KIDNEY DISEASE OF

Summary

The veteran, who served in the U.S. Navy for less than one month in March 1972, appeals the denial of service connection for a kidney condition, bilateral hearing loss (BHL), tinnitus, and bipolar disorder. The Board denied the kidney condition claim, finding no in-service event, disease, or injury related to the current kidney lesions, despite the agency of original jurisdiction conceding a present disability. The veteran testified that he believes his kidney condition worsened due to a lack of VA care after his brief service, but the Board found no evidence linking the condition to his service. For BHL and tinnitus, the Board denied service connection, noting that while a current disability and in-service noise exposure were conceded, the VA examiner opined the conditions were less likely than not related to service. The Board gave significant weight to the examiner's opinion, finding the evidence against a service connection, and also noted the veteran's own uncertainty about the onset of his hearing loss and tinnitus. The claim for bipolar disorder was also denied. The Board acknowledged an in-service psychiatric diagnosis of immature personality disorder and a later diagnosis of bipolar disorder. However, the Board found the in-service symptoms were not early signs of bipolar disorder, relying on a VA examiner's opinion that concluded the immature personality disorder was distinct from bipolar disorder. The Board also noted that personality disorders are not service-connected and that bipolar disorder did not manifest in service or relate to service otherwise. The case was remanded for a new VA examination regarding the right knee condition, specifically chondromalacia, due to an inadequate initial opinion that did not fully consider the veteran's testimony about lack of post-service treatment access.

Rationale

No in-service event, disease, or injury related to current kidney lesions; Service treatment records silent for kidney symptoms/treatment; Veteran's testimony did not describe in-service event for kidney condition

Full Decision Text

Citation Nr: A26025301
Decision Date: 03/20/26	Archive Date: 03/20/26

DOCKET NO. 210203-137398
DATE: March 20, 2026

ORDER

1. Entitlement to service connection for kidney condition is denied.

2. Entitlement to service connection for bilateral hearing loss (BHL) is denied.

3. Entitlement to service connection for tinnitus is denied.

4. Entitlement to service connection for bipolar disorder (also claimed as acquired psychiatric condition) is denied.

REMANDED

Entitlement to service connection for chondromalacia, right knee, is remanded.

FINDINGS OF FACT

1. There was no in-service event, disease, or injury related to current kidney lesions. 

2. The Veteran's bilateral hearing loss and tinnitus did not manifest in-service and is not shown to be causally or etiologically related to an in-service event, injury, or disease, to include conceded military noise exposure. 

3. The Veteran was diagnosed with an immature personality disorder in service. 

4. Many years subsequent to service, he was diagnosed with bipolar disorder. 

5. Symptoms present in service and diagnosed as immature personality disorder were not harbingers of bipolar disorder or any other acquired psychiatric disorder and were not early signs of any subsequently diagnosed psychiatric disorder. 

CONCLUSIONS OF LAW

1.  The criteria for service connection for kidney condition are not met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307(a)(3), 3.309(a), 3.385. 

3. The criteria for service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

4. The criteria for service connection for an acquired psychiatric disorder, to include bipolar disorder, have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty for the United States Navy from March 1972 to April 1972. 

This appeal is before the Board of Veterans' Appeals (Board) from September 2020 and October 2020 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). 

The Veteran submitted a VA Form 10182 notice of disagreement (NOD) which was received in February 2021. The Veteran selected the Hearing docket review option. The Veteran appeared at a hearing before a Veterans Law Judge (VLJ) in June 2024. As the Veteran selected the hearing docket, the Board is limited to review of the evidence of record at the time of the September 2020 rating decision for right knee and psychiatric condition, and October 2020 rating decision for bilateral hearing loss, tinnitus, and kidney condition, as well as evidence received within 90 days of the June 2024 Board hearing. 38 C.F.R. § 20.302(a).

Service Connection 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (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, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims (Court) discussed the steps to be taken in determining whether a VA examination
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, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims (Court) discussed the steps to be taken in determining whether a VA examination is necessary prior to final adjudication of a claim. In disability compensation claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the appellant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the appellant's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for VA to make a decision on the claim. 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i). The Court in McClendon observed that the third prong, which requires that the evidence of record "indicates" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83.

