KIDNEY DISEASE OF

B. D. WATSON · 2026 · Case ID: A26033426

MIXED

Summary

The Veteran, a Marine Corps Veteran who served from April 1990 to December 1998, appeals two January 2025 rating decisions concerning increased ratings for nephrolithiasis, atrial fibrillation, and an abdominal scar. The Board reviewed the evidence of record at the time of the rating decisions and evidence submitted with the appeals. For nephrolithiasis, the Veteran sought an increased rating beyond the 10% already awarded. While the Veteran had a history of kidney stones and procedures, the Board found the evidence did not meet the criteria for a 20% or 30% rating, as the condition did not require frequent attacks of colic with infection or impaired kidney function, nor did it necessitate more than one procedure per year. The Board found the VA examiner's measurements more persuasive than the private evaluator's, concluding the scar did not meet the 39 square centimeter threshold for a 10% rating. For atrial fibrillation, the Veteran sought an increased rating beyond the 10% awarded. The VA examiner noted continuous medication use and 1-4 treatment interventions per year, consistent with a 10% rating. The Board found the private evaluator's report, while emphasizing the condition's recurrent nature, did not establish a need for five or more interventions annually. For the abdominal scar, the Board found the VA examiner's measurement of 18 square centimeters more accurate than the private evaluator's approximation, which was insufficient for a compensable rating. The Board denied increased ratings for all three conditions, finding the evidence did not warrant higher evaluations and the benefit-of-the-doubt doctrine was not applicable due to a clear preponderance of evidence against the claims. The case was remanded for new VA examinations concerning chronic adjustment disorder and deep vein thrombosis with pulmonary embolism due to pre-decisional duty to assist errors.

Rationale

Evidence does not demonstrate recurrent stone formation requiring procedures more than two times per year (for 30% rating).; Evidence does not demonstrate frequent attacks of colic requiring catheter drainage (for 20% rating).; Evidence does not show infection or impaired kidney function (for 30% rating).

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250222-526273

Full Decision Text

Citation Nr: A26033426
Decision Date: 04/10/26 Archive Date: 04/10/26

DOCKET NO. 250222-526273
DATE: April 10, 2026

ORDER

Entitlement to a rating in excess of 10 percent for nephrolithiasis is denied.

Entitlement to a rating in excess of 10 percent for atrial fibrillation is denied.

Entitlement to a compensable rating for an abdominal scar is denied.

REMANDED

Entitlement to service connection for chronic adjustment disorder is remanded.

Entitlement to a compensable rating for deep vein thrombosis with pulmonary embolism is remanded.

FINDINGS OF FACT

1. The Veteran's nephrolithiasis condition results in only occasional attacks of colic, not infected, and does not require catheter drainage or result in impairment of kidney function.

2. The Veteran's atrial fibrillation does not require five or more treatment interventions per year.

3. The Veteran's abdominal scar is a scar of the trunk with underlying soft tissue damage, is not painful or unstable, and does not measure at least 39 square centimeters.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating in excess of 10 percent for nephrolithiasis have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.115b, Diagnostic Codes 7508, 7509.

2. The criteria for entitlement to a rating in excess of 10 percent for atrial fibrillation have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.104, Diagnostic Code 7010.

3. The criteria for entitlement to a compensable rating for an abdominal scar have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.118, Diagnostic Codes 7800 - 7805.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from April 1990 to December 1998.

This case comes on appeal of two January 2025 rating decisions by the agency of original jurisdiction (AOJ). In February 2025, the Veteran submitted a VA Form 10182 in response to each of those rating decisions, individually. As the Veteran submitted the forms on the same day and elected to have both appeals adjudicated under the Evidence Submission docket, the two appeals were docketed together at the Board.

Based on the procedural history here, the Board may consider the evidence that was of record at the time of the respective rating decisions. The Board may also consider the evidence that was submitted along with the VA Form 10182, as well as any evidence submitted within the 90-day period following those submissions. The Board may not consider evidence outside of these prescribed evidentiary windows, but may consider argument raised at any time.

