Case A26037393

A. ODYA-WEIS · 2026 · Case ID: A26037393

DENIED

Summary

The veteran, who served from July 2004 to July 2024, appeals the denial of a compensable rating for chronic kidney disease, specifically autosomal dominant polycystic kidney disease (ADPKD). Service connection for cystic kidney disease was previously granted with a noncompensable rating. The veteran sought an increased rating, asserting her chronic kidney disease was more severe than initially rated. The Board reviewed VA examinations from May 2024, January 2025, and April 2025, along with a May 2025 private treatment record. These examinations consistently showed a GFR of 71-73 mL/min/1.73 m2 and noted the absence of specific markers like RBC casts or an albumin/creatinine ratio of 30 mg/g for at least three consecutive months. The Board noted the veteran's use of Jynarque medication for treatment and discussed the legal precedent regarding discounting the ameliorative effects of medication. However, the Board found that obtaining a non-speculative opinion on the medication's impact would be unlikely and would further delay adjudication. Consequently, the Board denied entitlement to a compensable rating, as the veteran's condition did not meet the criteria for a 30 percent rating or higher, specifically lacking evidence of GFR between 45-59 mL/min/1.73 m2 for the required duration.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250929-598332

Full Decision Text

Citation Nr: A26037393
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 250929-598332
DATE: April 22, 2026

ORDER

Entitlement to a compensable rating for chronic kidney disease, to include autosomal dominant polycystic kidney disease (ADPKD), is denied.

FINDING OF FACT

Throughout the period on appeal, the Veteran's chronic kidney disease, to include ADPKD, has not manifested as GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months.

CONCLUSION OF LAW

The criteria for a compensable rating for chronic kidney disease, to include ADPKD, have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1 - 4.7, 4.115b, Diagnostic Code 7530.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 2004 to July 2024.

In the September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket for Board review of an April 2025 adjudication of the evaluation for cystic kidney disease. Initially, the Board notes that an April 2025 rating decision continued the noncompensable evaluation for cystic kidney disease; however, that rating decision was subject to a valid supplemental claim and readjudicated in a May 2025 rating decision, which then received a Higher Level Review (HLR) from a June 2025 VA Form 20-0996 in an August 2025 HLR rating decision. That August 2025 rating decision continued the denial of a compensable rating for the Veteran's chronic kidney disease disability.

The Board may construe argument liberally to determine whether such raises issues on appeal and finds the request to review the evaluation for cystic kidney disease can be construed as a dispute on the August 2025 HLR rating decision, which is a valid request to review this claim that has been continuously pursued since the noted April 2025 decision. See 38 C.F.R. § 20.202(a). As the Veteran has elected the Direct Review Docket, the Board may consider evidence of record at the time of the May 2025 rating decision underlying the August 2025 HLR rating decision. 38 C.F.R. § 20.303.

If evidence was submitted either (1) during the period after the AOJ issued the decision that was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board observes that the Veteran requested Board review of additional issues in the September 2025 VA Form 10182 but concludes that none of the other requests are properly before the Board at this time and will not be discussed in this decision.

For the issues of entitlement to increased ratings for service-connected major depressive disorder, left elbow disability, and left ulnar neuropathy, the request to review is not timely. These issues were last adjudicated in an August 2024 rating decision. As such decision was issued over a year previously and no good cause motion has been provided, the issues will not be reviewed by the Board. 38 C.F.R. §§ 20.202, 20.203.

For the issues of entitlement to increased ratings for service-connected gastroesophageal reflux disease (GERD), migraines, and bilateral restless leg syndrome, the Board cannot review the claims because the Board review is precluded by a valid concurrent election of HLR review. The Veteran filed a VA Form 20-0996 in August 2025 electing HLR of an August 2025 rating decision on those issues; which was valid and pending at the time the VA Form 10182 was received. See 38 C.F.R. § 3.2500(b) (a claimant who has filed for a supplemental claim, HLR, or Board review may not, while that review is pending final adjudication, file for review under a different available option); see also 38 C.F.R. § 3.2500(e) (a claimant may change the review option selected by withdrawing the request and filing the appropriate application for the requested review option within one year from the date on which VA issued notice of a decision on an issue). As no request to withdraw the HLR is of record; rather, the issues were adjudicated in a later HLR rating decision, the Board cannot review these claims and they are not on appeal. See December 2025 HLR Rating Decision.

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Board should consider only those factors contained in the rating criteria. Massey v. Brown, 7 Vet. App. 204 (1994). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Entitlement to a compensable rating for chronic kidney disease, to include ADPKD, is denied.

The Veteran asserts that her chronic kidney disease is more severe than the noncompensable rating assigned.

By way of history, service connection for cystic kidney disease was granted in an August 2024 rating decision. The AOJ assigned an initial noncompensable rating under 38 C.F.R. § 4.115b, Diagnostic Code (DC) 7533, effective from August 1, 2024. DC 7533, states that cystic diseases are to be assigned a rating based on renal dysfunction.

