Citation Nr: 18144488 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 13-16 584 DATE: October 24, 2018 ORDER Entitlement to service connection for a liver disability as associated with exposure to Gulf War environmental hazards is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a diagnosis of a liver disability; and there is no competent evidence that any cysts are due to an in-service event. CONCLUSION OF LAW The criteria for service connection for liver condition as associated with exposure to Gulf War environmental hazards are not met. 38 U.S.C. §§ 1110 (wartime), 1112 (chronic diseases), 1113 (rebuttable, intercurrent causes), 1131 (peacetime), 1137 (wartime presumptions), 5107(b); 38 C.F.R. §§ 3.102, 3.303(a)-(b), (d), 3.307, 3.309(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the U.S. Army from May 1963 to November 1966, and from September 1990 to August 1991. Service records indicate that the Veteran was ordered to active duty in support of Operation Desert Shield/Desert Storm, and had active service in Southwest Asia from November 1990 to July 1991. The Veteran’s appeal comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. The Board previously remanded the Veteran’s claim in June 2016 to obtain a medical opinion from a VA examiner to determine whether further diagnostic testing was needed and to have the medical examiner offer an opinion as to whether the claimed lung condition was related to service. In an October 2016 rating decision, the RO granted service connection for chronic obstructive lung disease, claimed as lung condition, and assigned a 10 percent disability rating, effective August 24, 2010. The record currently before the Board contains no indication that the Veteran initiated an appeal with the rating or effective date assigned. Thus, this matter is no longer in appellate status. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements, such as the disability rating or effective date assigned). Additionally, the Board remanded the Veteran’s claim to obtain a separate medical opinion to determine whether the Veteran’s claimed liver disability is etiologically related to his active military service, to include exposure to environmental hazards in Southwest Asia. The claim has since been returned to the Board for further appellate action. The Board is satisfied there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-57 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board has reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). 1. Liver Disability The Veteran contends that he was diagnosed with a liver disability following diagnostic imaging that showed simple hepatic cysts and a hepatic lesion, and that this disability is due to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The Veteran’s service treatment records are silent for any diagnosis of a liver condition in service or within one year of separation. Private treatment records associated with the record on appeal do not reveal a diagnosis of a liver disability, but confirm the hepatic cysts developed after a private medical exam conducted by private physician D.K. in November 2005. In the October 2010 general VA examination, the examiner stated the Veteran’s simple hepatic cysts were not caused by or occurred secondary to a specific exposure or event experienced by the Veteran during service in Southwest Asia. The examiner then discussed various possible etiologies, but determined that more diagnostic testing was required as to not base the rationale on speculation. Following the directives of the remand, VA provided the Veteran with another examination in September 2016. The VA examiner evaluated the Veteran and determined that the simple hepatic cysts and left hepatic lesion are not considered diagnoses, and further explained that the cysts and lesion are merely incidental findings on diagnostic imagining as cysts can present in many locations throughout the body and are not specifically definitive of any diagnosis. The examiner concluded that the Veteran does not have a diagnosis of a liver condition. Further, subsequent VA treatment records do not contain a diagnosis of a liver condition, but only show the benign hepatic cysts and lesion were observed in diagnostic imaging. While the Veteran believes he has a current diagnosis of a liver condition that is related to his service, he is not competent to provide a diagnosis or nexus opinion in this case. The issue is medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. The Board concludes that the Veteran does not have a current diagnosis of a liver disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim, and there is no competent evidence that any cysts are due to an in-service event. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). As all the elements necessary to substantiate the claim have not been met, service connection for a liver disability is not warranted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ohlstein, Law Clerk