The condition is defined as the narrowing of the main blood vessels of the kidneys (renal artery stenosis), due to the deposit of substances such as cholesterol and other fatty substances in arterial walls (atherosclerosis). The condition may progress to complete occlusion and atrophy of the kidneys.

Atherosclerosis results from cholesterol-fatty-calcium deposits in or fibrosis of the walls (fibromuscular dysplasia) of the main blood vessels of kidneys. The condition occurs more frequently in persons who smoke heavily and whose cholesterol levels are high.

The condition may be asymptomatic or associated with severe hypertension. It may also result in progressive loss of renal function.

Diagnostic measures include: the captopril studies of the kidney (renography); intravenous (within the vein) dye studies; renal artery arteriogram; ultrasound; and Doppler studies.

Control of blood pressure is essential. In addition, angioplasty or surgical revascularization may be performed.

The development of end-stage renal disease (ESRD) is very common in progressive, severe hypertension. Maintenance by dialysis then becomes a necessity. In malignant hypertension, untreated patients die within months mostly from uremia. Death may also result from coronary heart disease or stroke.

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• A report of the Institute of Medicine of the National Academy of Sciences has identified some long-term health effects, listed in the table embedded within 38 CFR 3.317(d), that potentially are associated with the infectious diseases listed in 38 CFR 3.317(c)(2). These health effects and diseases are listed alphabetically and are not categorized by the level of association stated in the National Academy of Sciences report. If a veteran who has or had an infectious disease identified in column A also has a condition identified in column B as potentially related to that infectious disease, VA must determine, based on the evidence in each case, whether the column B condition was caused by the infectious disease for purposes of paying disability compensation. This does not preclude a finding that other manifestations of disability or secondary conditions were caused by an infectious disease. See 38 CFR 3.317(d) - Long-term health effects potentially associated with infectious diseases. 

• If a Veteran presumed service connected for one of the diseases listed in 38 CFR 3.317(c)(2) is diagnosed with one of the diseases listed in column “B” in the table embedded within 38 CFR 3.317(d) within the time period specified for the disease in the same table, if a time period is specified or, otherwise, at any time, VA will request a medical opinion as to whether it is at least as likely as not that the condition was caused by the veteran having had the associated disease in column “A” in that same table. See 38 CFR 3.317(d) - Long-term health effects potentially associated with infectious diseases.

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

• GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes when determined to be appropriate and calculated by a medical professional.