NEPHROLITHIASIS

Summary

The Veteran, who served from June 1967 to May 1969, appeals the denial of service connection for a kidney stone disability. The Veteran contends the condition is due to Agent Orange exposure during service in Vietnam or is secondary to his service-connected PTSD and prostate cancer. The Board found that the July 2025 rating decision made favorable findings regarding the Veteran's kidney stone diagnosis and conceded toxic exposure risk activity (TERA) involving herbicide agents. A November 2024 VA examination report provided a favorable nexus opinion, stating the kidney stone disability was at least as likely as not caused by Agent Orange exposure, citing the association between dioxin exposure, oxidative stress, and kidney stone formation. The Board assigned substantial probative weight to this opinion. A subsequent April 2025 VA clinician review was deemed inadequate as it relied on general principles and failed to address the Veteran's specific circumstances, thus receiving no weight. A December 2025 statement from the Veteran's treating physician was also found inadequate for lacking a nexus opinion. Given the probative VA opinion and resolving all doubt in the Veteran's favor, service connection for kidney stones was granted.

Rationale

Favorable VA examination opinion linking kidney stones to Agent Orange exposure.; Agent Orange exposure associated with metabolic and renal disturbances.; Resolving doubt in Veteran's favor.

Full Decision Text

Citation Nr: A26025605
Decision Date: 03/23/26	Archive Date: 03/23/26

DOCKET NO. 250731-572109
DATE: March 23, 2026

ORDER

Service connection for a kidney stone disability is granted.

FINDING OF FACT

The evidence is at least in approximate balance as to whether the Veteran's kidney stone disability is at least as likely as not related to his service.

CONCLUSION OF LAW

The criteria for service connection for a kidney stone disability are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from June 1967 to May 1969.

The rating decision on appeal was issued in May 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the July 2025 VA Form 10182, Decision Review Request:  Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On November 5, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the May 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or the Veteran's representative within 90 days following receipt of the request to withdraw the hearing.  38 C.F.R. § 20.302(b).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Establishing entitlement to direct service connection generally 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 - which is the so-called "nexus" requirement.  Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection for a kidney stone disability is granted.

The Veteran contends that he has a kidney stone disability due to his service.  He reports that he remembers being sprayed with Agent Orange during his time in Vietnam.  See November 2024 VA Examination Report.  Alternatively, the Veteran contends that his kidney stone disability is due secondarily to his service-connected posttraumatic stress disorder or service-connected prostate cancer.  See November 2025 Representative Correspondence.

The May 2025 rating decision made favorable findings that the Veteran was diagnosed with a kidney stone disability and that participation in a toxic exposure risk activity (TERA) involving exposure to herbicide agents (agent orange) is conceded.  The Board is bound by these favorable findings.  38 C.F.R. § 3.104.

The Veteran was provided with a VA examination in November 2024.  The VA examiner opined that the Veteran's kidney stone disability was at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) 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 of the Veteran.  The VA examiner rationalized that exposure to dioxin, the toxic component in Agent Orange, has been associated with an increased risk of metabolic and renal disturbances that could lead to kidney stone formation, particularly in individuals with pre-existing conditions such as cancer and prostate issues.  The VA examiner noted that the route of exposure of Agent Orange was inhalation and dermal and personal protective equipment was not used.  Agent Orange contains dioxins, known to cause oxidative stress and inflammation, both of which can contribute to kidney dysfunction.  The VA examiner further noted that studies suggest that oxidative stress can increase the likelihood of calcium buildup and crystal formation in the kidneys, predisposing individuals to kidney stones.  The VA examiner concluded by rationalizing that given the correlation between Agent Orange exposure, oxidative stress, and kidney stone formation, it
 component in Agent Orange, has been associated with an increased risk of metabolic and renal disturbances that could lead to kidney stone formation, particularly in individuals with pre-existing conditions such as cancer and prostate issues.  The VA examiner noted that the route of exposure of Agent Orange was inhalation and dermal and personal protective equipment was not used.  Agent Orange contains dioxins, known to cause oxidative stress and inflammation, both of which can contribute to kidney dysfunction.  The VA examiner further noted that studies suggest that oxidative stress can increase the likelihood of calcium buildup and crystal formation in the kidneys, predisposing individuals to kidney stones.  The VA examiner concluded by rationalizing that given the correlation between Agent Orange exposure, oxidative stress, and kidney stone formation, it is at least as likely as not that the Veteran's kidney stones are linked to his exposure to Agent Orange during service.  The exposure to toxins, combined with his medical history and documented urinary issues post-prostate cancer treatment, supports a likely association.  The opinion has a clear conclusion and rationale based on the provider's examination of the Veteran and his medical history and serves to link the claimed kidney stone disability to the Veteran's TERA.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Therefore, the Board assigns this opinion substantial probative weight.

In April 2025, a VA clinician reviewed the Veteran's claims file and opined that the claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) 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 of the Veteran.  The VA clinician rationalized that the Veteran's medical history indicates other potential risk factors such as dietary factors, fluid intake, and metabolic disorders; the VA clinician continues after each listed risk factor to note that the risk factor is not specified in the Veteran's medical records.  This opinion is inadequate, as the VA clinician's opinion is based on general principles, not on the facts relating to the Veteran's individual circumstances.  See Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018) (holding that a medical opinion was inadequate as a matter of law because the rationale was based solely on general articles and did not discuss any facts pertaining to a veteran's condition or individual circumstances).  Therefore, this opinion is entitled to no weight of probative value.

The Board notes that in December 2025, the Veteran submitted a statement from his treating physician noting his diagnoses.  To the extent that the statement is presented as a private nexus opinion, this opinion is inadequate as it fails to include a nexus opinion linking the Veteran's active-duty service to his kidney stone disability, and thus, the opinion is entitled to no weight of probative value.  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).

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While the Board recognizes the Veteran's general contention that he has a kidney stone disability secondary to his service-connected posttraumatic stress disorder and service-connected prostate cancer, a secondary service connection analysis is unnecessary in light of the conclusion herein.

Accordingly, as the November 2024 opinion is the most probative opinion evidence of record and relates the Veteran's kidney stone disability to his service, the Board resolves all doubt in the Veteran's favor and finds that service connection for a kidney stone disability is warranted.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  His appeal is granted.

 

 

M. SORISIO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Knerr

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.