KIDNEY DISEASE OF

STEVEN D. REISS · 2026 · Case ID: A26039814

MIXED

Summary

The Veteran, a U.S. Marine Corps Veteran who served from August 1965 to December 1967, including a tour at Camp Lejeune from December 1965 to October 1966, appeals the denial of service connection for several conditions. The Veteran claimed direct service connection for kidney disability, urinary incontinence with hematuria, renal incontinence, renal toxicity, macrocytic anemia, anxiety, and migraine headaches, asserting these conditions were related to service, particularly due to exposure to contaminated water at Camp Lejeune. The Board granted service connection for kidney disability and urinary incontinence with hematuria. The Board found that the Veteran's service at Camp Lejeune established the necessary exposure to contaminated water, and competent lay and medical evidence, including a private medical opinion, supported a nexus between the Veteran's current kidney and urinary symptoms and his service. The Board accorded limited weight to a negative VA medical opinion, finding it inadequate and disregarding the Veteran's credible lay testimony regarding symptom onset during service. The Board did not rely on presumptive service connection for these conditions as they are not listed under the relevant regulation but found direct service connection established. The claims for psychiatric disability, migraine headaches, and macrocytic anemia were remanded for readjudication in light of the granted conditions.

Rationale

Competent and credible lay and medical evidence; Private medical opinion supports nexus; Resolving doubt in Veteran's favor

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250930-580010

Full Decision Text

Citation Nr: A26039814
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 250930-580010
DATE: April 28, 2026

ORDER

Service connection for kidney disability is granted.

Service connection for urinary incontinence with hematuria is granted.

REMANDED

Entitlement to service connection for psychiatric disability is remanded.

Entitlement to service connection for migraine headaches is remanded.

Entitlement to service connection for macrocytic anemia is remanded.

FINDINGS OF FACT

1. Resolving doubt in the Veteran's favor, the Veteran's kidney disability had its onset in and is related to service.

2. Resolving doubt in the Veteran's favor, the Veteran's urinary incontinence with hematuria, had its onset in and is related to service.

CONCLUSIONS OF LAW

1. The criteria for service connection for kidney disability have been met. 38 U.S.C. §§ 1154(a), 5107(b);?38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

2. The criteria for service connection for urinary incontinence with hematuria have been met. 38 U.S.C. §§ 1154(a), 5107(b);?38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marines Corps from August 1965 to December 1967 and was stationed at Camp Lejeune from December 1965 to October 1966.

These matters come before the Board of Veterans' Appeals (Board) on appeal from the October 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The October 2024 rating decision constitutes an initial decision thus the modernized review system applies, also known as the Appeals Modernization Act (AMA).

By way of procedural history, in July 2022, the Veteran filed a new claim for service connection for anemia, depression, anxiety, hematuria, urinary incontinence, renal incontinence, headaches, and migraines, and in the September 2022 rating decision, the RO denied service connection for anxiety disorder, migraine headache, urinary / renal incontinence with hematuria, macrocytic anemia, and kidney condition.

In June 2024, the Veteran filed a supplemental claim for service connection for any acquired psychiatric disorder to include anxiety, migraines, urinary / renal incontinence, macrocytic anemia, and kidney condition, and in the October 2024 rating decision, the RO confirmed and continued the denials of service connection for anxiety disorder, kidney condition, macrocytic anemia, migraine headache, and urinary / renal incontinence.

The Board notes that in August 2024 the Veteran failed to appear for his scheduled VA examinations for his claimed conditions, and the RO denied the claims based on the Veteran's failure to appear. However, the RO only requested a VA examination for the Veteran's psychiatric conditions and a medical opinion regarding the Veteran's other claimed conditions. Therefore, an examination is not necessary to decide the claims for kidney disability, urinary incontinence, migraine headaches, and macrocytic anemia. See July 2024 VA correspondence; January 2026 correspondence; January 2026 hearing transcript; see also Turk v. Peake, 21 Vet. App. 565, 569 (2008); 38 C.F.R. § 3.655(a).

In the September 2025 VA Form 10182, the Veteran appealed the October 2024 rating decision and elected the Board's Hearing docket. Therefore, the Board generally may only consider the evidence of record at the time of the notice of agency of original jurisdiction (AOJ) decision, as well as any evidence submitted by the Veteran or his representative within 90 days following the hearing.

A hearing was held before the undersigned Veterans Law Judge in January 2026. Additional evidence was submitted during the 90-day period following the January 2026 hearing, which will be considered by the Board in the adjudication of this appeal.

