Kidney Disease VA Rating

A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 7,076 decided Board rulings on kidney disease from 2021 to 2026, 20.9% were granted, 28.9% denied and 50.1% remanded. But the headline number isn't the grant rate. It's the connection-type split. Almost half of the decided service connection rulings went through secondary connection, and those secondary claims were granted far more often than direct claims or claims that ran through a presumption.

That pattern stands out. A presumption is usually treated as the easy road to service connection. For kidney disease, it buys almost nothing over a direct claim, and secondary is the strongest path by a wide margin. The reason is structural: in developed countries, chronic kidney disease is most commonly attributed to diabetes and hypertension (Chen, JAMA, 2019), both conditions veterans often have service connected, and the medical literature on that chain is well-established enough that the Board recognizes it. I want to walk through what 7,076 decided rulings say about where these claims actually win, why direct connection is the harder path, where the presumptions fit, and what the rating ladder under 38 CFR § 4.115a does to the math once service connection is established.

This page covers the kidney disease rating chart (the GFR-based renal dysfunction scale), the CKD stage 3 rating, the diagnostic codes, how much VA pays, kidney disease secondary to diabetes or hypertension, the Agent Orange, Camp Lejeune and PACT Act presumptions, how to prove service connection and what the nephrology opinion needs, the C&P exam and labs, and why VA denies kidney disease claims.

TL;DR

• Across 7,076 decided Board rulings on kidney disease from 2021 to 2026, 20.9% were granted, 28.9% denied and 50.1% remanded. That grant rate is 3.8 points below the Board-wide 24.7 percent, and remand is the most common outcome, 4.8 points above the Board-wide remand share of 45.3%.
• Secondary connection is the strongest path. Diabetes and hypertension, the conditions most often blamed for chronic kidney disease, are also the conditions kidney disease is most often claimed secondary to at the Board. The Board section below shows the pairs and how direct, secondary and presumptive claims fared.
• Since November 14, 2021, kidney disease is rated on glomerular filtration rate (GFR): 0%, 30%, 60%, 80% and 100%, with each finding held for at least three consecutive months in the past 12. CKD stage 3a (eGFR 45 to 59) lines up with 30 percent and stage 3b (eGFR 30 to 44) with 60 percent.
• 100% requires GFR below 15 for three consecutive months, regular routine dialysis, or status as an eligible kidney transplant recipient.
• Camp Lejeune is a presumptive overlay that matters for kidney cancer, not chronic kidney disease. The contaminated-water exposure rule (at least 30 days of service there from August 1, 1953 to December 31, 1987) is in 38 CFR § 3.307(a)(7), and the listed conditions in § 3.309(f) include kidney cancer.
• With service-connected diabetes, a kidney complication that is rated 0 percent is folded into the diabetes rating; one that is compensable is rated separately (Note (1) to DC 7913).

Kidney disease VA rating criteria (38 CFR 4.115a)

Once kidney disease is service connected, most kidney diagnostic codes send the rater to the renal dysfunction scale in 38 CFR § 4.115a. VA rewrote that scale in a final rule effective November 14, 2021 (86 FR 54081), replacing descriptive terms with lab values.

The renal dysfunction rating chart

The renal dysfunction ratings now turn on glomerular filtration rate (GFR), and each finding must be present for at least 3 consecutive months during the past 12 months.

• 0%: GFR 60 to 89 plus recurrent red blood cell, white blood cell, or granular casts; OR GFR 60 to 89 plus structural kidney abnormalities (cystic, obstructive, or glomerular); OR GFR 60 to 89 plus an albumin/creatinine ratio of 30 mg/g or higher
• 30%: Chronic kidney disease with GFR 45 to 59
• 60%: Chronic kidney disease with GFR 30 to 44
• 80%: Chronic kidney disease with GFR 15 to 29
• 100%: Chronic kidney disease with GFR less than 15, OR regular routine dialysis, OR eligible kidney transplant recipient

Estimated GFR (eGFR) and creatinine-based approximations of GFR are accepted when determined to be appropriate and calculated by a medical professional.

The 100% tier is reserved for veterans with GFR below 15, on regular dialysis, or who are eligible kidney transplant recipients. A transplant itself is rated under DC 7531: 100% from hospital admission for the transplant, continuing until a mandatory VA examination one year after hospital discharge, and after that a residual rating with a 30% minimum. So a transplant recipient's rating can drop after that first year even when the transplant went well.

