Citation Nr: 22012128 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 10-39 085 DATE: March 2, 2022 ORDER Service connection for a liver condition is granted. REMANDED Service connection for a kidney condition is remanded. The appeal for a compensable evaluation for pulmonary tuberculosis is remanded. FINDING OF FACT Affording the Veteran the benefit of doubt, the evidence of record is at least evenly balanced for and against ("relative equipoise") finding that the Veteran's diagnosed liver condition is at least as likely as not proximately due to his service-connected tuberculosis (See the June 2021 VA examination in which the examiner opined that the Veteran's liver disability is the result (caused by) his service-connected tuberculosis because TB bacilli reach the liver via the hepatic artery from tuberculosis infection of the lungs and leads to liver disability; less probative value is given to the July 2018 negative causal link (nexus) VA medical opinion because it provided an inadequate rationale and the January 2021 VA medical opinion did not address secondary service connection; although the June 2021 VA examiner indicated no diagnosis, the prior VA examinations did indicate diagnoses during the appeal period sufficient to establish 1) a current diagnoses, 2) a service-connected disability, and 3) a causal link between the service-connected disability and the current nonservice-connected disability.) CONCLUSION OF LAW The criteria have been met for service connection for a liver condition. 38 U.S.C. §§ 1110, 5107(b) (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1953 to January 1955. These matters are before the Board of Veterans' Appeals (Board) on appeal from a May 2009 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In August 2016, a Board hearing was held before the undersigned; a transcript is in the record. In February 2017, September 2020, and May 2021, the Board remanded the Veteran's claims for further development. 1. Service connection for a liver condition is granted. For the reasons outlined in more detail above in the Findings of Fact section, the appeal for service connection for a liver condition is granted. REASONS FOR REMAND 1. Service connection for a kidney condition is remanded. Despite the additional and regrettable delay, another remand is required because the June 2021 VA examination for the Veteran's kidney condition is inadequate. The examiner indicated there was no kidney condition but did not provide an explanation for why the July 2018 and January 2021 VA examinations, which included diagnoses, were incorrect or not supported by the medical evidence. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise has no probative value). Accordingly, a remand is required for a new VA examination and addendum medical opinion. 2. The appeal for a compensable evaluation for pulmonary tuberculosis is remanded. In July 2021, VA obtained a new VA examination for the Veteran's pulmonary tuberculosis. The examiner indicated that the Veteran's tuberculosis has not resulted in any non-pulmonary tuberculosis conditions. However, the Veteran is service connected for a liver condition and a heart condition based on VA examinations in June 2021. These conditions were not discussed in the Veteran's prior VA examinations for his tuberculosis. Additionally, the rating criteria states a 20 percent rating is warranted when "Following moderately advanced lesions, provided there is continued disability, emphysema, dyspnea on exertion, impairment of health, etc." The use of the abbreviation "etc" could implicate many other types of conditions related to the Veteran's tuberculosis. 38 C.F.R. § 4.97. Accordingly, a VA addendum medical opinion is required in order to address these issues. The matters are REMANDED for the following action: 1. Please note that this Veteran's case has been advanced on the docket and, by law, ALL remanded claims must be processed expeditiously. 2. The AOJ should arrange for an addendum VA medical opinion with examination or telehealth interview of the Veteran only if deemed necessary by a medical professional, to determine the nature and likely cause of the Veteran's kidney conditions. The examiner should review the claim file (including this remand) and note that this review was conducted. Based on review of the record, the examiner should provide an opinion with detailed rationale that responds to the following: 3. For each KIDNEY disability diagnosed, is it at least as likely as not (50% or greater probability) that the disability was either caused or aggravated by the Veteran's service-connected tuberculosis? Please explain why. The opinion must address whether the disability increased in severity beyond its natural progression (i.e., was aggravated). If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation. The examiner is requested to fully explain any causal or aggravation and opine to the extent possible the likely cause of the Veteran's condition. 4. The examiner MUST address any conflicts in the medical evidence regarding whether the Veteran has a current diagnosis and explain why. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) 5. The AOJ should arrange for an addendum VA medical opinion with examination or telehealth interview of the Veteran only if deemed necessary by a medical professional, to assess the current severity of his service-connected tuberculosis. The examiner should review the claim file (including this remand) and note that this review was conducted. Based on review of the record, The examiner should provide a full description of the disability and report all signs and symptoms associated with the Veteran's disability. 6. Specifically, the examiner MUST address whether the Veteran meets any of the rating criteria listed in the pertinent diagnostic codes and whether there are moderately advanced lesions, and continued disability, emphysema, dyspnea on exertion, impairment of health, etc... 7. The examiner MUST address whether the Veteran's secondary service-connected conditions constitute any non-pulmonary tuberculosis conditions that would result in a higher rating. The examiner is reminded that the Veteran is competent to provide information about observable symptoms and events. The examiner should assume, for the purposes of the opinions, that the Veteran's reports are both accurate and credible. 8. The Board notes that the AOJ should consider whether an extra-schedular rating is warranted for the Veteran's tuberculosis. 9. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Williams, 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.