CHRONIC KIDNEY DISEASE

DUSTIN L. WARE · 2026 · Case ID: 26005106

DENIED

Summary

The Veteran, an Army Veteran who served from July 1970 to February 1972, appeals the denial of service connection for chronic kidney disease (CKD) and an increased disability rating for service-connected renal calculi. The Veteran contended that CKD was incurred in service or secondary to renal calculi, and also raised contentions related to toxic exposure risk activity (TERA) under the PACT Act. The Board denied service connection for CKD, finding that the evidence persuasively weighed against its onset in service, manifestation within one year of discharge, or causal relationship to service, TERA, or service-connected renal calculi. The Board noted that the Veteran's CKD was most likely related to diabetes mellitus, a common cause of CKD, and that the TERA exposure was outweighed by the history of diabetes and hypertension. The Board also denied an increased rating for renal calculi and associated voiding dysfunction, finding that the Veteran's condition did not meet the criteria for higher disability percentages under either prior or current rating schedules, nor did it demonstrate aggravation. The Board afforded greater probative value to VA medical opinions and treatment records over the Veteran's lay testimony regarding the etiology of CKD.

Rationale

Evidence persuasively weighs against onset in service, manifestation within one year, or causal relationship to service, TERA, or renal calculi.; CKD most likely related to diabetes mellitus and hypertension, which outweigh TERA exposure.; VA medical opinions found CKD not related to renal calculi or TERA.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-39 039

Full Decision Text

Citation Nr: 26005106
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 18-39 039
DATE: April 30, 2026

ORDER

Entitlement to service connection for chronic kidney disease (CKD) is denied.

Entitlement to a disability rating in excess of 30 percent for renal calculi is denied.

FINDINGS OF FACT

1. The Veteran's CKD did not have its onset during active service, did not manifest to a compensable degree within one year of discharge, and is not otherwise causally related to service, to include presumed participation in a toxic exposure risk activity (TERA), and not due to or aggravated by the service-connected renal calculi.

2. For the period on appeal, the Veteran's renal calculi did not manifest in constant albuminuria with some edema, definite decrease in kidney infection, or hypertension at least 10 percent disabling. From November 14, 2021, the Veteran's renal calculi did not manifest in GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months. The Veteran's separately-rated voiding dysfunction associated with renal calculi was not shown to require use of an appliance or wearing of absorbent materials which must be changed more than 4 times per day.

CONCLUSIONS OF LAW

1. The criteria for service connection for CKD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

2. The criteria for a disability rating in excess of 30 percent for the service-connected renal calculi have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.115a, 4.115b, Diagnostic Code 7510.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from July 1970 to February 1972.

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

The claims were remanded by the Board in July 2019, January 2023, and January 2026.

1. Entitlement to service connection for CKD.

The Veteran contends that he developed CKD as the result of service. Alternatively, the Veteran contends that his kidney disability is due to his service-connected renal calculi.

Service connection may be granted for a disability resulting from injury or disease that was incurred in, or aggravated by, military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after a veteran's discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

To establish entitlement to service connection, there must be: (1) competent and credible evidence confirming the Veteran has the claimed disability or at least has since filing the claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or injury; and (3) competent and credible evidence of a nexus or link between the in-service injury or disease and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability that is due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing before the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995).

To establish entitlement to service connection on a secondary basis, there must be (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509 (1998).

For certain chronic diseases, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. See 38 U.S.C. §§ 110
the degree of disability existing before the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 7 Vet. App. 439 (1995).

Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. See 38 C.F.R. § 3.303(b).

Additionally, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) establishes that if a Veteran submits a claim for service connection with evidence of disability and evidence of participation in a toxic exposure risk activity (TERA), then VA shall obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the TERA. 38 U.S.C. § 1168; see also 38 U.S.C. §§ 1710(e)(4), 1119; 38 C.F.R. § 3.320.

Here, the Veteran is presumed to have participated in a TERA including being exposed to per- and polyfluoroalkyl substances (PFAS) and asbestos during military service. See May 2024 VA memorandum.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Turning to the evidence of record, the Veteran's service treatment records (STRs) do not contain complaints or treatments for CKD. There is mention of treatment for the service-connected renal calculi.