If your appeal covers periods before November 14, 2021, the older criteria, which used terms like "definite decrease in kidney function" and counted hypertension, may govern those earlier periods. Which version applies to each period needs separate review.

CKD stage 3 VA rating

Chronic kidney disease stage 3 is split into 3a (eGFR 45 to 59) and 3b (eGFR 30 to 44), with stage 4 at 15 to 29 (Kurani, Journal of General Internal Medicine, 2020). Those bands match VA's tiers. When VA proposed the scale, it explained that the 30, 60 and 80 percent levels correspond to the remaining stages of chronic kidney disease as GFR declines.

• Stage 3a (eGFR 45 to 59): 30 percent
• Stage 3b (eGFR 30 to 44): 60 percent
• Stage 4 (eGFR 15 to 29): 80 percent
• Kidney failure (GFR below 15) or regular dialysis: 100 percent

The stage on a lab report does not set the rating by itself. VA needs the GFR in that band for at least three consecutive months during the past 12, so a series of results matters more than a single draw.

Diagnostic codes for kidney disease

The diagnostic codes in 38 CFR § 4.115b say which scale applies. These are the ones kidney disease claims most often meet.

• DC 7502: Chronic nephritis. Rated as renal dysfunction.
• DC 7507: Arteriolar nephrosclerosis (kidney damage from high blood pressure). Rated on the predominant symptoms as renal dysfunction, hypertension or heart disease; if rated under the cardiovascular schedule, the rating is raised to the next higher level.
• DC 7530: Chronic renal disease requiring regular dialysis. Rated as renal dysfunction, which assigns 100% when regular routine dialysis is required.
• DC 7531: Kidney transplant. 100% from hospital admission for the transplant, continuing until a mandatory VA examination one year after hospital discharge. After that, rated on residuals as renal dysfunction, with a minimum of 30%.
• DC 7532: Renal tubular disorders. A minimum of 20% when symptomatic, or rated as renal dysfunction.
• DC 7533: Cystic diseases of the kidneys, including polycystic kidney disease. Rated as renal dysfunction.
• DC 7535: Toxic nephropathy, including from antibiotics, contrast dye and nonsteroidal anti-inflammatory drugs. Rated as renal dysfunction.
• DC 7536: Glomerulonephritis. Rated as renal dysfunction.
• DC 7541: Renal involvement in diabetes mellitus type I or II. Rated as renal dysfunction.
• DC 7542: Neurogenic bladder. Rated as voiding dysfunction or urinary tract infection, whichever is predominant.

Rating appeals at the Board

Most kidney disease rulings at the Board are about service connection rather than the rating itself. DC 7541, renal involvement in diabetes, is the code that comes up most often in kidney rating appeals. The Board section below shows results by what the appeal asked for and by diagnostic code.

How much VA pays for kidney disease

At VA rates effective December 1, 2025 (the 2026 rates), for a veteran with no dependents, the dollar values matter.

• 30%: $552.47 per month
• 60%: $1,435.02 per month
• 80%: $2,102.15 per month
• 100%: $3,938.58 per month

The jump from 30% to 60% is $882.55 per month, or about $10,590 per year tax-free. The jump from 60% to 100% is another $2,503.56 per month, or about $30,040 per year tax-free. These tier thresholds are driven by specific lab values, which means the right workup at the right time can move the rating substantially.

Kidney disease secondary to diabetes or hypertension

Here's the finding that I think is the most important one in the whole dataset for kidney disease, and it's the one most veterans don't know about when they file.

Direct claims are the largest group of kidney disease service connection rulings at the Board, but secondary claims are the highest-yielding, granted far more often than direct claims. Rulings that ran through a presumption sit barely above direct. Diabetes is the condition kidney disease is most often claimed secondary to, followed by hypertension. The Board section below shows both pairs and how each theory fared. The kidney disease secondary to hypertension page covers that claim in full, and the hypertension and diabetes cause pages list the other conditions veterans claim from each.