VA generally recognizes a presumption of service connection for certain chronic diseases, to include bilateral hearing loss and tinnitus, which manifest to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Such a presumption is inapplicable when, as here, a claimant has less than 90 days of active service. 38 C.F.R. § 3.307(a)(1). 

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 claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc); 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, the benefit of the doubt is afforded the claimant.

1. Entitlement to service connection for kidney condition is denied. 

The Veteran claims service connection for a kidney condition, to include kidney lesions. 

The agency of original jurisdiction has conceded the presence of a current kidney condition, to include kidney lesions. Without evidence of clear and unmistakable error to rebut this favorable finding, the element of a present disability has been established.

Service treatment records do not reflect symptoms of or treatment for any kidney condition, and the Veteran did not report any such disability on the medical history report for his entrance examination. 

Treatment records include complaints of kidney lesions in August of 2020. 

The Veteran testified that he believes his kidney condition is due to his military service because he was not informed once he separated from the military that he could seek VA care, despite only serving on active duty for a month. Therefore, he avers, his kidney condition worsened due to the lack of care. See June 2024 Hearing Transcript page 3. 

The Board finds that the evidence persuasively weighs against the finding of an in-service event, disease, or injury related to current kidney lesions. Service treatment records show no indication of any kidney symptoms in service. There is nothing in the Veteran's treatment records or statements to VA that describe an in-service event, disease, or injury to which kidney lesions could be attributed. Indeed, the Veteran's testimony is silent for any in-service event, disease, or injury which could have led to his kidney condition. Moreover, the record reveals the Veteran served less than one month of active duty, and there is nothing in the record indicating that anything related to current kidney lesions occurred in the roughly four weeks between the Veteran's induction into service and his medical discharge. While the Veteran was not provided with a relevant VA examination, the Board finds that an examination is not necessary. There is no indication of a link between the Veteran
 show no indication of any kidney symptoms in service. There is nothing in the Veteran's treatment records or statements to VA that describe an in-service event, disease, or injury to which kidney lesions could be attributed. Indeed, the Veteran's testimony is silent for any in-service event, disease, or injury which could have led to his kidney condition. Moreover, the record reveals the Veteran served less than one month of active duty, and there is nothing in the record indicating that anything related to current kidney lesions occurred in the roughly four weeks between the Veteran's induction into service and his medical discharge. While the Veteran was not provided with a relevant VA examination, the Board finds that an examination is not necessary. There is no indication of a link between the Veteran's current kidney disease and his brief period of service. As such, an examination is not warranted. See McLendon, 20 Vet. App. at 83.  

For these reasons, the Board finds that the evidence persuasively weighs against the finding of service connection, and the claim is therefore denied.  

2. Entitlement to service connection for bilateral hearing loss (BHL) is denied. 

3. Entitlement to service connection for tinnitus is denied. 

The Veteran contends that his bilateral hearing loss and tinnitus are due to his active-duty service.

The agency of original jurisdiction has conceded the presence of a current disability, specifically bilateral sensorineural hearing loss and tinnitus, and an in-service event, injury, or incurrence, as the Veteran's MOS had a moderate probability of acoustic trauma. Without evidence of clear and unmistakable error to rebut the favorable findings, the first and second elements of service connection have been established. 

The Veteran was afforded a VA examination in October 2020. The examiner confirmed diagnosis of bilateral sensorineural hearing loss and concluded that the bilateral hearing loss and tinnitus are less likely as not caused by or a result of an event in service, to include military noise exposure. The examiner noted the Veteran's report that the onset of his hearing loss and tinnitus was 40 years post medical discharge, and that he experienced significant occupational noise exposure after the military until now. Considering the above, the examiner opined that it is less likely as not the Veteran's current right and left ear hearing loss and tinnitus are related to noise exposure during service. 

The Veteran's testimony before the undersigned includes his admission that he is not exactly sure when his hearing declined, but it likely was not in the Navy. See Hearing Transcript page(s) 8, 9. The Veteran further testified regarding his bilateral tinnitus that "I can't blame that on the Navy...because the ringing in the ears, it started relatively late..."