The Veteran was afforded VA examinations in August 2008, July 2009, July 2012, May 2015, January 2017, and July 2020. He was not diagnosed with any kidney disability outside of renal calculi.

An October 2012 VA nephrology note indicates that the Veteran had stage 1 CKD with microalbuminuria most likely related to his diabetes mellitus.

A July 2015 nephrology treatment note indicates that the Veteran had stage 1 CKD, and was encouraged to lose weight.

The Veteran was afforded another VA examination in March 2023. He was diagnosed with renal calculi and CKD. The Veteran reported chronic nephrolithiasis since 1972 with a kidney stone removal procedure during active duty. It was noted that the last time the Veteran noticed a passing kidney stone was in 2005. He was noted to have two indwelling kidney stones. He reported that he has been diagnosed with CKD and had a history of diabetes. He reported having lithotripsy twice in 2008 and 2010. He was noted to have intermittent flank pain. His treatment plan was not noted to include taking continuous medication.

The March 2023 examiner reviewed the Veteran's records and concluded that it is less likely than not that the Veteran's CKD was proximately due to, or the result of his service-connected renal calculi. The examiner cited the October 2012 nephrology note indicating that stage 1 CKD is most likely diabetes mellitus related. The examiner noted that CKD is causing the anomalies in the kidney function test. With respect to functional impairment, the examiner indicated that the Veteran's renal calculi can cause intermittent flank pain, which can impact his ability to do prolonged standing and walking only with the occurrence of a kidney stone. It was further noted that there were no limitations from the renal calculi in absence of passage of kidney stones.

In May 2024, VA produced a TERA-specific opinion. Following review of the Veteran's records, the examiner concluded that the claimed CKD was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military
stage 1 CKD is most likely diabetes mellitus related. The examiner noted that CKD is causing the anomalies in the kidney function test. With respect to functional impairment, the examiner indicated that the Veteran's renal calculi can cause intermittent flank pain, which can impact his ability to do prolonged standing and walking only with the occurrence of a kidney stone. It was further noted that there were no limitations from the renal calculi in absence of passage of kidney stones.

In May 2024, VA produced a TERA-specific opinion. Following review of the Veteran's records, the examiner concluded that the claimed CKD was less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran, and the synergistic, combined effect of all TERA. The examiner noted that the March 2023 examination report showed a diagnosed history of CKD, and a July 2015 primary care note showed a history of stage 1 CKD, which occurred over 40 years following the participation in the TERA. The examiner indicated that the Veteran had a history of diabetes and hypertension and cited appropriate medical literature indicating that these are the most common causes of CKD. The examiner indicated that although there is medical literature that shows correlation between PFAS exposure and CKD, the Veteran's records show a pertinent history of both diabetes and hypertension, which far outweigh the less than two-year history of TERA. The examiner cited appropriate medical literature.

In January 2026, VA produced an addendum medical opinion with respect to the issue of aggravation. The examiner noted that the baseline of severity of CKD was stage 1, and that the Veteran still had stage 1 CKD. The examiner cited the Veteran's medical records and indicated that there was no worsening or aggravation of CKD, and that an aggravation cannot be established.

In this case, the Board notes that there is evidence that the Veteran has been diagnosed with the claimed disability of CKD. However, the evidence persuasively weighs against a finding that CKD had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to service, to include due to participation in a TERA, or is secondary to the service-connected renal calculi. Accordingly, service connection is denied.

While the Board finds the Veteran is competent and credible to report observable symptoms, the specific issue in this case, whether his CKD is etiologically related to service, any incident therein, TERA, or service-connected renal calculi, falls outside the realm of common knowledge of the Veteran in this case. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Determining the etiology of the claimed disability is a medically complex task. It is not within the competence of the Veteran, who in this case has not been shown by the evidence of record to have the training, experience, or skills needed to determine the etiology of his disabilities.

