How to Service Connect Chronic Kidney Disease Secondary to Hypertension for VA Disability

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Yes, there is medical research to support a connection between chronic kidney disease secondary to hypertension in veterans.

Hypertension, or high blood pressure, is a leading cause of chronic kidney disease, damaging your kidneys over time and impacting your health significantly.

To prove secondary service connection for kidney disease secondary to hypertension, you’ll need to show three things to the VA: (#1) medical diagnosis of kidney disease, (#2) proof of service-connected hypertension, (#3) medical nexus evidence (nexus letter) showing causation or aggravation of how your service connected hypertension is linked to kidney disease.

The VA rates chronic kidney disease (CKD) secondary to hypertension under the rating criteria for renal dysfunction according to 38 CFR § 4.115a from 0% to 100% with breaks at 30%, 60%, and 80%.

In this guide, Brian Reese, the VA Claims Insider will lead you through the process of filing a claim for CKD secondary to hypertension.

We’ll cover how the VA rates kidney disease, current medical research between kidney disease and hypertension, important medical evidence you’ll need, how to prove secondary service connection, and why you should get a nexus letter.

Without further ado, let’s begin.

Summary of Key Points

• Kidney Disease Secondary to Hypertension: Hypertension, or high blood pressure, is a leading cause of chronic kidney disease (CKD), progressively damaging the kidneys and impacting overall health. Thus, you can file a VA disability claim for kidney disease secondary to hypertension for VA disability benefits.

• CKD Secondary to Hypertension: To establish a secondary service connection for CKD due to hypertension, veterans need to show three key elements: (#1) medical diagnosis of CKD, (#2) proof of service-connected hypertension, and (#3) medical nexus evidence from a healthcare provider linking the hypertension to the CKD.

• VA Rating Criteria: The VA rates chronic kidney disease secondary to hypertension under the criteria for renal dysfunction as outlined in 38 CFR § 4.115a. Ratings range from 0% to 100%, with breaks at 30%, 60%, and 80%, depending on the severity of symptoms and their negative impact on your work, life, and social functioning.

Chronic Kidney Disease and Hypertension Defined

Chronic Kidney Disease (CKD):

Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their ability to function effectively.

It is defined by reduced glomerular filtration rate (GFR) or evidence of kidney damage (e.g., albuminuria) persisting for three months or longer. CKD progresses through five stages, with the severity ranging from mild kidney damage in stage 1 to complete kidney failure in stage 5, which often requires dialysis or a kidney transplant.

• Symptoms: Early stages may be asymptomatic. Symptoms in later stages include swelling (edema), fatigue, weakness, decreased urine output, and difficulty concentrating.

• Causes: Common causes include diabetes, hypertension, glomerulonephritis, and polycystic kidney disease.

• Diagnosis: Diagnosis typically involves blood tests (e.g., creatinine and BUN), urine tests (e.g., albumin-to-creatinine ratio), imaging tests, and sometimes kidney biopsy.

Hypertension (High Blood Pressure):

Hypertension, commonly known as high blood pressure, is a condition where the force of blood against the artery walls is consistently too high.

It is typically defined as having a systolic blood pressure of 130 mm Hg or higher, or a diastolic blood pressure of 80 mm Hg or higher, based on the latest guidelines from the American Heart Association.

• Symptoms: Often called the “silent killer” because it may not cause symptoms for years. When symptoms occur, they can include headaches, shortness of breath, and nosebleeds, but these are not specific and usually occur only when blood pressure reaches a severe or life-threatening level.

• Causes: Primary (essential) hypertension has no identifiable cause but is associated with risk factors like age, family history, obesity, physical inactivity, and high sodium intake. Secondary hypertension results from underlying conditions such as kidney disease, hormonal disorders, and certain medications.

• Diagnosis: Regular blood pressure monitoring, lifestyle assessment, and additional tests to identify potential underlying causes if secondary hypertension is suspected.

VA Rating for Chronic Kidney Disease Secondary to Hypertension

The VA rates chronic kidney disease (CKD) from 0% to 100% depending on the severity of symptoms and how these symptoms negatively impact your work, life, and social functioning.

Kidney Disease VA Ratings

100% Rating:

• Regular dialysis

• Persistent edema and albuminuria with BUN over 80 mg%

• Creatinine over 8 mg%

• Generalized poor health with lethargy, weakness, anorexia, weight loss, or limitation of exertion

Explanation:

• The 100% rating represents the most severe level of kidney dysfunction, where the veteran’s health is significantly compromised, requiring regular dialysis and displaying severe biochemical markers of kidney failure. General health is poor, and the individual is severely limited in their daily activities.

