Citation Nr: 21063765 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-47 789 DATE: October 15, 2021 ORDER Service connection for a liver cyst is denied. REMANDED Entitlement to service connection for a low back disability is remanded. FINDING OF FACT The preponderance of the evidence is against finding that a liver cyst began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for liver cyst are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the U.S. Air Force from March 1987 to July 2008. These matters are before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded for additional development in April 2019. Entitlement to service connection for a liver cyst Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Veteran has filed a claim for entitlement to service connection for a cyst located on the liver. A review of the Veteran's service treatment records shows no reports of symptoms or diagnosis of disabilities affecting the liver or noting a cyst. Post-service treatments records from Whiteman Air Force Base reflect a June 2016 visit indicating that the Veteran had a history of discomfort with a cyst on his liver. A January 2020 VA examination report shows that the VA examiner opined that it was less likely than not that the current hepatic cyst condition was caused by military service. The examiner noted that the medical treatment records of Whiteman Air Force Base showed an incidental finding of a benign hepatic cysts on review of an imaging procedure of the abdomen in 2016 (which was 8 years after discharge from military service). The examiner noted the Veteran was complaining of right upper quadrant pain. The examiner also noted that the service treatment records showed no reports or diagnosis of any manifestations of liver disease, or right upper quadrant pain of the abdomen, therefore, it appeared unlikely that this condition existed during military service. The Board finds that the evidence of record does not support a finding of service connection for a cyst located on the liver. The Veteran's service treatment records are silent for any liver issues or manifestations of a cyst affecting the liver. The most probative evidence of record demonstrates the cyst is not related to service. Additionally, the January 2020 VA examination report is probative, because it are based upon a review of the evidence in the claims file, to include his service treatment records, and provides an explanation that contains clear conclusions and supporting data. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (holding that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). While the Veteran believes that the cyst located on the liver is related to an in-service injury, event, or disease, the Veteran in this case is not competent to provide a nexus opinion. The issue is medically complex, as it requires knowledge of the interaction between the body, anatomical relationship, and an interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). As such, his opinion on etiology is not competent and lacks weight. The Board gives more probative weight to the VA examination of record, as explained above. Therefore, the preponderance of the evidence is against the claim and service connection is denied. REASONS FOR REMAND Entitlement to service connection for a low back disability is remanded. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A review of the Veteran's service treatment records shows he was treated for back pain in April 1996. No other reports of back pain were noted during service to include on separation to service. Post-service treatment records from February 2014 and June 2016 from Whiteman Air Force Base indicated that the Veteran has had complaints of back pain on both the right and left sides. A January 2016 treatment record from Whiteman Air Force Base shows the X-rays revealed minor degenerative changes to the thoracic spine. A January 2020 VA examination report shows that after review of the claims file and exam of the Veteran, the examiner remarked that service treatment records do not show evidence of a chronic back condition during military service with only a single instance of back pain identified over many years of service. The examiner reported that physical exam showed a full range of motion of the thoracic and lumbar spine, with no guarding or obvious signs of pain. Radiographs obtained were noted to show mild degenerative changes affecting the thoracic and lumbar spine, which the examiner noted was a frequent incidental finding in asymptomatic middle-aged adults. The examiner reported that although the Veteran gave a credible history of frequent back symptoms, it did not appear that his back condition had risen to the level that caused significant disability. The examiner reported that there was no evidence that his back condition impaired his functional status either currently or during military service. The Board finds that the VA examination report of record appears to be internally inconsistent. Specifically, the examiner determined that the Veteran provided credible reports of a history of back symptoms and also that the Veteran's back condition did not rise to cause a significant disability. The Board finds that the VA examiner did not provide an adequate rationale explaining how the Veteran's statements of back pain history were credible but still determined that the back condition was not related to active service. Therefore, remand is required. This matter is REMANDED for the following action: Provide the Veteran with an appropriate examination to determine the etiology of his back disability. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (probability of approximately 50 percent or more) that the back disability had onset in, or is otherwise related to, active military service. The examiner must specifically address the Veteran's assertions of an in-service back pain since separation from service. (Continued on the next page) The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, Counsel 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.