Instead, greater probative value is afforded to the Veteran's STRs, post-discharge treatment records, as well as the March 2023, May 2024, and January 2026 VA medical opinions. Significantly, the October 2012 VA treatment note indicates that the Veteran was diagnosed with stage 1 CKD which was most likely related to his diabetes mellitus. His STRs and post-discharge records do not show prior diagnoses or treatment for CKD and corroborate this finding. This is further corroborated by the VA medical opinions.

As such, the Veteran's records show that CKD did not have its onset until approximately 40 years after discharge. This shows that CKD did not have its onset in service and did not manifest to a compensable degree within one year of discharge.

With respect to a nexus, as noted above, the Veteran's VA treatment records indicate that his CKD is most likely due to his diabetes mellitus. The VA medical opinions of record indicate that diabetes mellitus and hypertension are the most common causes of CKD. In other words, the record also shows that the Veteran's CKD is not otherwise causally related to an event or injury in service.

Next, regarding secondary service connection, the question for the Board is whether the Veteran has a current disability that is due to, or the result of, or was aggravated by service-connected disability. The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's CKD is due to, or the result of, or aggravated by, the service-connected renal calculi. 38 U.S.C. §§ 1110, 113
to his diabetes mellitus. The VA medical opinions of record indicate that diabetes mellitus and hypertension are the most common causes of CKD. In other words, the record also shows that the Veteran's CKD is not otherwise causally related to an event or injury in service.

Next, regarding secondary service connection, the question for the Board is whether the Veteran has a current disability that is due to, or the result of, or was aggravated by service-connected disability. The Board concludes that the evidence of record persuasively weighs against finding that the Veteran's CKD is due to, or the result of, or aggravated by, the service-connected renal calculi. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).

Here, the March 2023 and January 2026 VA medical opinions did not find a relationship between the Veteran's CKD and his service-connected renal calculi. The examiner cited the Veteran's medical records and appropriate medical literature and found that the Veteran's CKD is most likely related to his diabetes. With respect to aggravation, the examiner cited the Veteran's records indicating that he has stage 1 CKD and found that no aggravation occurred. The March 2023 and January 2026 VA medical opinions are afforded high probative value as they are corroborated by the Veteran's post-discharge records, including a finding that the Veteran's CKD was stage 1. Thus, the record shows that the Veteran's CKD is not due to or aggravated by his service-connected renal calculi.

Additionally, the Board considered whether the Veteran's CKD is due to his participation in a TERA in service. As noted above, exposure to PFAS and asbestos was conceded. However, the May 2024 found that the Veteran's CKD was less likely than not caused by TERA, after considering the total potential exposure through all applicable military deployments of the Veteran, and the synergistic, combined effect of all TERA. The examiner noted the length of the Veteran's exposure, and that approximately 40 years have passed since that exposure. The examiner then indicated that hypertension and diabetes are the most common causes of CKD and indicated that the Veteran has had a pertinent history of both, which far outweighs the TERA exposure. Essentially, the examiner considered the Veteran's medical and exposure history and found that his CKD is not related to his TERA. Based on the probative evidence outlined above, the Board find that the evidence persuasively weighs against the finding that the Veteran's CKD is due to TERA.

Thus, the evidence persuasively weighs against the finding that CKD had its onset in service, manifested to a compensable degree within one year of discharge, or is otherwise causally related to service, to include due to participation in TERA or secondary to the service-connected renal calculi.

Accordingly, service connection is denied. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to a disability rating in excess of 30 percent for the service-connected renal calculi.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

The veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In a claim for a greater original rating after an initial award of service connection, all of the evidence submitted in support of the veteran's claim is to be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and increase in disability rating is at issue, present level of disability is of primary concern. See Francisco v. Brown, 7
1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

When all the evidence is assembled, VA is responsible for determining whether the weight of the evidence is in approximate balance. If the positive and negative evidence is evenly or approximately balanced, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

The Veteran's service-connected renal calculi is rated as 30 percent disabling under 38 C.F.R. § 4.115a, Diagnostic Code 7510. He is also separately rated for voiding dysfunction associated with renal calculi, as 40 percent disabling from December 1, 2014, under 38 C.F.R. § 4.115a, Diagnostic Code 7517.