The reason isn't mysterious. In developed countries, chronic kidney disease is most commonly attributed to diabetes and hypertension (Chen, JAMA, 2019). Both of those underlying conditions are commonly service connected for veterans: diabetes through the Agent Orange presumption for Vietnam-era veterans, hypertension through direct connection or the Agent Orange route the PACT Act added in 2022, and both through other in-service onset pathways.

Once a veteran has service-connected diabetes or hypertension, the secondary claim under 38 CFR § 3.310 has a built-in medical foundation. The opinion has to show the service-connected condition caused the kidney disease, or aggravated it, meaning the kidney disease would be less severe but for the service-connected condition. An opinion that says only "not caused by" and skips aggravation is inadequate (El-Amin v. Shinseki, 26 Vet. App. 136 (2013)).

Chronic kidney disease secondary to diabetes

The chain works like this.

• A Vietnam-era veteran with qualifying service has Type 2 diabetes, presumptively service connected for herbicide exposure under 38 U.S.C. § 1116 and 38 CFR § 3.309(e)
• Diabetes is rated under 38 CFR § 4.119 DC 7913, from 10 to 100 percent depending on diet, oral medication, insulin, regulation of activities and complications
• Years of diabetes can produce diabetic kidney disease
• The veteran files a secondary claim for chronic kidney disease under 38 CFR § 3.310, identifying the diabetes as the underlying service-connected disability
• A nephrology opinion documents the connection: duration of diabetes, presence of albuminuria, eGFR decline pattern, exclusion of other causes
• The kidney disease is rated under DC 7541 on the renal dysfunction scale

One rule changes how this plays out. Note (1) to DC 7913 says compensable complications of diabetes are rated separately unless they are part of the criteria for a 100 percent diabetes rating, and noncompensable complications are part of the diabetes rating. A kidney finding that rates 0 percent (for example, GFR 60 to 89 with albuminuria) is folded into the diabetes rating. Once GFR stays below 60 for three consecutive months, the kidney disease is compensable and is rated on its own, unless it is part of the criteria for a 100 percent diabetes rating.

Chronic kidney disease secondary to hypertension

The same structure works with hypertension as the underlying disability. The rating schedule itself describes the nephrosclerotic type of nephritis as "originating in hypertension or arteriosclerosis" and developing slowly (38 CFR § 4.115). A hypertension-as-base, kidney-disease-as-secondary claim runs the same nexus analysis through that pathway.

The rating is where hypertension cases get complicated. Section 4.115 says separate ratings are not assigned for heart disease and any form of nephritis, because of the close relationship between the two. It names two cases where coexisting hypertension or heart disease is rated separately: when an absent kidney is the only renal disability, and when chronic renal disease requires regular dialysis. Arteriolar nephrosclerosis under DC 7507 is rated on whichever predominates: renal dysfunction, hypertension or heart disease. Whether your hypertension and kidney disease can both be rated outside those cases turns on these rules and on 38 CFR § 4.14, so check how VA applied them in your decision.

Kidney disease from medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are potential kidney toxins, and avoiding them is part of standard chronic kidney disease care (Chen, JAMA, 2019). Toxic nephropathy from NSAIDs is its own code, DC 7535. If you took NSAIDs for years for a service-connected joint or back condition, kidney disease secondary to that medication is a claim a nephrologist can evaluate.

Why secondary claims fail

The secondary claims that fail are usually cases where the underlying diabetes or hypertension hasn't been present long enough to plausibly cause the renal damage, where the kidney disease has an alternative explanation the examiner identifies (polycystic kidney disease, glomerulonephritis from a different cause, medication nephrotoxicity), or where the eGFR doesn't actually show clinically significant impairment yet.

For veterans with service-connected diabetes who haven't filed for kidney disease, the question is whether the renal function workup shows kidney damage. Chronic kidney disease is defined as a kidney abnormality that lasts more than three months, such as GFR below 60 or albuminuria (Chen, JAMA, 2019). If your labs show that, the chain is medically supportable. If your renal function is normal, the claim is premature. The threshold for filing isn't a specific number; it's whether a nephrology opinion can credibly tie current renal dysfunction back to the service-connected condition.

Is kidney disease a presumptive condition? Agent Orange, Camp Lejeune and the PACT Act

Chronic kidney disease is not on any of the major exposure lists. The presumptions still matter, mostly through the conditions that lead to kidney disease and through kidney cancer.

