Citation Nr: 21074778 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 13-15 477 DATE: December 16, 2021 REMANDED Entitlement to service connection for a liver disability, to include as secondary to service-connected irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), is remanded. REASONS FOR REMAND Entitlement to service connection for a liver disability is remanded. The Veteran asserts that a liver disability is related to service. Alternatively, the Veteran asserts that a liver disability is caused or aggravated by service-connected IBS and GERD. More specifically, the Veteran contends that medication and lack of exercise caused by the service-connected disabilities has caused or aggravated a liver disability. A February 2018 VA examination diagnosed fatty liver disease. The examiner stated that a liver disability was less likely as not related to service. The examiner stated that a liver disability was not caused by or aggravated beyond the natural progression of the disease by any service-connected disabilities. As a rationale, the examiner stated that service medical records showed that a liver disability did not exist prior to service and there was no history of diagnosis or treatment for a liver disability, to include fatty liver disease and hyperlipidemia, while in service or at separation. The examiner noted that the Veteran had been diagnosed with IBS and GERD. However, the examiner stated the liver disability was less likely than not (less than 50 percent probability) proximately due to or the result of IBS and GERD as "fatty liver disease [was] caused by either high alcohol consumption, obesity, or metabolic syndrome. Fatty liver disease [was] not caused by GERD or IBS. Even in the absence of GERD or IBS, there [was] no connection between constipation or slowed digestion and fatty liver condition." When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The examiner opined that the claimed disability was not caused or aggravated by IBS or GERD because it is caused by high alcohol consumption, obesity, or metabolic syndrome. The rationale provided did not support the examiner's finding that the claimed disability was not aggravated by the service-connected disabilities. More specifically, the examiner did ot address whether the prescribed medication and physical activity restriction potentially caused the claimed disability to progress quicker than natural progression. Therefore, additional opinion is necessary to fully address the Veteran's contentions. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination by a medical doctor who has not previously examiner the Veteran in conjunction with this claim. The examiner should diagnose all liver disabilities found or shown during the pendency of this appeal. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any liver disability is related to service or any event, injury, or disease during service. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any liver disability was caused by the service-connected disabilities, to specifically include IBS and GERD. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any liver disability has been aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected disabilities, to specifically include IBS and GERD, to include as a result of prescribed medication and/or physical activity restriction due to the service-connected disabilities. The examiner should provide the rationale for the opinions provided. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.