The Board notes that, effective November 14, 2021, VA amended 38 C.F.R. § 4.115a and 4.115b in part, to include amending §4.115a by revising the introductory text and the table entries for "Renal dysfunction" and "Urinary tract infection," revising the entry for Diagnostic Code 7508, removing the entry for Diagnostic Code 7510, as well as other relevant changes outlined below. See Schedule for Rating Disabilities; The Genitourinary Diseases and Conditions, 86 Fed. Reg. 54081 (Sep. 30, 2021).

The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Under the pre-November 14, 2021, criteria, the introductory text to 38 C.F.R. § 4.115a for Ratings of the genitourinary system dysfunctions reads as follows:

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

With respect to renal dysfunction, rated under 38 C.F.R. § 4.115a, prior to November 14, 2021, a 30 percent rating is warranted when albumin is constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema, or hypertension at least 10 percent disabling under Diagnostic Code 7101. A 60 percent rating is warranted when there is constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent rating requires persistent edema and albuminuria with blood urea nitrogen (BUN) 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
is constant or recurring with hyaline and granular casts or red blood cells; or, transient or slight edema, or hypertension at least 10 percent disabling under Diagnostic Code 7101. A 60 percent rating is warranted when there is constant albuminuria with some edema; or, definite decrease in kidney function; or, hypertension at least 40 percent disabling under Diagnostic Code 7101. An 80 percent rating requires persistent edema and albuminuria with blood urea nitrogen (BUN) 40 to 80mg%; or, creatinine 4 to 8mg%; or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion. A 100 percent rating requires regular dialysis, or precluding of more than sedentary activity from one of the following: persistent edema and albuminuria; or blood urea nitrogen more than 80mg%; or, creatinine more than 8mg%; or, markedly decreased function of kidney or other organ systems, especially cardiovascular. 38 C.F.R. § 4.115a.

With respect to voiding dysfunction, rated under 38 C.F.R. § 4.115a, prior to November 14, 2021, the criteria directs rating the particular condition as urine leakage, frequency or obstructed voiding.

With respect to urine leakage, a 40 percent rating is assigned with requiring of absorbent materials which must be changed 2 to 4 times per day. A 60 percent rating is assigned with requiring use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day.

With respect to urinary frequency, prior to November 14, 2021, a 40 percent rating is assigned for daytime voiding interval less than one hour or awakening to void 5 or more times per night.

With respect to obstructed voiding, prior to November 12, 2021, a 30 percent rating is assigned for urinary retention requiring intermittent or continuous catheterization.

With respect to urinary tract infections, prior to the November 2021 revision to 38 C.F.R. § 4.115a, a 10 percent rating is assigned for long term drug therapy, 1-2 hospitalizations per year and/or requiring intermittent intensive management. A 30 rating is assigned for recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times/year), and/or requiring continuous intensive management.

Pursuant to Diagnostic Code 7510, prior to November 14, 2021, ureterolithiasis is directed to be rated as hydronephrosis, except for recurrent stone formation requiring one or more of the following is assigned a 30 percent rating: 1. Diet therapy. 2. Drug therapy. 3. Invasive or non-invasive procedure more than two times per year.

Finally, pursuant to the criteria prior to November 14, 2021, Diagnostic Code 7517 governs ratings for bladder injury and instructs rating the condition as voiding dysfunction.

Under the current criteria, effective November 14, 2021, the introductory text to 38 C.F.R. § 4.115a for Ratings of the genitourinary system dysfunctions reads as follows:

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decision maker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Distinct disabilities may be evaluated separately under this section, pursuant to §4.14, if the symptoms do not overlap. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis. Id.

Under the disability rating current criteria, for renal dysfunction, a noncompensable evaluation is assigned for glomerular filtration rate (GFR) from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or granular casts for at least three consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least three consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) 30 mg/g for at least three consecutive months during the
for glomerular filtration rate (GFR) from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or granular casts for at least three consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least three consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) 30 mg/g for at least three consecutive months during the past 12 months.

