Citation Nr: 18146794
Decision Date: 11/01/18	Archive Date: 11/01/18

DOCKET NO. 16-42 088
DATE:	November 1, 2018
REMANDED
Entitlement to service connection for liver disease, to include as secondary to service-connected disabilities, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from May 1977 to June 1982 and from June 1983 to August 1994.
This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas.
Entitlement to service connection for liver disease, to include as secondary to service-connected disabilities.
In a June 2015 VA examination report, the examiner opined that it was less likely than not that the Veteran’s liver condition was proximately due to or the result of his heart condition.  The rationale was that the examiner had reviewed the Veteran’s echocardiograms, which were negative for valvular disease.  The VA examiner noted that the Veteran had a fatty liver that was at least as likely as not due to hyperlipidemia, obesity, and his history of alcohol abuse.
In a March 2017 VA examination report, the Veteran was diagnosed with posttraumatic stress disorder (PTSD), weight gain, and alcohol use disorder.  The examiner noted that the Veteran’s weight gain was likely due his sedentary lifestyle, medications, and stress eating as a result of his PTSD.  Additionally, the examiner reported that the Veteran’s alcohol use disorder was a result of the Veteran self-medicating his PTSD.  
The Board notes that the Veteran has never had a VA examination to determine if his liver condition is related to his service-connected PTSD, to include weight gain and alcohol use disorder.  As such, a new VA examination is necessary to determine if the Veteran’s liver condition is secondarily related to his service-connected PTSD.  38 C.F.R. § 3.159(c)(4).
The matter is REMANDED for the following actions:
1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all VA and private treatment records concerning this claim.
2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the claimed liver condition.  If any liver condition is diagnosed following testing, the examiner is requested to opine whether it is at least as likely as not (a 50 percent or greater probability) directly related to active military service.  The examiner is also requested to opine whether it is at least as likely as not that any liver condition is proximately due to or chronically aggravated by the Veteran’s service-connected PTSD, to include PTSD-induced weight gain and alcohol use disorder.  The examiner must review the claims file, to include the March 2017 VA examination report, noting that the Veteran’s weight gain and alcohol use disorder were related to his now service-connected PTSD.  
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All opinions must be supported by a detailed rationale.
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Abrams, Associate Counsel