A later May 2025 rating decision continued the Veteran's noncompensable evaluation, noting that an April 2025 VA examiner found that the previous diagnosis of cystic kidney disease was better described as ADPKD and was now a progression to chronic kidney disease, to include ADKPD. The Veteran's noncompensable rating was assigned under DC 7530, effective April 16, 2025. DC 7530 states that chronic renal disease is to be assigned a rating based on renal dysfunction.

The Veteran's chronic kidney disease disability is a genitourinary disorder rated under the Schedule of Rating Disabilities pursuant to 38 C.F.R. § 4.1115a. Under this schedule, the Veteran's service-connected chronic kidney disease disability is a genitourinary disorder.

Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. 38 C.F.R. § 4.115a. Rating Schedule provides descriptions of various levels of disability in each of these symptom areas (renal and voiding dysfunctions). 38 C.F.R. § 4.115a. 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. 38 C.F.R. § 4.115a.

Under 38 C.F.R. § 4.115a renal dysfunction,
disability is a genitourinary disorder.

Under 38 C.F.R. § 4.115a renal dysfunction, a noncompensable rating 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 3 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 3 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 3 consecutive months during the past 12 months. Id.

A 30 percent rating is assigned for chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. Id.

A 60 percent rating is assigned for chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. Id.

An 80 percent rating is assigned for chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. Id.

A 100 percent rating is assigned chronic kidney disease with GFR less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient. Id.

A note after the regulations states that 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.

During a May 2024 VA examination, the Veteran was diagnosed with cystic kidney disease. She reported mid to lower back pain, chronic fatigue, and constant urination. She had to have the bathroom close by, could not work in the heat, and had to take leave because pain was too bad. She treated her condition with medication, namely Jynarque (tolvaptan). Renal dysfunction was not present. The VA examiner noted that the Veteran had not had an albumin/creatinine ratio greater than or equal to 30mg/g, RBC casts, WBC casts, or hyaline casts present for at least 3 consecutive months in the past 12 months. Labs performed at the May 2024 examination revealed a GFR of 73.

During a January 2025 VA examination, the Veteran was diagnosed with cystic kidney disease. She reported having lower back and flank pain/discomfort, fatigue and persistent urination. She treated her condition with medication, namely Jynarque. The Veteran reported no loss of work as she was currently in college for nursing. She had pain periodically, medication dehydration, sleep affected by medication, and having to wake and urinate constantly. Renal dysfunction was not present. The VA examiner noted that the Veteran had not had an albumin/creatinine ratio greater than or equal to 30mg/g, RBC casts, WBC casts, or hyaline casts present for at least 3 consecutive months in the past 12 months. The VA examiner noted that labs performed at the January 2025 examination revealed a GFR of 71.

At an April 2025 VA examination, the Veteran was diagnosed with chronic kidney disease and autosomal dominant polycystic kidney disease. She reported having lower back and flank pain/discomfort, fatigue and persistent urination. She treated her condition with medication, namely Jynarque. The Veteran reported no loss of work as she was currently in college for nursing. She had pain periodically, medication dehydration, sleep affected by medication, and having to wake and urinate constantly. The examiner noted the Veteran had renal dysfunction. She did not require regular dialysis. The examiner indicated that the Veteran had cystic structural kidney abnormality for at least 3 consecutive months during the past 12 months. She had not had an albumin/creatinine ratio greater than or equal to 30mg/g, RBC casts, WBC casts, or hyaline casts present for at least 3 consecutive months in the past 12 months. The VA examiner cited to the most recent labs performed at the January 2025 examination, which revealed a GFR of 71.

A May 2025 private treatment record reflects an eGFR of 73.

Upon careful review, the evidence does not show that the Veteran's disability meets the criteria for a compensable evaluation of 30 percent as there is no evidence that she has had GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. Accordingly, the criteria for a compensable rating for chronic kidney disease to include ADPKD are not met.

In making the above findings, the Board is cognizant of the fact that the Veteran has used medication, including Jynarque, to treat her disability. The Court has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56 (2012). More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities." Ingram v. Collins, 38 Vet. App. 130 (2025).

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The Board notes, however, that neither Jones nor Ingram address how the Board is to discount the beneficial effects of medication without resorting to speculation. Remanding this appeal to order an addendum medical opinion based on Jones and Ingram would almost certainly require an examiner to engage in medical speculation and would result in a medical opinion that lacks the degree of certainty to ascertain, even under the benefit-of-the-doubt standard, the impact of the ameliorative effects of medication on the severity of a veteran's service-connected condition. See, e.g., Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2005) (medical opinions that are speculative have "little probative value"). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's chronic kidney disease disability would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication.

Entitlement to a compensable rating for chronic kidney disease, to include ADPKD, is denied.

A. Odya-Weis

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Griffith, S.

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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