Citation Nr: 0814780 Decision Date: 05/05/08 Archive Date: 05/12/08 DOCKET NO. 06-11 484 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana THE ISSUE Entitlement to service connection for liver disease. REPRESENTATION Veteran represented by: Vietnam Veterans of America ATTORNEY FOR THE BOARD O. Lee, Associate Counsel INTRODUCTION The veteran served on active duty from May 1976 to January 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2004 rating decision of the RO, which in pertinent part denied service connection for liver disease. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the veteran if further action is required. REMAND Under the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to assist veterans to obtain evidence needed to substantiate a claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2007). After a thorough review of the claims folder, the Board finds that the record is not sufficiently developed to ensure an informed decision. In seeking service connection for liver disease, the veteran has submitted a statement dated in March 2004 concerning his belief that his high liver enzyme readings are possibly the result of inservice chemical exposure. Specifically, he claims he was exposed to chemicals while stationed at a classified location in Nevada from 1986 to 1988 and at Holloman Air Force Base (AFB) in New Mexico from 1992 to 1995. The veteran states that he worked on the F-117 Stealth Fighter and used NAPTHA, acetone and many other unidentified substances. Service personnel records indicate that the veteran was assigned to a classified location from March 1984 to February 1988 and to Holloman AFB from January 1992 to January 1995. The records also show that his duties included, among other things, installation, inspection, maintenance, repair, modification and troubleshooting of the integrated avionics system. The records also confirm that he worked on the F-117 Stealth Fighter at Holloman AFB. There is competent medical evidence showing that the veteran has elevated liver enzymes. The Board acknowledges that elevated liver enzymes represent a laboratory finding and are not, in and of themselves, a disability for VA purposes. However, in several medical reports dated in 2004, Dr. M.S. stated that the veteran's elevated liver enzymes were most likely related to fatty liver disease. In a March 2004 opinion, Dr. M.S. recommended a liver biopsy to diagnose and determine the extent of the fatty liver disease. To date, there is no record that a liver biopsy has been performed. Likewise, a VA medical examination has not yet been conducted. On remand the AOJ should provide the veteran with a VA examination to determine whether he has fatty liver disease or any other liver disability and, if so, whether such disease is related to military service, to include claimed inservice exposure to chemicals. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); 38 U.S.C.A. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). (The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law.) Accordingly, the case is REMANDED for the following action: 1. The AOJ should schedule the veteran for a VA medical examination to determine whether he currently has a liver disability to include fatty liver disease. The entire claims folder and a copy of this REMAND must be made available to the examiner prior to the examination. Any appropriate testing should be conducted, and the results reviewed, prior to the final opinion. (a) The examiner should list any current diagnoses of a liver disability manifested by the veteran; (b) For any such diagnosis, the examiner should render an opinion as to whether the currently diagnosed disorder is at least as likely as not (i.e., to at least a 50:50 degree of probability) related to the veteran's military service (1976- 1995), to include claimed chemical exposure, or whether such a relationship is unlikely (i.e., less than a 50:50 probability). 2. Thereafter, the AOJ should readjudicate the claim for service connection for liver disease. If the benefits sought on appeal are not granted, the veteran and his representative should be provided a supplemental statement of the case and an applicable time to respond before the case is returned to the Board. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the veteran until further notice. However, the Board takes this opportunity to advise the veteran that the conduct of the efforts as directed in this remand, as well as any other development deemed necessary, is needed for a comprehensive and correct adjudication of his claims. His cooperation in VA's efforts to develop his claim, including reporting for any scheduled VA examination, is both critical and appreciated. The veteran is also advised that failure to report for any scheduled examination may result in the denial of a claim. 38 C.F.R. § 3.655. This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ K. PARAKKAL Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).