Agent Orange

The herbicide list in 38 U.S.C. § 1116 includes Type 2 diabetes and, since the PACT Act, hypertension, but it does not include chronic kidney disease. Kidney cancer is not on that list either. So when a Vietnam-era veteran files a kidney disease claim under the Agent Orange presumption, the Board is looking at a list that doesn't cover the diagnosis. The claim either fails on the presumption and gets reconsidered under direct connection, or the veteran files under secondary connection through service-connected diabetes or hypertension and the kidney disease becomes a downstream claim. That second pathway is where the grants live.

Camp Lejeune

Camp Lejeune is the exception for kidney cancer. Under 38 CFR § 3.307(a)(7), veterans, former reservists and National Guard members who served at Camp Lejeune for at least 30 days (consecutive or not) between August 1, 1953 and December 31, 1987 are presumed exposed to the contaminated drinking water (trichloroethylene, perchloroethylene, benzene and vinyl chloride), and the conditions listed in § 3.309(f) are presumptively service connected. The list is kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. Chronic kidney disease is not on it.

For Camp Lejeune veterans with kidney cancer, the case becomes a question of proving the service and the diagnosis. If your diagnosis is chronic glomerulonephritis or diabetic kidney disease, the Camp Lejeune presumption does not apply, and you may need to argue direct causation from the contaminated water exposure.

PACT Act and burn pits

The PACT Act list in 38 U.S.C. § 1120 includes kidney cancer but not chronic kidney disease. Burn-pit exposure claims for chronic kidney disease run on direct proof.

The one-year chronic disease presumption

Nephritis and "cardiovascular-renal disease, including hypertension" are on the list of chronic diseases in 38 CFR § 3.309(a). For a veteran with at least 90 days of qualifying service, one of them that became manifest to a degree of 10 percent or more within one year after separation is presumed service connected (38 CFR § 3.307(a)(1) and (a)(3)). Records from that first year after discharge can matter.

The takeaway: if you have Camp Lejeune service and kidney cancer, the presumption under § 3.307(a)(7) is usable. If you have chronic kidney disease and service-connected diabetes or hypertension, the secondary path under § 3.310 is the higher-yielding route. If you're trying to win a stand-alone direct claim for chronic kidney disease from in-service exposure without an underlying service-connected condition, you're on the hardest path in the data.

How to prove kidney disease is service connected

Every kidney disease claim needs a current diagnosis backed by labs. After that, the evidence depends on the theory.

Direct service connection

Direct service connection needs an in-service event, injury, disease or exposure and a medical opinion linking it to the current kidney disease. That is hard when the medical literature points to diabetes and hypertension as the usual causes, which is why direct kidney claims were granted far less often than secondary ones at the Board. In-service kidney infections, kidney injuries, abnormal urinalysis or creatinine results in service treatment records, and documented toxic exposures are the facts that make a direct claim workable.

Nexus letter for kidney disease

Kidney disease cases are unusually dependent on the medical opinion. The condition itself isn't visible without lab work. The connection to service isn't visible without a specialist analysis. In the Board's kidney disease rulings, when the Board credited a favorable opinion the claim was nearly always granted, and when it relied on an opinion against the claim the claim almost never was. Relying on a favorable opinion is how the Board grants, so read that as the shape of a win rather than proof that any opinion will carry the case. Claims with a private medical opinion in the record were also granted more often than kidney claims overall, an association rather than proof of cause. The Board section below shows what the Board did with medical opinions in kidney disease claims.

What tends to separate an opinion the Board credits from one it rejects comes down to a few features.

• Opinions the Board credits are usually written by a nephrologist or an internist with relevant expertise, walk through the specific pathophysiology of the renal damage, identify the underlying service-connected condition (diabetes, hypertension, or similar) and document its duration and severity, address competing causes, cite the relevant medical literature, and arrive at an "at least as likely as not" or stronger conclusion with clear reasoning.
• Opinions the Board rejects are often written by a generalist provider without renal expertise, state conclusions without showing reasoning, fail to address the duration or severity of the underlying condition, ignore competing causes, or rely on generic statements about service.

For a kidney disease claim that isn't running through the Camp Lejeune presumption, the private nephrology opinion is doing much of the lifting on the outcome.

