Citation Nr: 21011907 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 13-02 882 DATE: March 3, 2021 ORDER Entitlement to service connection for a liver disability is granted. FINDING OF FACT The probative evidence of record is at least in equipoise as to whether the Veteran’s liver disability was due to alcohol use caused or aggravated by the Veteran’s service-connected post-traumatic stress disorder (PTSD). CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran’s favor, the criteria for a grant of service connection for a liver disability due to alcohol use secondary to the Veteran’s service-connected PTSD has been met. 38 U.S.C. § 1131, 5107; 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1966 to March 1970 and from July 1970 to October 1970. He died in October 2014. The Appellant is his surviving spouse. In July 2020, the Appellant was substituted as the claimant in this appeal. The issue was remanded by the Board in August 2020 to afford an additional medical opinion regarding whether the Veteran’s alcohol use was caused by his service-connected PTSD. The Agency of Original Jurisdiction (AOJ) has done so, but for the reasons stated below, the Board finds that the opinion is inadequate. However, because the Board is granting the Veteran’s claim, any errors in compliance with the previous remand directives with regard to this claim are harmless. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 C.F.R. § 3.303; Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Generally, VA law and regulations preclude granting service connection for a disability that originated due to substance abuse, as this is deemed to constitute willful misconduct on the part of the claimant. See 38 U.S.C. § 105; 38 C.F.R. §§ 3.1(m), 3.301(d). However, a veteran may be service connected for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, his service-connected disability. In order to qualify for service connection, the Veteran must establish, by clear medical evidence, that his alcohol or drug abuse disability is secondary to or is caused by the primary service-connected disorder, and that it is not due to willful wrongdoing. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, a veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 11 Vet. App. 439, 448 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a nexus between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The benefit of the doubt rule provides that a Veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when (1) the weight of the evidence supports the claim or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to service connection for liver disability. Prior to his death, the Veteran contended that his cirrhosis of the liver was due to his service in Vietnam. Medical records submitted by the Veteran state that the Veteran’s cirrhosis was due to alcohol use. The Board notes that the Veteran was service connected for PTSD, rated as 100 percent disabling since September 2001. Review of a January 2001 examination of the Veteran’s PTSD states that the “[Veteran] began drinking in Vietnam as a stress reducer. His drinking escalated with his job loss in December of 1998 but has now leveled off with his treatment.” An additional medical opinion was provided in October 2020. The VA examiner was not able to resolve the issues of whether the Veteran’s alcohol use was caused by his PTSD without resorting to speculation. In so opining, the VA examiner stated that the development of alcohol use disorders is often the result of a complicated interaction of multiple risk factors, which include genetics, environmental factors, and personality traits. The VA examiner noted that while alcohol use disorders commonly comorbidly occur with PTSD, given the bidirectional association, it is not possible to state definitively whether the PTSD resulted in the alcohol use. The October 2020 VA examiner observed that at the Veteran’s VA evaluation dated January 2000, the examiner at that time noted that the Veteran’s loss of his job of 20 years was a significant factor in the development of his psychiatric symptoms. The October 2020 VA examiner also acknowledged that the Veteran possessed other risk factors including adverse life events, including neglect by his parents and divorce from his first wife. The October 2020 VA examiner stated that alcohol use disorders are the result of a complex interaction of multiple risk factors and it is not possible to reduce to one risk factor. While the October 2020 VA examiner acknowledged the January 2000 VA evaluation, he did not consider all of the statements made at that time. The October 2020 VA examiner omitted the portions of the January 2000 VA evaluation which discussed the Veteran’s service-connected PTSD and traumatic memories associated with his service, and how the Veteran used alcohol to cope. Specifically, the October 2020 VA examiner did not acknowledge that the January 2000 VA examiner observed that the Veteran’s loss of his job caused his memories from Vietnam to escalate. In full, the January 2000 VA examiner stated that the “triggering event was the [Veteran’s] loss of a twenty-year job. The job loss caused his trauma memories and feelings of victimization of from Vietnam to escalate, whereas previously he had distanced himself from his experiences in Vietnam by distracting himself with his work.” Additionally, the October 2020 VA examiner did not acknowledge previous statements made by the Veteran that he started drinking during Vietnam as a stress reducer. In the January 2000 evaluation, the VA examiner stated that the Veteran was experiencing an anxious depression in which he lost forty pounds, had suicidal thoughts, and increased his drinking to a twelve pack of beer several days per week. Other evidence of record includes medical treatment records from a mental health psychiatric assessment in October 1999. This assessment reflects that the Veteran stated that he had been drinking heavily, which has been a problem in the past since coming back from Vietnam. At this assessment, the Veteran also stated that he turned to beer when the memories came back as a coping mechanism, and that he was drinking up to a twelve pack several days per week. In May 2016, the Veteran’s first wife submitted a statement regarding the Veteran’s drinking its correlation with his symptoms of PTSD. The Veteran’s first wife stated that while the Veteran was recovering from injuries that he sustained in the Vietnam War, he started drinking. The Veteran’s first wife stated that the Veteran’s drinking was fine for a while, then it got to be a problem. The Veteran refused help, which caused the Veteran’s first wife to file for divorce. Subsequently, the Veteran promised to change, and they re-married in 1979, but his drinking again got worse. The Veteran’s first wife stated that “all of the medals [the Veteran] received came with a price.” As stated above, the October 2020 VA examiner stated that alcohol use disorders are the result of a complex interaction of multiple risk factors and it is not possible to reduce to one risk factor. However, the evidence described above indicates that, even though the Veteran did have multiple risk factors, his drinking began as a means to cope with his traumatic memories. Therefore, the evidence that the Veteran’s alcohol use was caused by or aggravated by his service-connected PTSD is at least in equipoise. Based on the evidence described above, and in light of the totality of the circumstances and giving the Veteran the full benefit of the doubt, the Board finds that it is at least as likely as not that the Veteran’s alcohol use disorder was caused by or aggravated by his service-connected PTSD, which caused his liver disorder. Accordingly, the Board finds that granting service connection for a liver disability is the decision that is most consistent with VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts of the case. 38 C.F.R. § 3.303(a). D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. DeVerter, 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.