The Board affords great probative weight to the October 2020 VA examiner's assessment as it is well supported by, and is consistent with, the most probative evidence of record. The most probative evidence of record is silent for a significant permanent threshold shift of his hearing in service. Moreover, the Veteran conceded that he was unsure when his hearing declined, but he does not believe it began in the Navy, and that his tinnitus was not due to the Navy because it started years after his medical discharge. 

As for presumptive service connection based on chronic disease and continuity of symptomatology, the Board finds that the Veteran's period of active duty is not eligible for presumptive service connection based on a chronic disability.

In sum, although the Veteran has established current disabilities, to include bilateral hearing loss and tinnitus, the evidence establishes that his bilateral hearing loss and tinnitus did not manifest during or due to service. 

For these reasons, the claims must be denied. Since the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38U.S.C. §5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1Vet. App.49, 55-57 (1990); 38 C.F.R. §3.102.  

4. Entitlement to service connection for bipolar disorder (also claimed as acquired psychiatric condition) is denied. 

The Veteran was on active duty for less than a month before being medically discharged. During his short period of service, he was found to be suffering from an immature personality disorder. The Veteran contends that he was misdiagnosed in service and that symptoms that manifested in service were early signs of bipolar disorder that was diagnosed many years later. 

Initially, the Board finds that the record indicates an in-service incurrence of a psychiatric disability. See March 1972 Service Treatment Record. Thus, the second element of service connection has been established. 

Additionally, the medical record reveals that the Veteran was diagnosed with bipolar disorder around 1989. Indeed, the agency of original jurisdiction has conceded
 disorder (also claimed as acquired psychiatric condition) is denied. 

The Veteran was on active duty for less than a month before being medically discharged. During his short period of service, he was found to be suffering from an immature personality disorder. The Veteran contends that he was misdiagnosed in service and that symptoms that manifested in service were early signs of bipolar disorder that was diagnosed many years later. 

Initially, the Board finds that the record indicates an in-service incurrence of a psychiatric disability. See March 1972 Service Treatment Record. Thus, the second element of service connection has been established. 

Additionally, the medical record reveals that the Veteran was diagnosed with bipolar disorder around 1989. Indeed, the agency of original jurisdiction has conceded the presence of a current disability, specifically bipolar disorder. See December 2010 VA Examination Report. Therefore, a present disability has been established.  

The Veteran's hearing testimony from March 2012, before a Veterans Law Judge who is not the undersigned, reflects that that he did not seek mental health treatment for many years after separation. The Veteran reported during his June 2024 hearing before the undersigned that he did not seek treatment because he was not told that he could utilize VA treatment service, despite being medically discharged from active duty early. See June 2024 Hearing Transcript page 3. 

The record contains only one competent medical opinion regarding whether symptoms in service characterized at the time as immature personality disorder were early signs of the subsequently diagnosed acquired psychiatric disorder bipolar disorder. In October 2010, the Veteran underwent a VA mental disorders examination for a determination as to whether any extant acquired psychiatric disorder was present in service and whether the symptoms displayed in service were signs of subsequently diagnosed psychiatric disorders. The October 2010 VA examiner reviewed all the pertinent evidence of record in detail and outlined all of the pertinent evidence in an exceptionally thorough report. Pursuant to such review and interview of the Veteran, he concluded that the Veteran's symptoms in service did amount to an immature personality as defined by the psychiatric field at that time (he explained that an immature personality disorder is not a currently available diagnosis pursuant to the more recent versions of the Diagnostic and Statistical Manual) and that the symptoms were not early signs of a subsequently diagnosed psychiatric disorder, to include bipolar disorder. The October 2010 VA examiner provided a comprehensive rationale for that opinion. As such, the Board affords the opinion great probative weight. 

To the extent that the Veteran is still suffering from a personality disorder, service connection for such cannot be granted. 38 C.F.R. § 3.303 (c). The most prevalent post-service psychiatric diagnoses have been of bipolar disorder, which is not a personality disorder, and polysubstance abuse. Service connection for polysubstance abuse likewise is unavailable under most circumstances. 38 U.S.C. § 105; 38 C.F.R. § 3.1(m); 3.301 (c). 