A 30 percent evaluation is assigned for chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least three consecutive months during the past 12 months.

A 60 percent evaluation is assigned for chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months.

An 80 percent evaluation is assigned for chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months.

A 100 percent evaluation is assigned for chronic kidney disease with GFR less than 15 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient.

Note: GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes under this section when determined to be appropriate and calculated by a medical professional.

With respect to the phrase "definite decrease in kidney function," which is part of the 60 percent criteria, the term "definite" has been defined as "distinct, unambiguous, and moderately large in degree," representing impairment that is "more than moderate but less than rather large." Hood v. Brown, 4 Vet. App. 301 (1993); VAOPGCPREC 9-93, 59 Fed. Reg. 4752 (1994). Also, the word "definite" has been defined as "clearly defined or determined; not vague or general; fixed; precise; exact." https://www.dictionary.com/browse/definite (last visited April 29, 2026).

With respect to the term "markedly decreased function of kidney or other organ systems, especially cardiovascular," which is part of the 100 percent criteria, the word "markedly" has been defined as "in a strikingly noticeable or conspicuous way." https://www.dictionary.com/browse/markedly (last visited April 29, 2026).

Under voiding dysfunction, the current criteria instructs rating the condition as urine leakage, frequency, or obstructed voiding.

With respect to urine leakage, the current criteria warrants a 40 percent disability rating for requiring the wearing of absorbent materials which must be changed 2 to 4 times per day. A 60 percent disability rating is warranted for requiring the use of an appliance or wearing of absorbent materials which must be changed more than 4 times per day.

With respect to urinary frequency, the current criteria warrants a 40 percent disability rating for daytime voiding interval less than one hour, or; awakening to void five or more times per night.

With respect to obstructed voiding, under the current criteria, a 30 percent disability rating is assigned with urinary retention requiring intermittent or continuous catheterization.

With respect to urinary tract infection, under the current criteria, a 30 percent disability rating is assigned with recurrent symptomatic infection requiring drainage by stent or nephrostomy tube; or requiring greater than 2 hospitalizations per year; or requiring continuous invasive treatment.

Diagnostic Code 7908 governs rating for nephrolithiasis/ureterolithiasis/nephrocalcinosis, and directs to rate the disability as hydronephrosis, except for recurrent stone formation requiring invasive or non-invasive procedures more than two times per year, which are evaluated as 30 percent disabling. 38 C.F.R. § 4.115b, DC 7508 (2025).

Diagnostic Code 7509 governs rating for hydronephrosis, and provides that a 10 percent rating is assigned for only an occasional attack of colic, not infected, and not requiring catheter drainage; a 20 percent rating is assigned for frequent attacks of colic, requiring catheter drainage; and a 30 percent rating is assigned for frequent attacks of colic with infection (pyonephrosis) with impaired kidney function. If
to rate the disability as hydronephrosis, except for recurrent stone formation requiring invasive or non-invasive procedures more than two times per year, which are evaluated as 30 percent disabling. 38 C.F.R. § 4.115b, DC 7508 (2025).

Diagnostic Code 7509 governs rating for hydronephrosis, and provides that a 10 percent rating is assigned for only an occasional attack of colic, not infected, and not requiring catheter drainage; a 20 percent rating is assigned for frequent attacks of colic, requiring catheter drainage; and a 30 percent rating is assigned for frequent attacks of colic with infection (pyonephrosis) with impaired kidney function. If hydronephrosis is severe, it is rated as renal dysfunction. 38 C.F.R. § 4.115b, DC 7509 (2025).

The words "recurrent," "occasional," "frequent," and "severe" are not defined in the rating schedule. For purposes of this decision, "recurrent" is defined as returning or happening time after time. "Occasional" is defined as encountered, occurring, appearing, or taken at irregular or infrequent intervals. "Frequent" is defined as common, usual, happening at short intervals. "Severe" is defined as very painful or harmful, or of a great degree. See Webster's New College Dictionary (3rd ed. 2008).

Under the current criteria, Diagnostic Code 5717 directs rating of bladder injury as voiding dysfunction.

