Citation Nr: 21022035 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-31 859 DATE: April 14, 2021 REMANDED Entitlement to service connection for a liver disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2010 to July 2014. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in May 2019. A transcript of the hearing is associated with the claims folder. This case was previously before the Board in January 2020, on which occasion the claim was remanded. The Board also remanded a claim of service connection for a low back disability. The RO granted service connection for degenerative disc disease of the lumbar spine in a January 2021 rating decision. The January 2021 rating decision represents a full grant of benefits sought on appeal and therefore the Board no longer has jurisdiction over the claim. Entitlement to service connection for a liver disability is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the Veteran’s claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of entitlement to service connection for a liver disability. In this regard, in the January 2020 Board decision, the Veteran’s claim was remanded for a new VA examination and opinion. In remanding the claim, the Board specifically directed the examiner to address findings of elevated liver enzymes and an abnormal liver ultrasound. In accordance with the January 2020 remand directives, the Veteran was afforded a VA examination and opinion in December 2020. The examiner opined that “[t]he [V]eteran’s most recent lab results do not demonstrate an abnormality in liver function except for an elevated bilirubin level.” In rendering their opinion, the examiner noted that elevated bilirubin can indicate liver disease, but in the absence of other liver abnormalities elevated bilirubin levels is assumed to be a “normal variant.” (12/11/2020, C&P Exam, p. 2). The examiner did not address findings of elevated liver enzymes and an abnormal liver ultrasound as directed by the Board. In failing to do so, the examiner did not substantially comply with the Board’s January 2020 remand directives. As such, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from August 2020 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any liver disability present, to include Gilbert’s disease, steatohepatitis, and fibrosis. The examiner should conduct all necessary testing, to include a liver ultrasound, and should clearly identify any hepatic disorders. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must address a September 2014 finding of elevated liver enzymes and abnormal liver ultrasound. (7/17/2015, CAPRI, p. 5); (8/2/2019, CAPRI, p. 9). Any opinion offered should be accompanied by a clear rationale and should reflect consideration of the lay evidence of record. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.