Increased Ratings

Disability evaluations are determined by the application of the facts presented to the VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet.
. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. (1999); Hart v. Mansfield, 21 Vet. App. (2007).

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disabilities. 38 C.F.R. § 4.14.

Generally, separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). The Court has also held that within a particular diagnostic code, a claimant is not entitled to more than one disability rating for a single disability unless the regulation expressly provides otherwise. Cullen v. Shinseki, 24 Vet. App. 74 (2010).

1. Entitlement to a rating in excess of 10 percent for nephrolithiasis

The Veteran filed a claim for an increased rating for nephrolithiasis in August 2024 and is rated at 10 percent for this disability throughout the period on appeal.

The rating schedule contemplates nephrolithiasis under 38 C.F.R. § 4.115b, Diagnostic Code 7508. However, Diagnostic Code 7508 instructs the evaluator to rate the condition as hydronephrosis, except for recurrent stone formation requiring invasive or non-invasive procedures more than two times per year. That scenario warrants a rating of 30 percent.

Diagnostic Code 7509 contemplates hydronephrosis. A condition with only an occasional attack of colic, not infected, and not requiring catheter drainage warrants a 10 percent rating.

A condition with frequent attacks of colic, requiring catheter drainage, warrants a 20 percent rating.

A condition with frequent attacks of colic, with infection-referred to as pyonephrosis-and impaired kidney function warrants a 30 percent rating.

A condition that is deemed severe is to be rated as renal dysfunction.

Following his claim, the Veteran underwent a VA examination in September 2024. The examiner noted that the Veteran had first episodes of a kidney stone in 2012 and had a right nephrostomy for kidney stone removal in 2023. At the time of the examination, the Veteran continued to have a 14 millimeter stone in the right kidney that was non-obstructing. He also had a history of lithotripsy procedures in 2020 and 2021. The Veteran was still seeing blood in the urine.

The examiner reported that the Veteran was not taking medication for the condition. He did not require regular dialysis and had not had cystic, obstructive, or glomerular structural abnormalities for at least three consecutive months over the prior year.

There was no renal tubular disorder and no signs or symptoms of hydronephrosis due to obstruction, other than urinary tract urolithiasis. The Veteran had occasional attacks of renal colic, but stone formation did not cause stricture of the ureter and there was no history of recurrent symptomatic urinary tract or kidney infections. The Veteran's invasive or non-invasive treatments for recurrent stone formation numbered between zero and one times per year.

The Veteran also submitted a report from A.N., a private evaluator. According to A.N., the Veteran reported suffering kidney stones on a regular basis, having passed multiple stones since service connection. A.N. stated the Veteran reported multiple ureteroscopy laser lithotripsies from 2020 through 2022, through VA, and in 2023 underwent percutaneous nephrolithotomy. A.N. further relayed the Veteran's report that he had undergone a routine CT scan in June 202
icture of the ureter and there was no history of recurrent symptomatic urinary tract or kidney infections. The Veteran's invasive or non-invasive treatments for recurrent stone formation numbered between zero and one times per year.

The Veteran also submitted a report from A.N., a private evaluator. According to A.N., the Veteran reported suffering kidney stones on a regular basis, having passed multiple stones since service connection. A.N. stated the Veteran reported multiple ureteroscopy laser lithotripsies from 2020 through 2022, through VA, and in 2023 underwent percutaneous nephrolithotomy. A.N. further relayed the Veteran's report that he had undergone a routine CT scan in June 2024 which showed multiple stones at that time and that the Veteran was awaiting a follow-up appointment to determine if further surgical intervention was necessary.

Other treatment records in evidence document the Veteran's history of problems with kidney stones, but do not speak to the information relevant to the rating criteria.

Based on this, the evidence of record persuasively favors a finding that a rating in excess of 10 percent is not warranted throughout the period on appeal.

