Citation Nr: 20003607 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 17-59 693 DATE: January 15, 2020 REMANDED Entitlement to service connection for liver disability, to include as due to herbicide agent exposure, is remanded. Entitlement to service connection for a digestive disability, as secondary to the Veteran's liver disability, is remanded. Entitlement to service connection for a blood disability, as secondary to the Veteran's liver disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1970 until his honorable discharge in June 1973. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision by the St. Petersburg, Florida Regional Office (RO) of the United States Department of Veterans Affairs (VA). This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). In October 2019, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge (VLJ), sitting at the Regional Office (RO) in St. Petersburg, Florida. A transcript of the hearing has been associated with the record on appeal. During the hearing, the undersigned held the record open for 60 days to allow for the submission of additional evidence. During the 60 days, the Veteran submitted a note from his private provider. 1. Entitlement to service connection for liver disability, to include as due to herbicide agent exposure, is remanded. The Veteran asserts that his liver disability is due to herbicide agent exposure from his service on the Korean DMZ. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Here, the Veteran is diagnosed with cirrhosis with liver failure; exposure to herbicide agents has been conceded by the RO; the Veteran’s liver disability may be related to his herbicide exposure during active service. Specifically, the Veteran’s private provider noted in his September 2019 correspondence that the Veteran is diagnosed with cirrhosis with liver failure and that there is a reasonable cause of high suspicion that herbicide agent exposure could cause the disability. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination is required. 2. Entitlement to service connection for a digestive disability, as secondary to the Veteran's liver disability, is remanded. 3. Entitlement to service connection for a blood disability, as secondary to the Veteran's liver disability, is remanded. Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below. The Veteran asserts that his digestive disability and blood disability are secondary to his liver disability. Finally, because a decision on the remanded issues of entitlement to service connection for a liver disability could significantly impact a decision on the issues of service connection for a digestive disability and a blood disability; the issues are inextricably intertwined. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any liver disability. The examiner must opine whether it is at least as likely as not (50 percent probability or greater) related to an in-service injury, event, or disease, including herbicide agent exposure. The examiner is requested to opine whether it at least as likely as not (50 percent probability or greater) (1) began during active service or (2) manifested within one year of discharge. Furthermore, the examiner is requested to opine whether it is at least as likely as not (50 percent probability or greater) related to in-service herbicide agent exposure, including addressing the Veteran’s September 2019 private provider note that states that there is reasonable cause of high suspicion that the Veteran’s cirrhosis with liver failure is due to herbicide agent exposure. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to service connection for a digestive disability and service connection for a blood disability, as secondary to the Veteran’s liver disability. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. (Continued on the next page)   If necessary, return the case to the Board for further appellate review. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Deemer The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.