Albuminuria refers to the presence of albumin (a protein) in the urine. Dorland's Illustrated Medical Dictionary 45 (32nd ed. 2012).

Turning to the evidence of record, the Veteran was afforded a VA examination in May 2015. He was diagnosed with nephrolithiasis, nephrolithotomy to include lithotripsy, and asymptomatic urinary tract infection. He was noted to require taking continuous medication. He was not noted to have renal dysfunction. He was noted to have 0 to 1 invasive or non-invasive procedures as the result of urolithiasis per year. He was noted to have occasional attacks of colic causing voiding dysfunction. His BUN level was 20, his Creatine 0.90, and his EGFR was 104. His urinary analysis was within normal limits and he was noted to have elevated glucose. Under functional impact, it was noted that the Veteran's nephrolithiasis interfered with work due to pain, spasm, and stiffness.

The Veteran was afforded a VA examination in January 2017. He was diagnosed with nephrolithiasis and was noted to require continuous medication and continued diet of low sodium. He was not noted to have renal dysfunction. His nephrolithiasis symptoms were listed as occasional attacks of colic. He was not noted to have a history of recurrent symptomatic urinary tract infections. The Veteran's records were cited, including August 2016 imaging showing several small nonobstructing stones within the left renal collecting system. His bladder was noted to be grossly normal. There was no functional impact noted.

The Veteran was afforded a VA examination with respect to kidney and urinary tract conditions in July 2020. He was diagnosed with urinary tract infection and voiding dysfunction. It was noted that his condition improved and his last urinary tract infection was 2 years ago. His current symptoms were listed as dysuria, occasional hematuria, frequent urgency, nausea with urination, and symptoms of incomplete voiding. It was noted that voiding dysfunction caused urinary leakage, and that the Veteran reported using absorbent material at night. It was noted that voiding dysfunction did not require use of an appliance. The Veteran was noted to have voiding dysfunction cause increased urinary frequency, with daytime voiding interval of less than 1 hour, and nighttime awakening to void 3 to 4 times. It was further noted that voiding dysfunction caused obstructed voiding, including marked hesitancy, markedly slow stream, and markedly weak, slow, and decreased stream. It was further noted that his voiding symptoms were secondary to his kidney stones. He was noted to have Suprapubic Cystotomy. He was not noted to have a blader injury or other bladder conditions. Under functional impact, it was noted that the Veteran would require frequent bathroom breaks. With respect to kidney stones, the Veteran reported his current symptoms as pain in the back and flank, occasional nausea with morning urination, dysuria, occasional blood in urine and urge to urinate. He was not noted to have renal dysfunction. His urolithiasis was noted to
caused obstructed voiding, including marked hesitancy, markedly slow stream, and markedly weak, slow, and decreased stream. It was further noted that his voiding symptoms were secondary to his kidney stones. He was noted to have Suprapubic Cystotomy. He was not noted to have a blader injury or other bladder conditions. Under functional impact, it was noted that the Veteran would require frequent bathroom breaks. With respect to kidney stones, the Veteran reported his current symptoms as pain in the back and flank, occasional nausea with morning urination, dysuria, occasional blood in urine and urge to urinate. He was not noted to have renal dysfunction. His urolithiasis was noted to require 0 to 1 invasive or non-invasive procedures per year and drug therapy. He was noted to have occasional attacks of colic causing voiding dysfunction. His BUN, creatine, and EGFR testing results were normal. Under functional impact, it was noted that the Veteran would have difficulties pushing, pulling, lifting, and climbing ladders.

The Veteran was afforded a VA examination in February 2023 with respect to urinary tract conditions. He was noted to have voiding dysfunction and renal calculi. He reported worsening of symptoms and his kidney stones causing urinary frequency. He was noted to require absorbent material which must be changed less than 2 times per day and did not require use of an appliance. He was noted to have urinary frequency with daytime voiding interval between 1 and 2 hours. He was not noted to have signs or symptoms of obstructed voiding. There were no other pertinent findings. Under functional impact, the examiner noted that the Veteran lost 1 to 2 weeks of work in the last 12 months and would frequent the bathroom due to voiding dysfunction.