80% Rating:

• Persistent edema and albuminuria with BUN 40 to 80 mg%

• Creatinine 4 to 8 mg%

• Generalized poor health with frequent exacerbations

Explanation:

• At the 80% rating, the veteran experiences substantial symptoms, including severe kidney dysfunction as evidenced by high BUN and creatinine levels. The veteran’s health is generally poor with frequent flare-ups of symptoms.

60% Rating:

• Constant albuminuria with some edema

• Definite decrease in kidney function

• Hypertension at least 40% disabling under diagnostic code 7101

Explanation:

• The 60% rating indicates significant kidney impairment with consistent presence of albumin in the urine and some swelling (edema). There is a noticeable reduction in kidney function, and the veteran also has severe hypertension.

30% Rating:

• Constant or recurring albumin with hyaline and granular casts or red blood cells

• Hypertension at least 20% disabling under diagnostic code 7101

Explanation:

• Veterans with a 30% rating have moderate kidney dysfunction. They experience constant or frequent presence of albumin and casts in the urine, indicating ongoing kidney damage. Hypertension is present but less severe than in higher ratings.

0% Rating:

• Albumin and casts with a history of acute nephritis or hypertension non-compensable under diagnostic code 7101

Explanation:

• The 0% non-compensable rating indicates mild kidney dysfunction without significant impact on the veteran’s overall health or daily functioning. The presence of albumin and casts in the urine is noted, but it does not reach the level required for compensation. The hypertension is not severe enough to be compensable under the relevant diagnostic code.

Key Terms and Their Meanings

• Albuminuria: Presence of albumin in the urine, indicating kidney damage.

• Edema: Swelling caused by excess fluid trapped in the body’s tissues.

• BUN (Blood Urea Nitrogen): A measure of urea levels in the blood, which can indicate kidney function.

• Creatinine: A waste product measured in the blood that can indicate kidney function.

• Dialysis: A medical procedure to remove waste and excess fluid from the blood when the kidneys are not functioning properly.

• Hyaline and Granular Casts: Protein structures in urine that indicate kidney disease.

High Blood Pressure and Kidney Disease: What’s the Connection?

According to the National Kidney Foundation, high blood pressure (hypertension) and chronic kidney disease (CKD) are closely interconnected, influencing each other in significant ways:

High Blood Pressure as a Cause of CKD:

• Blood Vessel Damage: Over time, high blood pressure can damage blood vessels throughout your body, including those in the kidneys. This damage reduces blood supply to the kidneys, impairing their function.

• Kidney Damage: Hypertension can damage the tiny filtering units in your kidneys, known as nephrons. This damage hampers the kidneys’ ability to remove waste and extra fluid from your blood. The buildup of extra fluid in your blood vessels can further raise blood pressure, creating a vicious cycle.

• Result: As a result, untreated high blood pressure can lead to chronic kidney disease, where the kidneys lose their ability to filter waste effectively.

High Blood Pressure as a Complication of CKD:

• Regulation Role: Healthy kidneys help regulate blood pressure by balancing fluid and electrolyte levels and releasing hormones that control blood pressure. When kidneys are diseased, they struggle to perform these functions effectively.

• Increased Blood Pressure: Diseased kidneys release hormones that can increase blood pressure. Consequently, high blood pressure is a common complication of CKD.

• Progression and Heart Problems: High blood pressure can accelerate the progression of kidney disease and increase the risk of cardiovascular problems. Managing blood pressure is crucial to slowing the progression of CKD and preventing heart disease.

Medical Research Between Kidney Disease and Hypertension

• Hypertension as a Key Risk Factor: Research has consistently shown that hypertension is a significant risk factor for the development and progression of chronic kidney disease (CKD). Elevated blood pressure accelerates the decline in kidney function, leading to CKD and potentially end-stage renal disease (ESRD)​.

• Mechanisms and Management: Various mechanisms contribute to the progression of CKD in hypertensive patients, including the renin-angiotensin-aldosterone system (RAAS), oxidative stress, and endothelial dysfunction. Effective management strategies often involve RAAS antagonists, renal nerve denervation, and blood pressure control to slow CKD progression and reduce cardiovascular risks associated with hypertension​.

