KIDNEY DISEASE OF

Summary

The Veteran, a Veteran who served from July 1985 to July 1989, including service at Camp Lejeune, appeals the denial of service connection for end stage renal disease (IgA nephropathy), status post kidney transplant. The Veteran claims this condition is related to exposure to contaminated water at Camp Lejeune. The Board found that the Veteran served at Camp Lejeune for at least 30 consecutive days, establishing exposure to contaminated water. The primary evidence considered was a May 2023 private medical opinion from Dr. S.R.B., which concluded it was at least as likely as not that the Veteran's IgA nephropathy was associated with Camp Lejeune contaminants, citing benzene as a contributing factor to autoimmune diseases. While VA provided multiple opinions, the Board found them conclusory and less probative than Dr. S.R.B.'s opinion. The Board determined the evidence was in equipoise regarding the nexus between the Veteran's condition and Camp Lejeune exposure. Applying the benefit of the doubt doctrine, the Board granted service connection for end stage renal disease (IgA nephropathy), status post kidney transplant.

Rationale

Veteran served at Camp Lejeune for at least 30 consecutive days, establishing exposure to contaminated water.; Private medical opinion from Dr. S.R.B. found it at least as likely as not that the condition is associated with Camp Lejeune contaminants.; Evidence was in equipoise; benefit of the doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26039346
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 260128-634167
DATE: April 28, 2026

ORDER

Entitlement to service connection for end stage renal disease (IgA nephropathy), status post kidney transplant, is granted.

FINDINGS OF FACT

1. The Veteran had at least 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987.

2. The evidence of record is at least in relative equipoise as to whether the Veteran's end stage renal disease (IgA nephropathy), status post kidney transplant, is related to his in-service exposure to contaminated water at Camp Lejeune.

CONCLUSION OF LAW

The criteria for service connection for end stage renal disease (IgA nephropathy), status post kidney transplant, are met. 38 U.S.C. §§ 1110, 1710, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty from July 1985 to July 1989.

In May 2023, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of his claim for service connection for end stage renal disease, most recently addressed in a March 2023 Board decision.  In April 2024, the agency of original jurisdiction (AOJ) issued the supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  

In October 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the April 2024 decision.  Later that month, 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 February 2025, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  

In the January 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the February 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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. 

Service Connection

The Veteran asserts that service connection is warranted for end stage renal disease (IgA nephropathy), status post kidney transplant.  Specifically, he claims that his end stage renal disease (IgA nephropathy), status post kidney transplant, is related to his exposure to the contaminated water while serving at Camp Lejeune.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge,  when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1112; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

In 
 for any disease diagnosed after discharge,  when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. 38 U.S.C. § 1112; 38 C.F.R. § 3.304. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

In 2012, Congress enacted legislation authorizing VA to provide medical services for 15 specific illnesses, including renal toxicity, to certain veterans as well as their eligible family members, who were stationed at Camp Lejeune from January 1, 1957, to December 31, 1987. See Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, § 102, Pub. L. 112-154, 126 Stat. 1165 (2012) (codified at 38 U.S.C. § 1710).  For a Camp Lejeune veteran, VA will assume that a "covered illness or condition" listed above is attributable to the veteran's active duty service at Camp Lejeune unless it is clinically determined, under VA clinical practice guidelines, that such an illness or condition resulted from a cause other than such service. 38 C.F.R. § 17.400(c).

Effective March 14, 2017, 38 C.F.R. §§ 3.307 and 3.309 were amended to add eight diseases found to be associated with contaminants present in the water supply at Camp Lejeune.  As amended, 38 C.F.R. §§ 3.307 and 3.309 establish presumptive service connection for veterans who served at Camp Lejeune for no less than 30 days from August 1, 1953, to December 31, 1987, and who have been diagnosed with certain diseases. 38 C.F.R. § 3.309(f).  The Board notes that end stage renal disease (IgA nephropathy) is not listed as a disease presumptively related to contaminated water exposure under 38 C.F.R. § 3.309(f).

Nevertheless, a nexus between the disease and service may be established on the basis of direct service connection. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). When a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact incurred during service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

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.

In this case, the Veteran's service records indicate that he was stationed at Camp Lejeune for at least 30 consecutive days.  Thus, the Veteran is presumed to have been exposed to contaminants in the water supply at Camp Lejeune.

The February 2025 rating decision on appeal made the favorable finding that the Veteran had a current diagnosis of end stage renal disease (IgA nephropathy), status post kidney transplant.  Thus, the remaining question is whether his end stage renal disease (IgA nephropathy), status post kidney transplant, is directly related to his exposure to contaminants in the water supply at Camp Lejeune.

In support of his claim, the Veteran submitted a May 2023 opinion from Dr. S.R.B., who concluded that it was at least as likely as not that the Veteran's end stage renal disease (IgA nephropathy), status post kidney transplant was associated with his exposure to contaminants in the water supply at Camp Lejeune.  Dr. S.R.B. reasoned that multiple lines of evidence suggested that autoimmune diseases such as IgA nephropathy had an environmental component.  Moreover, Dr. S.R.B. noted that some diseases could worsen or reoccur even after exposure to the suspected environmental agent.  Dr. S.R.B. then noted that the pollutants and contaminants present at Camp Lejeune included trichloroethylene (TCE), tetrachioroethylene (PCE), and benzene.  Dr. S.R.B. then indicated that benzene has been identified as a contributing factor in
IgA nephropathy), status post kidney transplant was associated with his exposure to contaminants in the water supply at Camp Lejeune.  Dr. S.R.B. reasoned that multiple lines of evidence suggested that autoimmune diseases such as IgA nephropathy had an environmental component.  Moreover, Dr. S.R.B. noted that some diseases could worsen or reoccur even after exposure to the suspected environmental agent.  Dr. S.R.B. then noted that the pollutants and contaminants present at Camp Lejeune included trichloroethylene (TCE), tetrachioroethylene (PCE), and benzene.  Dr. S.R.B. then indicated that benzene has been identified as a contributing factor in the development of autoimmune diseases, such as IgA nephropathy.  Dr. S.R.B. then concluded that the contaminants at Camp LeJeune had a significant impact on his health, but that the impact was not immediate after exposure.

The Board notes that the AOJ obtained a number of VA medical opinions addressing the Veteran's contentions in May 2023, July 2023, and December 2024.  However, the opinions expressed are not more probative than the May 2023 opinion from Dr. S.R.B.  Rather, the opinions are conclusory, and they fail to reflect consideration of pertinent evidence.  Moreover, the opinions do not rebut the conclusion reached by Dr. S.R.B.

There is no evidence of record indicating or suggesting that the Veteran's disability is related to any other cause.  

Based on the unique facts and medical evidence in this case which are specific to this Veteran's own unique disability picture, the Board finds the weight of the evidence both for and against the Veteran's claim to be in equipoise as to whether the Veteran's end stage renal disease (IgA nephropathy) is at least as likely as not related to his exposure to the contaminated waters while serving at Camp Lejeune.  Although the VA medical opinions weigh against such a finding, the May 2023 opinion from Dr. S.R.B. provides a positive opinion identifying the Veteran's exposure to the contaminated waters while serving at Camp Lejeune as a contributing factor to his end stage renal disease (IgA nephropathy), along with a supportive explanation.

When the evidence for and against the claim is in relative equipoise, the Board must resolve all reasonable doubt in favor of the Veteran. Therefore, resolving 

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reasonable doubt in favor of the Veteran, the Board will grant the Veteran's claim for service connection for end stage renal disease (IgA nephropathy), status post kidney transplant. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	James R. Springer, 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.