What wins a kidney disease claim

Pulling the patterns together, the kidney disease claims that succeed at the Board usually have a few things in common.

A clear underlying service-connected condition. For many successful claims, the path runs through already service-connected diabetes or hypertension. If you have service-connected diabetes and your recent labs show eGFR decline or persistent albuminuria, the secondary claim is the strongest theory.

A nephrology opinion that walks through the specific pathway. The opinion needs to identify the underlying condition, document its duration, show the renal damage progression over time, exclude competing causes, and arrive at an "at least as likely as not" conclusion with reasoning. Generic primary care notes saying "kidney function is declining" don't move these cases. Specific nephrology analysis does.

Current labs that support the rating tier. Kidney disease rating is lab-driven. GFR or eGFR (usually calculated from serum creatinine), the urine albumin/creatinine ratio, and urinalysis findings such as casts: these are the data points the rater uses to assign 0%, 30%, 60%, 80%, or 100%. Because each tier requires the finding for at least three consecutive months during the past 12 months, a series of results matters more than a single draw. If your most recent workup is more than a year old, the C&P examiner often won't have what's needed to assign the higher tier.

Camp Lejeune documentation where applicable. For veterans who served at Camp Lejeune for at least 30 days between 1953 and 1987 with kidney cancer, the service evidence is the lever. The exposure is presumed once qualifying service is documented.

Resolved alternative explanations. Polycystic kidney disease, glomerulonephritis from autoimmune causes, medication-induced nephrotoxicity, and inherited renal conditions are the main alternative explanations C&P examiners point to in denied cases. A well-reasoned nexus opinion either rules these out or addresses them directly. A claim that doesn't engage with the alternative explanations is leaving an attack surface.

Patience through the remand cycle. Half of decided kidney disease rulings went back for more work, so many kidney disease claims at the Board will see at least one remand before the final decision. Treating the remand as a development opportunity rather than a loss (using the remand period to gather the labs, get the nephrology opinion, pull the diabetes records) is how the second-pass grants happen.

None of this is a guarantee. The 20.9% overall grant rate is an average across every kidney disease file the Board decided, strong and weak alike. But the structural levers that move kidney disease outcomes (secondary connection, strong nephrology opinion, current labs, Camp Lejeune presumption where applicable) are knowable, and the cases that grant tend to have them.

The kidney disease C&P exam and labs

Kidney disease isn't a clinical exam diagnosis. It's a labs diagnosis. Estimated glomerular filtration rate (eGFR), serum creatinine (used to calculate eGFR), the urine albumin/creatinine ratio, urinalysis findings, sometimes a biopsy: these are the markers the rating schedule and the medical opinion depend on. A C&P examiner who didn't pull the recent labs is producing an exam that can't be used to assign a rating, and the Board sends those cases back.

Before the exam, gather your last year of kidney labs, with dates, so the examiner can see whether a GFR band held for three consecutive months. Bring your nephrology records, your diabetes or blood pressure records, and a medication list that shows any long-term NSAID use. C&P exam prep can help you organize it.

Why VA denies kidney disease claims

Kidney disease claims do worse at the Board than the average claim. Across 7,076 decided Board rulings on kidney disease from 2021 to 2026, 20.9% were granted, 28.9% denied and 50.1% remanded. That grant rate is 3.8 points below the Board-wide 24.7 percent, measured over 1,241,238 decided rulings.

When the Board denies kidney disease service connection, the most common reason is the link to service, followed by no in-service event or exposure, and then no current diagnosed disability. The patterns behind those denials repeat.

No medical link. The only opinion in the file is against the claim, or a favorable opinion states a conclusion without reasoning, or no one addressed the question at all.

A secondary opinion that skips aggravation. For kidney disease claimed secondary to diabetes or hypertension, an opinion that says only "not caused by" without asking whether the condition made the kidney disease worse is incomplete.

Another cause the examiner can name. Polycystic kidney disease, glomerulonephritis from another cause, medication, age or a nonservice-connected condition gets the blame, and the record does not answer it.

The wrong presumption. The claim relies on the Agent Orange or PACT Act list, which does not include chronic kidney disease, and nothing else supports it.

No current disability. Labs are normal, or a single abnormal result was never repeated, so there is no chronic kidney disease to rate.

