Citation Nr: 21074594 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 12-00 148A DATE: December 15, 2021 REMANDED Entitlement to service connection for a liver condition, to include hepatitis C, and to include as secondary to service-connected bipolar disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from November 1978 to May 1981. This matter comes before the Board of Veterans Appeals (Board) on appeal from a December 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was most recently before the Board in September 2021 at which time it was remanded for further evidentiary development. Although regretting the additional delay, the Board finds that remand is again needed before a decision may be rendered on the claim to ensure substantial compliance with the prior remand requests. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a liver condition, to include Hepatitis C, and as secondary to service-connected bipolar disorder, is remanded. The Veteran has contended that his liver condition (diagnosed as hepatitis C) is a result of medications he took to treat his service-connected bipolar disorder. Also raised by the record is a contention that alcohol and/or drug use undertaken as self-medication for the service-connected psychiatric disability resulted in the current condition. The September 2021 remand requested that a VA opinion be provided which addressed whether the liver condition was the result of service or was secondary to bipolar disorder, through use of prescribed medications or alcohol and/or drug use. A VA opinion was obtained in September 2021. Unfortunately, the clinician found that he could not provide an opinion without speculating regarding alcohol and/or drug use because he did not know whether the Veteran used such substances. As the clinician identified a deficiency in the record which caused his inability to provide an opinion, the Board finds that remand is needed to address that deficiency so that an adequate opinion may be obtained. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Jones v. Shinseki, 23 Vet. App. 382, 390-92 (2010). Further, although determining that the Veteran's hepatitis C was not aggravated by his bipolar disorder or treatment therefor, the clinician did not provide any rationale for the conclusion that actually addressed aggravation. As such, a new opinion is needed which provides an adequate rationale for all conclusions. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate VA clinician. Following review of the claims file, the examiner is asked to address the following: (a.) Interview the Veteran as to his history to determine whether any risk factors for a liver condition/hepatitis C are applicable to his circumstances, specifically to include past alcohol and/or drug use; (b.) Provide a diagnosis of any liver condition/hepatitis C; (c.) Determine whether it is at least as likely as not that any liver condition/hepatitis C was proximately caused or aggravated (i.e., worsened beyond natural progression) by the service-connected bipolar disorder, to specifically include any psychiatric medication required for treatment and self-medication with alcohol and/or drugs. (d.) The VA examiner is cautioned that the term "aggravated," as used in 38 C.F.R. § 3.310(b), does not require that there be "permanent worsening" of the nonservice-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence." See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). (e.) The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports should be acknowledged and considered in formulating any opinion. (f.) If medical literature is relied upon in rendering this determination, the examiner should identify and specifically cite each reference material used. (g.) All opinions should be accompanied by supporting rationale explaining how the examiner arrived at the conclusions expressed. (h.) The examiner is specifically asked to not copy and paste prior opinions and merely add a sentence or two, but to instead formulate a fully formed and supported opinion on his/her own that takes into account information obtained from the Veteran about his medical and social history. (i.) If the examiner determines that s/he cannot provide an opinion without resorting to speculation, the clinician should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. 2. Ensure that the requested opinion is associated with the claim file. After completing the above, and any additionally indicated development, readjudicate the claim. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rachel E. Jensen, Associate 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.