As was discussed above, a 30 percent rating under Diagnostic Code 7508-the only rating available under that Diagnostic Code-requires recurrent stone formation requiring invasive or non-invasive procedures more than two times per year. Here, the evidence does not demonstrate that the Veteran's condition has required corrective procedures more than two times per year. At most, the Veteran has required corrective procedures once per year. Therefore, a 30 percent rating under Diagnostic Code 7508 is not warranted.

To warrant a 20 percent rating under Diagnostic Code 7509, the Veteran's condition must present with frequent attacks of colic, requiring catheter drainage. Here, the Veteran's condition presents with only occasional attacks of colic and has never been shown to require catheter drainage.

The criteria for a 30 percent rating is successive to the 20 percent rating, requiring frequent attacks of colic, but with infection, as well as impaired kidney function. Not only does the evidence not demonstrate frequent attacks of colic, it does not show infection or impaired kidney function.

The Board acknowledges that A.N.'s report describes the Veteran's kidney condition in more drastic sounding language than that of the VA examiner; however, the facts are relatively the same across reports. The Veteran's interventions for his condition-mostly occurring prior to the period on appeal-occurred, at most, once per year. Further, there is no evidence that the kidney stones A.N. reported the Veteran as having at the time of evaluation required additional intervention.

Thus, there is no basis for entitlement to a rating in excess of 10 percent for the Veteran's nephrolithiasis. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an increased rating for the Veteran's nephrolithiasis is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

2. Entitlement to a rating in excess of 10 percent for atrial fibrillation

The Veteran filed a claim for an increased rating for atrial fibrillation in August 2024 and is rated at 10 percent for this disability throughout the period on appeal.

The rating schedule contemplates atrial fibrillation under 38 C.F.R. § 4.104, Diagnostic Code 7010, which is the Diagnostic Code for supraventricular tachycardia. Note (1) to Diagnostic Code 7010 explains that "Examples of supraventricular tachycardia include, but are not limited to: Atrial fibrillation..." Thus, atrial fibrillation is explicitly contemplated by this Diagnostic Code.

Under Diagnostic Code 7010, a 10 percent rating is warranted for supraventricular tachycardia, confirmed by echocardiogram (ECG), with one to four treatment interventions per year; or, with either continuous use of oral medications or use of vagal maneuvers to control the condition.

A 30 percent rating is warranted for supraventricular tachycardia, confirmed by ECG, with five or more treatment interventions per year.

Note (2) to Diagnostic Code 7010 clarified that a treatment intervention occurs whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.

After filing this claim, the Veteran underwent a VA heart conditions examination in September 2024. At that time, the examiner noted the Veteran's need for continuous medication to control his heart
echocardiogram (ECG), with one to four treatment interventions per year; or, with either continuous use of oral medications or use of vagal maneuvers to control the condition.

A 30 percent rating is warranted for supraventricular tachycardia, confirmed by ECG, with five or more treatment interventions per year.

The examiner reported that the Veteran's supraventricular tachycardia had been documented by ECG and had required cardioversion between one and four times per year.

The Veteran also submitted a July 2024 report from A.N. A.N. reported that there were "multiple occasions in which" the Veteran had gone into tachycardia and that the Veteran reported two specific severe episodes in 2020 and 2022 which led him to the emergency room, where he was kept until he could return to a normal heart rhythm. The Veteran also described private cardiology treatment in 2023. A.N. noted that this was a condition that required life-long medication and monitoring.

Additional treatment records do not offer relevant information regarding the evaluation of the severity of the Veteran's disability.

Based on the above, the evidence of record persuasively favors a finding that the Veteran's atrial fibrillation disability does not warrant a rating in excess of 10 percent.

As was discussed above, to warrant a rating of 30 percent, the condition must require five or more treatment interventions per year. In this case, the Veteran's disability has not required more than four treatment interventions per year with continuous use of oral medications. This level of severity is fully contemplated by a 10 percent rating.