As to bipolar disorder, service connection is not warranted under any potential theory of entitlement. It did not have its onset in service, as evident from the VA examiner's conclusion. Thus, service connection based on an in-service incurrence is precluded. 38 C.F.R. § 3.303 (a). Next, service connection is not warranted presumptively as the Veteran's period of active duty is not eligible for presumptive service connection. 38 C.F.R. §§ 3.307, 3.309(a). Finally, there is no evidence that shows bipolar disorder or any other psychiatric disorder is otherwise related to service, and service connection under 38 C.F.R. § 3.303(d) is precluded. 

The Board is aware that a claim of service connection for a psychiatric disorder is broad and need not encompass solely the diagnosis that is claimed. See Clemons v Shinseki, 23 Vet. App. 1, 5-6 (2009). With the exception of polysubstance abuse, the record primarily reflects diagnosis of bipolar disorder. Schizoaffective disorder was also noted. In any event, with such a broad license in the case of psychiatric disorders, the Board finds no evidence of any such current disability having manifested in service, close in time to service, or that is otherwise related to service.

Finally, as there is not an approximate balance of positive with negative evidence to otherwise warrant a favorable decision, service connection for an acquired psychiatric disorder, to include bipolar disorder, is denied. 

REASONS FOR REMAND

Entitlement to service connection for chondromalacia, right knee, is remanded.

Upon review of the record, the Board finds that a remand is needed to obtain an adequate VA examination and opinion.

Initially, the agency of original jurisdiction has conceded the presence of a current disability, specifically, chondromalacia of the right knee, and in-service complaints of right knee pain
 no evidence of any such current disability having manifested in service, close in time to service, or that is otherwise related to service.

Finally, as there is not an approximate balance of positive with negative evidence to otherwise warrant a favorable decision, service connection for an acquired psychiatric disorder, to include bipolar disorder, is denied. 

REASONS FOR REMAND

Entitlement to service connection for chondromalacia, right knee, is remanded.

Upon review of the record, the Board finds that a remand is needed to obtain an adequate VA examination and opinion.

Initially, the agency of original jurisdiction has conceded the presence of a current disability, specifically, chondromalacia of the right knee, and in-service complaints of right knee pain and swelling which culminated in a medical discharge. Without evidence of clear and unmistakable error to rebut these favorable findings, the first and second elements of service connection have been established. 

 The July 2005 VA medical opinion found that the Veteran's right knee condition was less likely than not related to the condition treated while in military service. The rationale states that there is a lack of treatment records between service and the date of examination, thus indicating that the Veteran went for a long period of time after medical discharge without significant knee difficulties. The Board finds this opinion inadequate as the emphasis on the lack of documented treatment is an inadequate basis. Moreover, this opinion does not consider the Veteran's testimony, provided in June 2024, that he did not seek treatment because he was unaware of the medical treatment available to him by way of VA service. The Veteran testified that it was not until years after his medical discharge that he was informed of the medical services VA could provide, and he immediately sought treatment. See Hearing Transcript page 3. 

Once VA undertakes the effort to provide an examination in connection with a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one, or at minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

Here, as the sole VA opinion of record is inadequate, and the agency of original jurisdiction relied on said inadequate opinion to support denial of service connection, a pre-decisional duty to assist error has been established and remand is warranted. 

The matters are REMANDED for the following action:

1. Obtain an addendum opinion regarding the nature and etiology of the Veteran's right knee disability. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination.

The examiner should provide an opinion with detailed rationale that responds to the following: 

(a)	 Please identify, by diagnosis, all right knee diagnoses present during the appeal period. 

(b)	 For each right knee disability diagnosed, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such disability was either incurred in or otherwise related to the Veteran's military service?  Please explain why.

In providing the above requested opinions, consider the Veteran's STRs showing numerous complaints of right knee pain and swelling. Service Treatment Record March 25, 1972; see also March 27, 1972. Consider also the Veteran's testimony that he did not seek treatment after his medical discharge because he was unaware that he could access VA treatment. 

The examiner is reminded that a lack of diagnosis or treatment in service is an insufficient basis to determine that no nexus exists. 

 The examiner is further reminded that a lack of contemporaneous medical evidence is an insufficient basis to disregard the Veteran's lay contentions.

A complete and detailed rationale must be provided for all opinions expressed.

 

 

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Russell, Tangela

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.