The Veteran was afforded a VA examination with respect to kidney conditions in March 2023. As noted above, he was diagnosed with CKD and renal calculi, which the examiner found to be separate and unrelated conditions. The Veteran was noted to have ureter and kidney urolithiasis, which did not cause stricture of the ureter. It was noted that the Veteran had treatment for recurrent stone formation, including diet therapy. He was noted to require 0 to 1 invasive or non-invasive treatments per year, with the last procedure being 2010 lithotripsy. He was not noted to require catheter drainage and was not noted to have attacks of colic. He was also not noted to have recurrent symptomatic urinary tract or kidney infections. Laboratory results were summarized and were noted to be within normal limits. The examiner cited a May 2017 renal imaging showing two non-obstructing stones in the left kidney. There were no other significant findings. The examiner found that the Veteran renal calculi did not impact his ability to work, further noting that the renal calculi can cause intermittent flank pain, which can impact his ability to do prolonged standing and walking, but only with an occurrence of a kidney stone. It was further noted that in the absence of passage of kidney stones, there are no limitations from the renal calculi.

The Veteran's VA treatment records for the period on appeal contain largely similar findings. The record does not show that the Veteran had hypertension that was 10 percent disabling (diastolic pressure predominately 100 or more or systolic pressure predominantly 160 or more).

In this case, a disability rating in excess of 30 percent is not warranted for the service-connected renal calculi for any period on appeal. Moreover, an increased disability rating is not warranted for the Veteran's separately rated voiding dysfunction associated with renal calculi. Accordingly, the claim is denied.

As noted above, the Veteran's renal calculi is rated as 30 percent disabling under Diagnostic Code 7510. This is the maximum schedular rating allowed under the Diagnostic Code. Thus, the Board will next consider whether a higher disability rating is warranted under other applicable criteria for genitourinary system.

A higher disability rating is not warranted under renal dysfunction under the prior or current criteria, as the record does not show that the Veteran had constant albuminuria with some edema, definite decrease in kidney infection, or hypertension that was at least 10 percent disabling. With respect to post-November 14, 2021, amended criteria (which may be applied from November 14, 2021), the Veteran's laboratory tests for that time period did not show GFR readings from 30 to 44 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months. See Veteran's VA treatment records and March 2023 VA examination report.

The Board has
inary system.

The Board has considered whether a disability rating in excess of 40 percent is warranted for the service-connected voiding dysfunction associated with renal calculi. However, the record does not show that the Veteran requires use of an appliance or wearing of absorbent materials which must be changed more than 4 times per day. Here, although the Veteran reported wearing absorbent material at night, he was not noted to require more than 4 changes per day, and did not require use of an appliance. See July 2020 and February 1012 VA examination reports. Accordingly, a higher disability rating is not warranted for the service-connected voiding dysfunction, under the prior and current rating criteria.

The Board considered other Diagnostic Codes pertaining to the genitourinary system and does not find that rating under other criteria would warrant a rating higher than 30 percent for the service-connected renal calculi and higher than 40 percent for the service-connected voiding dysfunction associated with renal calculi. Staged ratings were considered, and the record shows that the Veteran's symptoms were largely of the same severity and frequency throughout the period on appeal. Thus, staged ratings are not applicable here.

In sum, for the period on appeal, the Veteran's renal calculi did not manifest in constant albuminuria with some edema, definite decrease in kidney infection, or hypertension at least 10 percent disabling. From November 14, 2021, the record did not show GFR from 30 to 44 mL/min/1.73 m 2 for at least 3 consecutive months during the past 12 months. The Veteran's separately-rated voiding dysfunction associated with renal calculi was not shown to require use of an appliance or wearing of absorbent materials which must be changed more than 4 times per day for the period on appeal. Accordingly, a disability rating in excess of 30 percent is not warranted for the service-connected renal calculi. Additionally, a rating in excess of 40 percent is not warranted for the service-connected voiding dysfunction associated with the service-connected renal calculi.

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Kuksova, Kseniya

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.

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