Although A.N.'s report emphasized the recurrent and permanent nature of the Veteran's condition, it did not describe a disability picture that is contemplated by anything other than a 10 percent rating. Indeed, notwithstanding the fact that A.N.'s report primarily pertains to the history of the Veteran's condition prior to the period on appeal, it does not show more than one treatment intervention per year.

Thus, there is no basis for a rating in excess of 10 percent. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an increased rating for atrial fibrillation is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

3. Entitlement to a compensable rating for an abdominal scar

The Veteran filed a claim for an increased rating for an abdominal scar in August 2024 and is rated at 0 percent for this disability throughout the period on appeal.

Scars are rated under Diagnostic Codes 7800 - 7805 within 38 C.F.R. § 4.118. Pursuant to the rating schedule, Diagnostic Code 7800 rates scars of the head, face, and neck.

Diagnostic Code 7801 rates scars not of the head, face, or neck, that are associated with underlying soft tissue damage.

Diagnostic Code 7802 rates scars not of the head, face, or neck, that are not associated with underlying soft tissue damage.

Diagnostic Code 7804 rates scars that are unstable or painful.

Diagnostic Code 7805 rates scars that are not covered under any of the previous Diagnostic Codes, with the instruction to evaluate any other disabling effects under an appropriate Diagnostic Code.

Essentially this means that scars are evaluated based on their location, their depth, their linear or nonlinear qualities, their stability, and their pain, as well as any other effects they may cause.

After filing his claim, the Veteran underwent a VA examination in September 2024. The examiner observed a right lower abdominal scar for ileocecal resection for Crohn's disease. The examiner noted that the scar occurred on the Veteran's trunk, with no scar on the head, face, or neck. Further, the trunk scar was not painful, not unstable with frequent loss of covering of skin over the scar, or due to burns. The examiner measure the scar at 18 centimeters by 1 centimeter and documented underling soft tissue damage.

The Veteran also submitted a report from A.N. regarding the scar. According to A.N., the Veteran
, as well as any other effects they may cause.

The Veteran also submitted a report from A.N. regarding the scar. According to A.N., the Veteran "suffers from an approximate 10[-inch] long scar which is keloid in nature" and "Itchiness of the scar persists."

There is no other relevant evidence specifically related to the Veteran's abdominal scar during the period on appeal.

Here, noting that the Veteran's scar is not of the head or neck, Diagnostic Code 7800 does not apply. As the scar is associated with underlying soft tissue damage, Diagnostic Code 7801 may apply and Diagnostic Code 7802 does not apply. As the scar is not painful, Diagnostic Code 7804 does not apply. As there are no other disabling effects that are not evaluated under Diagnostic Codes 7800 - 7804, Diagnostic Code 7805 does not apply.

Under Diagnostic Code 7801, to warrant a 10 percent rating, a scar must cover an area of at least 39 square centimeters. In this case, the measurements of the Veteran's abdominal scar differ between A.N.'s report and the VA examiner's report. Notably, A.N.'s measurement appears to be only an approximation and not an exact measurement. Thus, the Board finds the measurement of 18 centimeters by 1 centimeter to be more persuasive in its accuracy. This measurement equates to 18 square centimeters, which falls short of the requirement for a 10 percent rating.

Even accepting as true that the Veteran's scar measures 10 inches in length, this would equate to approximately 25.4 square centimeters, which remains noncompensable under Diagnostic Code 7801.

The Veteran's scar is not ratable under any other Diagnostic Code. Accordingly, the evidence persuasively favors a finding that the Veteran's abdominal scar does not warrant a compensable rating. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and an increased rating for the Veteran's abdominal scar is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021).

REASONS FOR REMAND

1. Entitlement to service connection for chronic adjustment disorder is remanded.

Remand is necessary to correct a pre-decisional duty to assist error.

Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). An adequate medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).

Further, when adjudicating a claim, VA must address all reasonably raised theories of entitlement. Robinson v. Peake, 21 Vet. App. 545, 552 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009).

Here, the Veteran has presented multiple theories of entitlement regarding his diagnosed chronic adjustment disorder. First, the Veteran has stated that the sudden change in direction of his life at the time of his discharge from service, as well as his diagnosis with Crohn's disease, created a significant amount of distress leading to his mental disorder. The Veteran has also attributed his chronic adjustment disorder to his physical service-connected disabilities. The Veteran has specifically identified the steroids taken for treatment of his Crohn's disease as exacerbating his irritability and anger.

The Veteran underwent a VA examination in September 2024. At that time, the examiner opined that it was less likely than not that the Veteran's mental disorder was caused by or incurred in service. However, as rationale, the examiner only stated that there was a lack of evidence of symptoms
the Veteran has stated that the sudden change in direction of his life at the time of his discharge from service, as well as his diagnosis with Crohn's disease, created a significant amount of distress leading to his mental disorder. The Veteran has also attributed his chronic adjustment disorder to his physical service-connected disabilities. The Veteran has specifically identified the steroids taken for treatment of his Crohn's disease as exacerbating his irritability and anger.

This statement does not represent medical rationale, as it is simply a recitation of evidence readily observable to any layperson. There is no explanation as to how such evidence informed the examiner's opinion. Further, the matter at issue is not just whether the Veteran's mental disorder had its onset during service, but whether it was caused by service.

In this case, the Veteran has also reasonably raised the issue of secondary service connection. Thus, an adequate examination must also address whether the Veteran's mental disorder was caused or aggravated by his service-connected disabilities, to include the medication taken to treat those disabilities.

Thus, on remand, a new examination, with an adequate medical opinion, is needed.

2. Entitlement to a compensable rating for deep vein thrombosis with pulmonary embolism is remanded.

VA regulations do not allow VA to consider the ameliorative effects of medications when evaluating the severity of a disability, unless?those effects are contemplated in the relevant Diagnostic Codes.? See?Jones v. Shinseki,?26?Vet. App.?56, 63?(2012).?

Here, the evidence demonstrates that the Veteran requires regular medication for the treatment of his deep vein thrombosis.

The Veteran underwent a VA examination to address the severity of his deep vein thrombosis in January 2025. However, there is no indication that the VA examiner discounted the ameliorative effects of the Veteran's medications in assessing the severity of the Veteran's disability.

Accordingly, on remand, the AOJ should correct the pre-decisional duty to assist error by affording the Veteran an adequate VA examination to evaluate his deep vein thrombosis disability. This examination should include an opinion as to how severe the Veteran's disability would be when?medication treatment is discounted.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA mental disorders examination. The examiner should review the entire claims file, to include a copy of this Remand, and the report of examination should include discussion of the Veteran's documented history and assertions. All indicated tests and studies should be accomplished and all clinical findings should be reported in detail.

The examiner should clearly identify all current acquired psychiatric disorders. Then, with respect to each such diagnosed disability, the examiner should render an opinion, as to whether it is at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the disability had onset in, or is otherwise related to service. In doing so, the examiner should specifically address the Veteran's contentions that the sudden nature of his discharge, his Crohn's disease diagnosis, and his adjustment to post-military life contributed to his mental health condition.

The examiner should also render an opinion as to whether it is at least as likely as not that the disability was caused or aggravated by a service-connected disability, to include Crohn's disease and the medications taken to treat Crohn's disease.

The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion.

2. Schedule the Veteran for an examination of the current severity of his deep vein thrombosis disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

The examiner's evaluation of the Veteran's disability should include an opinion as to the effects of the disability when the?ameliorative effects?of medication are disregarded.? In other words, if the Veteran were not taking medications to treat his deep vein thrombosis disability, is it at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the disability would result in additional symptoms, as contemplated by the rating criteria listed in the disability benefits questionnaire?

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A complete rationale must be given for all
disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

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A complete rationale must be given for all opinions and conclusions expressed. If it is not possible to provide a description of the disability's severity when discounting the ameliorative effects of medication without resorting to mere speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required, with an explanation as to what those facts are), or the examiner (does not have the knowledge or training).

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Giaquinto

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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