When the Board sends a kidney disease claim back instead of deciding it, the most common reason is an inadequate VA exam or opinion, ahead of records VA still had to get. The gaps I see are specific: missing labs, missing nephrology opinion, missing analysis of the secondary connection question. Those are fixable problems on remand, which is why so many of these cases get a second chance rather than a denial. The Board section below shows how often each denial and remand reason came up, and what happened after a remand.

What I Can't Tell You From This Data

There are real limits on what 7,076 decided Board rulings can teach you about your specific claim.

I can't tell you whether your kidney disease is medically caused by your service-connected diabetes or hypertension. That's a clinical question for a nephrologist with access to your records, not a question the aggregate data can resolve. The medical literature supports the chain in general; whether it applies to your specific eGFR trajectory, glucose control history, and renal pathology findings is a case-by-case analysis.

I can't tell you whether your Camp Lejeune service during the qualifying window will trigger the presumption for your specific diagnosis. The presumptive list in 38 CFR § 3.309(f) covers kidney cancer specifically, not the broader chronic kidney disease population.

I can't tell you whether your specific lab values will support the 30% versus 60% versus 80% tier under the renal dysfunction schedule. The rating depends on your GFR over at least three consecutive months and, at the 0% level, findings such as the albumin/creatinine ratio, urinary casts, or structural abnormalities. The thresholds in the regulation are specific, and your numbers either clear them or don't.

I can't fully explain why rulings that ran through a presumption do so poorly here. The most likely explanation is what I described above: the most common presumptive lane (Agent Orange) doesn't cover the most common diagnosis (chronic kidney disease), so veterans filing under that theory often lose on the presumption and fall back to direct connection.

What the data can tell you is the structural shape of these claims at the Board. Secondary outperforms both direct and presumptive, which sit close together. A credited favorable opinion is a near-ceiling outcome, and an opinion against the claim is close to zero. The Camp Lejeune presumption matters for the specific subset it covers. The renal dysfunction rating tiers are driven by labs, not by symptoms.

What it can't tell you is which side of those distributions your case will land on.

Questions veterans ask about kidney disease

What is the VA rating for chronic kidney disease stage 3?

Stage 3a (eGFR 45 to 59) rates 30 percent and stage 3b (eGFR 30 to 44) rates 60 percent under the renal dysfunction scale in 38 CFR § 4.115a. The GFR has to stay in that band for at least three consecutive months during the past 12 months.

Can kidney disease be secondary to hypertension?

Yes. High blood pressure is one of the two most common causes of chronic kidney disease in developed countries, and kidney disease can be service connected secondary to service-connected hypertension under 38 CFR § 3.310. The opinion has to explain how the hypertension caused or worsened the kidney disease and rule out other causes.

Can you get VA ratings for both hypertension and kidney disease?

Sometimes. 38 CFR § 4.115 bars separate ratings for heart disease and nephritis, but rates coexisting hypertension separately when kidney disease requires regular dialysis or an absent kidney is the only kidney disability. Kidney damage from high blood pressure (DC 7507) is rated on whichever predominates, so check how VA applied these rules in your decision.

Is chronic kidney disease presumptive for Agent Orange?

No. The Agent Orange list in 38 U.S.C. § 1116 includes Type 2 diabetes and hypertension but not chronic kidney disease. The usual route is to claim kidney disease secondary to service-connected diabetes or hypertension.

Does Camp Lejeune cover kidney disease?

Only kidney cancer. The Camp Lejeune presumption in 38 CFR § 3.309(f) lists kidney cancer, not chronic kidney disease, for veterans with at least 30 days at the base between August 1, 1953 and December 31, 1987. Other kidney disease from the water needs direct proof.

What is the VA rating for dialysis or a kidney transplant?

Regular routine dialysis rates 100 percent on the renal dysfunction scale. A kidney transplant rates 100 percent from hospital admission until a mandatory VA exam one year after discharge, then at least 30 percent based on how the kidney works.

