Veterans Affairs (VA) Regional Office in a January 2025 rating decision and is no longer before the Board.

The Board also notes that issue of service connection for a heart disability has since been adjudicated by the Agency of Original Jurisdiction (AOJ) since the time of the Board's most recent remand. The AOJ issued an October 2025 rating decision in the modernized appeal system that granted service connection for coronary artery disease with atrial fibrillation, supraventricular arrythmia, and valvular heart disease.

However, in Concepcion-Maldonado v. Collins, 38 Vet. App. 294 (2025), the United States Court of Appeals for Veterans Claims (Court) held that a Legacy appeal seeking service connection is not automatically moot by virtue of an Appeals Modernization Act (AMA) rating decision awarding the same benefit. If the Legacy appeal could allow for an earlier effective date of service connection, the Legacy appeal remains a live case or controversy notwithstanding the award of service connection in a decision adjudicated under the provisions of the AMA. In this case, the issue of service connection for a heart disability appears to have been adjudicated by the AOJ solely in the context of the AMA, and the Board finds that the legacy appeal regarding service connection remains pending as a grant of this benefit may potentially result in an earlier effective date for the Veteran.

Service Connection

1. Entitlement to service connection for a renal cyst

The Veteran has not presented any substantial argument that a kidney cyst is directly related to his military service aside from a potential causal link to an exposure to an herbicide agent. Rather, he has primarily attempted to obtain service connection for this disability on a secondary basis. He initially asserted that a kidney cyst was related to his ulcerative colitis. That disability has not yet been granted service connection. However, in the June 2025 appellate brief, the representative contended that this disability may be caused or aggravated by his newly-service connected disabilities of diabetes mellitus, hypertension, or tinnitus.

may potentially result in an earlier effective date for the Veteran.

Service Connection

1. Entitlement to service connection for a renal cyst

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the most persuasive evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id.

The evidence relating to the Veteran's renal cyst is not particularly complicated. He most recently attended a VA medical examination to evaluate the nature and etiology of this disability in June 2025. The clinician who conducted that evaluation confirmed that he had a diagnosis of a renal cyst. The Veteran had previously attended an additional VA medical examination to evaluate his kidney condition in January 2025. The examiner who conducted that evaluation provided an opinion regarding whether the Veteran's renal cyst was related to toxic exposures he sustained during his military service. However, the examiner also provided a detailed recitation of the particular risk factors that had led to the Veteran's kidney cyst.

That examiner explicitly stated that the Veteran's hypertension was a risk factor can cause renal dysfunction which leads to the development of renal cysts. She also highlighted that the Veteran's eGFR test results were indicative of mild renal dysfunction. Accordingly, she opined that the Veteran's risk factors "far exceed" the risks from the toxic exposure the Veteran experienced.

Although the examiner did not express the opinion in the explicit context of a secondary service connection analysis, the Board finds that this evidence is at least in equipoise regarding the question of whether the Veteran's renal cyst is proximately due to the Veteran's service-connected hypertension. The examiner provided a detailed rationale explaining how the Veteran's hypertension was a potential cause for this disability and pointed to specific laboratory findings in the record in support of this possibility. As a result, the Board finds that the evidence is in relative equipoise and the claim for service connection for a renal cyst on a secondary basis must be granted.

2. Entitlement to service connection for a heart disability

The Veteran also seeks service connection for a heart disability that has since been granted. However, for the reasons explained above, the Board finds that it must continue adjudication of this issue in the Legacy appeal system.

Service connection requires competent evidence showing: (1) the existence of a present disability; (2) 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Certain diseases associated with in-service herbicide agent exposure are presumed to be service connected if the disease is manifested to a compensable degree within a specified time period. 38 C.F.R. §§ 3.307, 3.309. If a Veteran was exposed to an herbicide agent, including Agent Orange, during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6) are met, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. The list of diseases associated with exposure to certain herbicide agents includes but is
disease is manifested to a compensable degree within a specified time period. 38 C.F.R. §§ 3.307, 3.309. If a Veteran was exposed to an herbicide agent, including Agent Orange, during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6) are met, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. The list of diseases associated with exposure to certain herbicide agents includes but is not limited to coronary artery disease. 38 C.F.R. § 3.309(e).

The Board emphasizes that the Veteran has been granted service connection for coronary artery disease with atrial fibrillation, supraventricular arrythmia, and valvular heart disease in the October 2025 rating decision on the basis that the coronary artery disease with resulting heart complications are presumptively due to the Veteran's in-service exposure to an herbicide agent. This diagnosis has been confirmed at the Veteran's June 2026 VA medical examination. He has also been found to have been exposed to an herbicide agent. The Board therefore finds that, under the Legacy appeal system, the criteria for service connection for this disability on a presumptive basis have been met.

REASONS FOR REMAND

1. Entitlement to service connection for ulcerative colitis is remanded.

2. Entitlement to service connection for a cyst on the spleen is remanded.

3. Entitlement to service connection for an acquired psychiatric disability is remanded.

4. Entitlement to service connection for headaches is remanded.

The Board finds that it must remand the remaining issues on appeal for several reasons. First, the record reflects that a substantial amount of additional substantive medical evidence has been received since the May 2025 supplemental statement of the case (SSOC). In October 2025, the Board sent the Veteran correspondence asking if the Veteran would like to waive AOJ consideration of this new evidence and that if the Board did not receive a response, it would remand the matter for that initial AOJ consideration. No response was received.

The Board also observes that the updated VA medical records confirm the existence of potentially relevant non-VA records. An August 2025 VA treatment note indicates the Veteran's health at that time was actively being managed by Dr. P.E., a non-VA provider. At a June 2025 VA psychiatric evaluation, the Veteran also reported that this physician prescribed him psychiatric medication. The Board finds that these records are potentially relevant to the course and onset of the remaining disabilities for which the Veteran seeks service connection. A remand is required to make reasonable efforts to obtain those records.

As the Board is remanding the matters for other concerns, it is also prudent to obtain a new medical opinion that addresses a new theory proposed by the Veterans' representative in the June 2025 appellate brief. Since the time of the initial adjudication of this appeal, the Veteran has been granted service connection for hypertension, diabetes mellitus, and tinnitus. The representative asserted that the issues on appeal may be proximately due to or aggravated by those disabilities. A remand is required to obtain an opinion regarding the possibility that service connection on a secondary basis might be warranted.

Finally, the Board finds that the June 2025 VA psychiatric examination sufficiently explains whether and to what extent the Veteran has had an acquired psychiatric disability. It states that the Veteran did not then and never had had a diagnosis for a psychiatric disability. However, it acknowledged that the Veteran had reported a history of psychiatric treatment from his primary care provider. Unfortunately, the examiner did not appear to provide that opinion regarding a diagnosis with the benefit of those underlying records or explain the discrepancy between an apparent prescription for a psychiatric disability without a diagnosis.

The matters are REMANDED for the following action:

1. Ask the Veteran to complete a VA Form 21-4142 for Dr. P.E. and any other non-VA provider who has treated the Veteran for his ulcerative colitis, spleen cyst, headaches, and any acquired psychiatric disability. Make two requests for the authorized records from any authorized provider, unless it is clear after the first request that a second request would be futile.

2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's ulcerative colitis is at least as likely as not: