KIDNEY STONES

Summary

The Veteran, a Veteran who served from August 2001 to April 2014, appeals the denial of an increased disability rating for nephrolithiasis (kidney stones). The Veteran sought an increased rating from August 1, 2022, and an earlier effective date. The Veteran's history of kidney stones began during service, with multiple procedures including hospitalizations, lithotripsy, and stent placements occurring over several years. The current claim focuses on the period starting August 1, 2022, when the Veteran experienced increased flank pain, leading to diagnostic imaging revealing kidney stones and mild hydronephrosis. This was followed by multiple stent placements and a lithotripsy within a short period in early 2024. The Board found the September 2024 VA C&P examination unpersuasive due to inconsistencies with treatment records, specifically noting the examiner failed to document a second stent placement and incorrectly stated no history of infection despite a sepsis diagnosis. Based on VA treatment records showing three procedures in early 2024, the Board found the criteria for a 30 percent rating under Diagnostic Code 7508 met, as this exceeds the two procedures per year threshold. The effective date was set to August 1, 2022, based on the increase in flank pain and subsequent stent placement within the one-year look-back period. The Board could not assign a rating higher than 30 percent as it is the maximum schedular rating for this condition.

Rationale

VA examination found unpersuasive due to inconsistencies with treatment records.; Treatment records show three procedures in early 2024, meeting the criteria for 30% rating under DC 7508.; 30% is the maximum schedular rating for nephrolithiasis.

Full Decision Text

Citation Nr: A26034189
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 251118-607264
DATE: April 14, 2026

ORDER

Entitlement to an increased rating of 30 percent, but no higher, from August 1, 2022, for nephrolithiasis (kidney stones) is granted.

FINDING OF FACT

The Veteran's nephrolithiasis (kidney stones) disability manifested by requiring invasive or non-invasive procedures more than two times per year from August 1, 2022.

CONCLUSION OF LAW

The criteria for entitlement to an increased rating of 30 percent, but no higher, from August 1, 2022, for nephrolithiasis (kidney stones) are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115b, Diagnostic Code 7508.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 2001 to April 2014.  The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

The rating decision on appeal was issued in December 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

Although the Veteran initially requested Higher-Level Review when submitting the May 2024 VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. 

In the November 18, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.  Therefore, the Board may only consider the evidence of record at the time of the December 2024 agency of original jurisdiction (AOJ) Supplemental Claim decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182.  38 C.F.R. § 20.303.  If evidence was submitted either (1) during the period after the AOJ issued the Supplemental Claim decision on appeal and prior to receipt of the VA Form 10182, or (2) more than 90 days following receipt of the VA Form 10182, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.303, 20.801.

Entitlement to an increased rating of 30 percent, but no higher, from August 1, 2022, for nephrolithiasis (kidney stones)

In a Supplemental Claim submitted on April 12, 2023, the Veteran sought an increased rating for kidney stones.  The period on review began one year prior to that date.  The Veteran also seeks an earlier effective date prior to September 15, 2024, the date the AOJ increased the rating to 10 percent.

The Veteran's long history of kidney stones began during active service around 2003.  Since then, the Veteran has undergone several procedures related to treatment of the kidney stones.  He had a hospitalization in 2014, a lithotripsy in 2017, and a stent placement in July 2020, which was followed by another lithotripsy.  See C&P Exam, October 17, 2020, and Medical Treatment Record - Non-Government Facility, December 17, 2020.

The Veteran began to experience increasing flank pain on August 1, 2022.  The next day, a trip to the emergency department led to a diagnostic ultrasound that was normal.  Symptoms continued into the next month, when another trip to the emergency department led to a CT scan that revealed kidney stones on each side with mild left hydronephrosis.  The Veteran underwent a stent placement in September, and they were removed the next month.  See CAPRI, December 13, 2024.

Another stent placement procedure took place in mid-January 2024 and was followed by another lithotripsy.  After that stent was removed, another placement was required at the end of January, and the Veteran was diagnosed with pyelonephritis and sepsis.  The latter stent was removed in February.  Id.

The Veteran was afforded a VA examination in connection with this claim.  The examiner noted that the Veteran's flank pain
 to the emergency department led to a CT scan that revealed kidney stones on each side with mild left hydronephrosis.  The Veteran underwent a stent placement in September, and they were removed the next month.  See CAPRI, December 13, 2024.

Another stent placement procedure took place in mid-January 2024 and was followed by another lithotripsy.  After that stent was removed, another placement was required at the end of January, and the Veteran was diagnosed with pyelonephritis and sepsis.  The latter stent was removed in February.  Id.

The Veteran was afforded a VA examination in connection with this claim.  The examiner noted that the Veteran's flank pain is incapacitating during episodes of colic, which occurred occasionally.  The examiner indicated that the Veteran underwent 0 to 1 treatment per year, noting a stent placement and lithotripsy in January 2024.  Finally, the examiner noted that there was no history of infections.  See C&P Exam, September 18, 2024.

Applicable Laws and Regulations

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule).  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

Separate evaluations may be assigned for separate periods of time based on the facts found.  In other words, the evaluations may be "staged." Hart v. Mansfield, 21 Vet. App. 505 (2007) (staged ratings are appropriate when the factual findings show a distinct period where the service-connected disability exhibits symptoms that would warrant different ratings.)  Where the question for consideration is entitlement to a higher initial rating assigned following the grant of service connection, evaluation of the medical evidence since the effective date of the award of service connection is required.  Fenderson v. West, 12 Vet. App. 119, 126 (1999).  Where, as here, entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

Diagnostic Code 7508 directs that nephrolithiasis/ureterolithiasis/nephrocalcinosis is to be rated as hydronephrosis under Diagnostic Code 7509, except for recurrent stone formation requiring invasive or non-invasive procedures more than two times per year.  If evaluated under this code, the rating assigned will be 30 percent.  38 C.F.R. § 4.115b, Diagnostic Code 7508.  This is the only schedular rating available under the diagnostic code.

Under Diagnostic Code 7509, 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.  A 30 percent maximum schedular rating is assigned for frequent attacks of colic with infection (pyonephrosis), kidney function impaired.  The rating criteria directs that severe hydronephrosis is to be rated as renal dysfunction.

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).

The Board has included as the period on appeal the one-year look back period prior to April 12, 2023, and the Board will consider such evidence of record during that one-year period and will determine whether an increased rating is warranted for this time.  Hart v. Nicholson, 21 Vet. App. 505, 509 (2007).

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

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall
 period on appeal the one-year look back period prior to April 12, 2023, and the Board will consider such evidence of record during that one-year period and will determine whether an increased rating is warranted for this time.  Hart v. Nicholson, 21 Vet. App. 505, 509 (2007).

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

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102, 4.3.

Analysis

At the outset, the Board observes that the September 2024 VA examination conflicts with treatment records.  The examiner noted that the Veteran experienced 0 to 1 treatments per year and noted stent placement and lithotripsy on January 26, 2024.  However, the examiner failed to note that the Veteran underwent a second stent placement on January 30.  Further, the examiner indicated that the Veteran had no history of infections, while the Veteran had sepsis, a condition which is triggered by an infection, in early 2024.  Because of these inconsistencies, the Board finds the VA examination to be unpersuasive and affords it little probative weight.

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?

Based on VA treatment records, the Veteran underwent two stent placements and a lithotripsy in the span of 30 days in early 2024.  Diagnostic Code 7508 requires a 30 percent rating when recurrent stone formation requires invasive or non-invasive procedures more than two times per year.  The Veteran's three procedures in early 2024 satisfied this requirement.  Therefore, a 30 percent rating for nephrolithiasis (kidney stones) is warranted.  38 C.F.R. § 4.115b.  Under Diagnostic Code 7508, 30 percent is the highest allowable rating.  The Board cannot assign a rating higher than 30 percent.

When considering the effective date, the Board will apply the one year look-back provision of 38 U.S.C. § 5110(b)(3).  The Veteran reported an increase in flank pain on August 1, 2022.  This led to a stent placement the next month.  This is within the one year look-back provision.  It is factually ascertainable that the Veteran's disability began to increase in severity on August 1, 2022.  Therefore, the effective date for the increase is August 1, 2022.

 

 

J. JACK

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Chris Bumgarner, Associate Counsel

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.