• Veteran-Specific Data: Studies within the VA healthcare system indicate that veterans with CKD often have a high prevalence of hypertension. This demographic shows unique patterns of disease progression and comorbidity, emphasizing the need for tailored interventions and close monitoring to manage both conditions effectively​.

Important Medical Evidence to Service Connection VA Disability for Chronic Kidney Disease Secondary to Hypertension

To successfully file a VA disability claim for chronic kidney disease (CKD) secondary to hypertension, it’s crucial to provide comprehensive medical evidence that establishes both the primary condition (hypertension) and the secondary condition (CKD), as well as the nexus (link or connection) between them.

Here’s the essential medical evidence needed:

1. Current Diagnosis of CKD

• Medical Records: Obtain detailed medical records from your healthcare providers that confirm a diagnosis of CKD. These records should include lab results, imaging studies, and any other diagnostic tests that support the diagnosis.

• Nephrologists Report: A specialist’s report outlining the severity and stage of your CKD is particularly valuable.

2. Evidence of Service-Connected Hypertension

• VA Rating Decision: Include documentation showing that your hypertension is already recognized as a service-connected condition by the VA.

• Medical Records: Provide historical medical records documenting the diagnosis and ongoing treatment of hypertension.

3. Nexus Letter From a Private Healthcare Provider

• Nexus Letter: A detailed letter from your healthcare provider, preferably a nephrologist or a specialist familiar with both conditions, explaining how your service-connected hypertension has caused or aggravated your CKD. The letter should reference specific medical evidence and provide a clear rationale for the connection.

• Sample Statement: “Based on the veteran’s medical history and clinical findings, it is my professional opinion that the chronic kidney disease is at least as likely as not a result of their service-connected hypertension.”

• Do I Need a Nexus Letter? Yes, you need to submit a nexus letter from a private healthcare provider showing causation or aggravation between chronic kidney disease and hypertension. Secondary service connection requires Medical Nexus Evidence that your new disability is “proximately due to” or “aggravated by” a current service-connected disability

4. Evidence of Kidney Dysfunction

• Lab Results: Include blood tests showing levels of blood urea nitrogen (BUN) and creatinine, which are key indicators of kidney function.

• Urine Tests: Provide urinalysis results showing albuminuria (protein in the urine) and other relevant abnormalities. This might be done at your C&P exam or via past urinalysis samples.

5. Documentation of Symptoms and Impact

• Medical Records: Records detailing symptoms such as fatigue, edema, decreased urine output, and other signs of kidney dysfunction.

• Functional Impact Statements: Statements from healthcare providers about how CKD affects your daily life and ability to work.

6. Additional Supporting Evidence

• Treatment Records: Documentation of all treatments you have received for CKD and hypertension, including medications, dialysis (if applicable), and any hospitalizations.

• Secondary Complications: Evidence of any secondary complications arising from CKD, such as cardiovascular issues, which can further support the severity of your condition.

How Do I Get a Nexus Letter for a VA Secondary Condition?

There are many private healthcare providers who can write nexus letters for secondary conditions.

Veterans should start by doing online research for doctors who write Nexus Letters.

Be sure to evaluate online customer reviews and the credentials of the provider before selecting a nexus letter doctor to help support your VA disability claim.

In 2024, you can expect to pay around $1,500 for a high-quality Nexus Letter.

Here are two good options to get high-quality Nexus Letters (with high probative value), from licensed providers nationwide:

#1. Telemedica

Pros: High-quality company with extensive experience helping over 15,000 veterans to-date with credible Nexus Letters. Serves veterans nationwide and in Puerto Rico. Also offers virtual exams, rush services, DBQs, rebuttal letters, and recurring mental health therapy. Veterans can connect with a licensed provider in their state from a mobile device, anytime, anywhere with Telemedica’s simple and easy to use telehealth platform.

Cons: Lack of specialty medical doctors. Not available for in-person evaluations.

*Disclaimer: Telemedica is a VACI-Affiliated Provider and VA Claims Insider Elite Members can get Nexus Letters and DBQs at 61-67% off Telemedica’s published rates.

#2. MRPY Professional Services

Pros: Veteran-owned and operated company that provides medical evidence documentation to veterans nationwide. Also offers NexusPrep™, virtual exams, DBQs, and rebuttal letters. Competitive rates on all products and services.

Cons: Lack of specialty medical doctors. Not available for in-person evaluations.

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