Bottom Line

Kidney disease is rated under 38 CFR § 4.115a using the renal dysfunction scale, with diagnostic codes in § 4.115b covering the range of underlying pathologies. Across 7,076 decided Board rulings on kidney disease from 2021 to 2026, 20.9% were granted, 28.9% denied and 50.1% remanded, a remand share 4.8 points above the Board-wide 45.3%, and the remands I read usually trace to C&P exams that fail to pull the labs and specialist opinions the schedule requires. Secondary service connection is the strongest path, granted far more often than direct claims or claims that ran through a presumption. The reason is structural: the Agent Orange list covers diabetes and hypertension but not chronic kidney disease, so the highest-yielding path is to use service-connected diabetes (or hypertension) as the underlying condition and file kidney disease as secondary under 38 CFR § 3.310. Camp Lejeune is the meaningful exception on the presumptive side: the presumption in 38 CFR §§ 3.307(a)(7) and 3.309(f) covers kidney cancer for veterans with at least 30 days at the base between 1953 and 1987. The medical opinion the Board credits drives the outcome. The rating ladder once service connection is established runs 0%, 30%, 60%, 80%, and 100%, based mainly on GFR held for at least three consecutive months, with CKD stage 3a at 30 percent and stage 3b at 60 percent. The 100% tier requires GFR below 15, regular dialysis, or eligible kidney transplant recipient status. At VA rates effective December 1, 2025 (the 2026 rates), the difference between 30% and 100% for a veteran with no dependents is $3,386.11 per month, tax-free, which makes the specific lab values driving the tier assignment the single most consequential evidentiary detail in the rating analysis.

Methodology and Limitations

• Data source: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 7,823 Board rulings on kidney disease, 7,076 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Across 7,076 decided Board rulings on kidney disease from 2021 to 2026, 20.9% were granted, 28.9% denied and 50.1% remanded. Board-wide, the grant rate on decided rulings is 24.7%. Rating criteria are from 38 CFR §§ 4.115, 4.115a and 4.115b (genitourinary), as revised effective November 14, 2021 (86 FR 54081), and the diabetes note from § 4.119 DC 7913. Secondary service connection mechanics are from 38 CFR § 3.310. The Camp Lejeune presumption is at 38 CFR §§ 3.307(a)(7) and 3.309(f), the chronic disease presumption at §§ 3.307(a)(3) and 3.309(a), the Agent Orange list at 38 U.S.C. § 1116, and the PACT Act list at 38 U.S.C. § 1120. Compensation figures are VA rates effective December 1, 2025 (the 2026 rates) for a veteran with no dependents.
• Medical sources: Chen, Knicely and Grams, "Chronic Kidney Disease Diagnosis and Management: A Review," JAMA (2019); Kurani and colleagues, "Use of Potentially Nephrotoxic Medications by U.S. Adults with Chronic Kidney Disease," Journal of General Internal Medicine (2020), for the stage 3a, 3b and 4 eGFR bands. VA's statement that the 30, 60 and 80 percent levels track the stages of chronic kidney disease is from its proposed rule, 84 FR 55086 (October 15, 2019).
• Classification approach: Rulings are assigned to kidney disease by Claim Raven's extraction of the condition in each Board ruling. Connection type, medical opinion findings, secondary pairs, appeal types, diagnostic codes, and denial and remand reasons are shown in the Board section below rather than typed into the text. Medical opinion findings record what the Board credited on each service connection ruling it granted or denied, not a grade of the opinion's quality. Connection type reflects the theory of service connection the Board addressed in its decision, which may not always match the original claim theory at the regional office.
• Limitations:
• The weak result for rulings that ran through a presumption likely reflects the mismatch between the Agent Orange list (which covers diabetes and hypertension but not chronic kidney disease) and the most common renal diagnosis. A ruling can carry a presumption and a direct or secondary theory at once, so the presumptive group overlaps the other two.
• The Camp Lejeune presumption covers kidney cancer specifically under §§ 3.307(a)(7) and 3.309(f). It does not cover the broader chronic kidney disease population.
• The data does not record the rating tier the Board granted, so this page gives the tiers from the regulation rather than from counts.
• The renal dysfunction scale applies from November 14, 2021. Appeals that cover earlier periods may involve the older criteria.
• Cases that made it to the BVA are not representative of all kidney disease claims. Many kidney disease claims are granted at the regional office or never appealed, and they don't appear in this dataset.
• These observations reflect patterns from BVA decisions. They are not predictions of individual outcomes.