As a final preliminary matter, the Board finds it appropriate to recharacterize the Veteran's claim of service connection for renal incontinence and renal toxicity, to one that includes all kidney disabilities reasonably raised by the record. Further, the Board finds it appropriate to recharacterize the Veteran's claim of service connection for anxiety, to one that includes all
(AOJ) decision, as well as any evidence submitted by the Veteran or his representative within 90 days following the hearing.

As a final preliminary matter, the Board finds it appropriate to recharacterize the Veteran's claim of service connection for renal incontinence and renal toxicity, to one that includes all kidney disabilities reasonably raised by the record. Further, the Board finds it appropriate to recharacterize the Veteran's claim of service connection for anxiety, to one that includes all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

1. Service connection for kidney disability is granted.

2. Service connection for urinary incontinence with hematuria is granted.

The Veteran seeks service connection for hematuria, urinary incontinence, renal incontinence and a kidney condition to include renal toxicity. See July 2022 VA Form 21-526EZ. The Veteran maintains that his conditions are related to service to include direct service connection as his kidney condition started in-service and as due to exposure to contaminated waters while stationed at Camp Lejeune. See January 2026 correspondence; see also March 2026 private medical opinion; July 2024 TERA memorandum.

In support, the Veteran provided the March 2026 private medical opinions, from S.E., an M.D. and a team of researchers, discussing medical literature and the relationship between the Veteran's service and his conditions. S.E. opined that the Veteran's exposure to contaminated drinking water at Camp Lejeune caused or contributed to the development of his chronic kidney disfunction. S.E. also opined that the Veteran's exposure to contaminated drinking water at Camp Lejeune caused or contributed to the development of his urinary incontinence. S.E. noted that her opinions were not based on whether the sole cause of his conditions was due to ingestion of contaminated drinking water at Camp Lejeune, but rather one of the causative factors in the development of his conditions.

Here, as explained below, the Board finds that all three elements of direct service connection are established by the competent and credibly lay and medical evidence of records as to the Veteran's kidney disability and urinary incontinence with hematuria. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may 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).??

To establish service connection on a direct basis, the evidence must show: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link between the current disability and the disease or injury incurred or aggravated in service (the "nexus" element). Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).??

Under 38 C.F.R. §§?3.307 and 3.309, effective March 14, 2017, service connection shall be granted for certain diseases associated with exposure to contaminants present in the water supply at Camp Lejeune, so long as the Veteran served at Camp Lejeune no less than 30 days from August 1, 1953, to December 31, 1987.

The Board notes that kidney disability and urinary incontinence is not a disease listed as presumptively related to contaminated water exposure under 38 C.F.R. §?3.309(f). The availability of presumptive service connection for a disability based on exposure to toxic substances at Camp Lejeune does not preclude a veteran from establishing service connection with proof of direct causation. Stefl v. Nicholson, 21?Vet. App.?120 (2007); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The United States Court of Appeals for the Federal Circuit (Federal Circuit) issued a decision that addressed the issue of causation in

The United States Court of Appeals for the Federal Circuit (Federal Circuit) issued a decision that addressed the issue of causation in 38 U.S.C. § 1110. See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). The Federal Circuit explained that the phrase "resulting from" in the statute refers to "but-for" causation (which is broad, undisputedly broader than proximate causation) and is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. Spicer, 61 F.4th at 1363-64.

The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15?Vet. App.?362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13?Vet. App.?482, 488-89 (2000); Wilson v. Derwinski, 2?Vet. App.?614, 618 (1992).

Turning to the evidence, in the October 2024 rating decision, the RO made favorable findings that the Veteran was diagnosed with a kidney infection, and urinary incontinence with hematuria. See June 2022 and July 2022 VA treatment records. The evidence shows that the Veteran performed service in Camp Lejeune from December 1965 to October 1966. See also September 2022 rating decision. These are favorable findings by which the Board is bound. See 38 U.S.C. § 5104a; 38 C.F.R. § 3.104(c).

Given his service while stationed at Camp Lejeune is greater than 30 days, the Veteran is presumed to have been exposure to contaminated water at Camp Lejeune. 38 C.F.R. § 3.307 (a)(7); see also July 2024 TERA memorandum.

As the finder of fact, the Board concludes that the first and second element of service connection can be reasonably conceded. What remains necessary is competent evidence of a nexus between the current conditions and service.

As noted above, service connection for kidney disability and urinary incontinence is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.307(a)(7), 3.309(f).

