Citation Nr: 21069335 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 15-44 380 DATE: November 18, 2021 ORDER Service connection for a liver disability, to include non-alcoholic cirrhosis of the liver, due to Ditert Butyl Nitrophenol (DBNP) is denied. FINDING OF FACT The Veteran's liver disability is not related to an in-service injury, disease, or event including any chemical exposures. CONCLUSION OF LAW The criteria for service connection liver disability, to include for non-alcoholic cirrhosis of the liver, due to DBNP have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1131; 38 C.F.R. § 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1975 to May 1977. In March 2019, the Veteran's appeal for service connection for non-alcoholic cirrhosis of the liver due to DBNP was denied by the Board which was then vacated by the Court of Appeals for Veterans Claims (Court). This appeal has now been returned to the Board for compliance with a July 2020 Joint Motion for Remand (JMR). In February 2021, the Board remanded the appeal for additional development consistent with the JMR, namely for a new VA examination. The Board finds that there was substantial compliance with the remand directives and is ready for review. See Stegall v. West, 11. Vet. App. 268 (1998). Service connection for liver disability, to include nonalcoholic cirrhosis of the liver The Veteran asserts that his current liver disability is due to his military service, namely his exposure to the chemical DBNP while serving as a firefighter. The Veteran's military personnel file shows he served aboard the USS M. G. Vallego (SSBN 658) as a fireman. His service treatment records reveal no reports of or treatment for a liver disability. Post-service treatment reports show a diagnosis of liver disease, described as stable in April 2013. Other diagnoses include cirrhosis and cryptogenic cirrhosis (documented by liver biopsy). Extensive VA and private treatment records pertaining to his treatment for his various liver conditions such as liver cirrhosis/end-stage liver disease secondary to non-alcoholic steatohepatitis (NASH) and a liver transplant. The Board recognizes within the private treatment records, the Veteran stated he found a study done at the Navy regarding possible toxin exposure causing non-alcoholic liver cirrhosis on sailors. However, upon a careful review of the extensive post-service treatment records, an etiological opinion supporting the Veteran's contention was not within the evidence. The Veteran submitted an article showing studies on DBNP and rats and an article titled "Absorption, Distribution, and Clearance of 2,6-Di-tert-Butyl-4-nitrophenol (DBNP)" however these articles do not show a relationship between the Veteran's current liver disability and DBNP. As such, they are afforded little probative value. Pursuant to the July 2020 Board remand, new VA opinions were obtained in April 2021 and August 2021. According to the April 2021 VA opinion, upon review of the evidence of record, the VA examiner determined that the Veteran's liver conditions were less likely than not incurred in or caused by the claim in-service injury, event, or illness to include possible DBNP exposure during service. The VA examiner explained that the primary risk factor present in this case for the development of NASH was the Veteran's long-standing obesity. The August 2021 VA clinician opined that the Veteran's previous liver cirrhosis due to NASH and current status post liver transplant, claimed as liver disability to include non-alcoholic cirrhosis of the liver, was less likely than not incurred in or caused by the claimed in-service injury, event, or illness to include possible DBNP. The August 2021 VA clinician referred to the National Academies of Sciences, Engineering, and Medicine article titled "Emergency and Continuous Exposure Guidance Levels for Selected Submarine Contaminants" which included a discussion on DBNP. The VA clinician stated that based on article there was "no evidence presented of any direct, causal relationship between DBNP exposure and development of [NASH]. The primary risk factors present in this case for the development of NASH (and subsequently cirrhosis leading to transplant) was obesity and diabetes. There is no nexus to service." After consideration of the entire record and the relevant law, the Board finds that the Veteran's liver disability is not related to service and service connection is not established. The Veteran's service treatment records, to include separation examination, are negative for any reports of liver disease or disorder. Moreover, the earliest documentation of a liver disability was in 2012, several decades following service separation. Furthermore, there is no competent opinion of record that links the Veteran's current liver disability to service, to include as a result of DBNP exposure. The April 2021 and August 2021 VA clinicians specifically found that the liver disability was not due to any claimed in-service exposure to DBNP as an etiological link is not supported by any scientific finding. Rather, they noted that the Veteran's longstanding obesity was the primary risk factor. Here, the only evidence of record in support of the Veteran's claim consists of his own lay statements. The Board acknowledges the Veteran's belief that his liver disability was caused by his military service, namely claimed DBNP exposure, and the progression of his symptoms. The Veteran is considered competent to report the observable manifestations of his claimed disability. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). However, the Veteran is not competent (meaning medically trained) to opine on the etiology of his liver disability. Where a determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In this case, the etiology of the current liver disability is a complex medical question that is not within the competence of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). In light of the above, the claim for entitlement to service connection for a liver disability is denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. 38 U.S.C. § 5107. S. Sorathia Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Yoo, 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.