The Board, however, is required to consider theories of entitlement to benefits that are either raised by the claimant or reasonably raised by the record. In this case, the Veteran's primary theory of entitlement is that his kidney and bladder conditions, to include urinary incontinence with hematuria, had its onset in service and continued to the present time.

With regard to this last element, there is evidence for and against the claim.

The Veteran was afforded a VA examination for male reproductive organ conditions in August 2022. In the August 2022 VA examination, the examiner noted that the Veteran has a history of severe lower urinary tract symptoms and urinary incontinence. During the August 2022 VA examination, the Veteran reported that his symptoms started when he was stationed at Camp Lejeune in 1966.

In the subsequent August 2022 VA medical opinion for contaminated water at Camp Lejeune, the examiner noted that the Veteran's symptoms of urinary incontinence,
ence with hematuria, had its onset in service and continued to the present time.

With regard to this last element, there is evidence for and against the claim.

In the subsequent August 2022 VA medical opinion for contaminated water at Camp Lejeune, the examiner noted that the Veteran's symptoms of urinary incontinence, hematuria, and renal incontinence (not a diagnosis), are not kidney issues, but are likely a combination of both bladder and age-related prostate symptoms. The examiner further noted that the Veteran's VA treatment records include recurrent kidney and bladder infections. See also July 2022 correspondence.

In the August 2022 VA medical opinion, the examiner opined that the Veteran's kidney issues were not aggravated beyond any natural progression of active service, including service at Camp Lejeune. The examiner noted that this condition is not a result of any presumptive renal toxicity, as this condition would have manifested itself acutely with apparent signs and symptoms which would have warranted a formal medical examination. The Veteran's records are silent with respect to treatment for any acute renal toxicity. The examiner's rationale included reference to the Veteran's development of a renal infection in-service.

While the Board acknowledges the August 2022 negative nexus opinion, the Board accords limited probative weight as the examiner failed to provide an adequate assessment regarding the Veteran's kidney and bladder conditions. The examiner effectively disregarded the Veteran's competent and credible lay account of having symptoms during service and since, reported during the VA examination and throughout the Veteran's record. See also July 2022 correspondence.

Further, as to the nexus, the Board finds that the consistent lay statements and testimony constitute competent and credible evidence that his current kidney and urinary symptoms began during service and have been recurrent since that time. See Layno v. Brown,?6?Vet. App.?465 (1994);?Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).?

For the above reasons, the evidence, both lay and medical,?supports the Veteran's account that his kidney and urinary disability had an onset during service at Camp Lejeune.??In light of?the foregoing, service connection for kidney disability, and urinary incontinence with hematuria are warranted. ?See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en?banc).????

Further, in light of the Board's favorable determination based on the competent and credible evidence showing that the Veteran's conditions had its onset in service, the Board need not address the Veteran's other theories of service connection.

REASONS FOR REMAND

1. Entitlement to service connection for psychiatric disability is remanded.

2. Entitlement to service connection for migraine headaches is remanded.

3. Entitlement to service connection for macrocytic anemia is remanded.

In light of the Board's favorable decision in this appeal granting service connection for kidney disability and urinary incontinence with hematuria, the Board remands the issue of service connection for psychiatric disability, migraine headaches, and macrocytic anemia for the RO to reconsider the merits of the claim.

The Veteran seeks service connection for anemia, anxiety, and migraine headaches. See July 2022 VA Form 21-526EZ. The Veteran has advanced multiple theories as to why his conditions are related to service, to include direct service connection, secondary service connection, and as due to exposure to contaminated waters while stationed at Camp Lejeune. See January 2026 correspondence; see also March 2026 private medical opinion; July 2024 TERA memorandum.

Accordingly, on remand, the RO should reconsider these claims in light of the subsequent grants of service connection for kidney disability and urinary incontinence with hematuria. See Green v. McDonough, 37?Vet. App.?127 (2024) ("The Board also has the discretion to "remand for correction of any other error by the [AOJ] in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating the appellant's claim." 38 C.F.R. §?20.802(a))."

As such, the Board will remand this claim for initial AOJ consideration on the merits without directing additional development
TERA memorandum.

As such, the Board will remand this claim for initial AOJ consideration on the merits without directing additional development pursuant to Green. See also Hickson v Shinseki, 23?Vet. App.?394 (2010); 38 C.F.R. §?20.802(a).

The matters are REMANDED for the following action:

1. Readjudicate the claim for entitlement to service connection for psychiatric disability, migraine headache, and macrocytic anemia in light of the Board's grant of service connection for kidney disability and urinary incontinence with hematuria.

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Nettles, 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.

Analyze in VA Law Explorer