Citation Nr: 22014072 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 16-34 202 DATE: March 11, 2022 REMANDED Service connection for a liver disability, including as secondary to service-connected psoriasis (medication taken for treatment thereof), is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from October 1977 to October 1997. This matter is on appeal from an October 2014 rating decision. In February 2020, the Veteran testified at a videoconference Board hearing before the undersigned. In May 2020, the Board remanded the issues of service connection for a liver disability, right and left elbow disabilities, and right and left knee disabilities for VA examinations with medical opinions. As a result of the ordered development, service connection was established for left knee arthritis, right knee arthritis, left elbow arthritis, right elbow arthritis, left elbow arthritis with painful motion of the forearm and right elbow arthritis with painful motion of the forearm, all effective from May 22, 2014. Because the benefits sought on appeal were fully resolved in the Veteran's favor, those issues are no longer before the Board. The only issue remaining on appeal is service connection for a liver disability, as reflected above. As noted above, in May 2020, the Board, in pertinent part, remanded the issue of service connection for an upper respiratory disability for a VA examination with a medical opinion addressing whether any current liver disability (i.e., NASH) had its onset during or was causally related to service or was otherwise caused or aggravated by medication taken for treatment of service-connected psoriasis, and subsequent readjudication of the appeal. The Board specifically directed the examiner to consider and discuss the following evidence when rendering the medical opinion: December 1997 service treatment records showing a slight elevation in liver function tests; the role of post-service obesity in causing the current liver disability; the November 2009 abdominal ultrasound findings showing mild fatty infiltration of the liver; December 2009 and May 2010 VA treatment records showing an assessment of elevated LFTs; a July 2010 VA treatment record showing an assessment of elevated LFTs probably secondary to fatty liver; the May 2016 VA medical opinion; and a February 2017 VA treatment record showing a history of NASH with stage 3 fibrosis, and April 2017, April 2019, and December 2019 VA treatment records confirm the diagnosis of NASH. In an attempt to comply with the Board's remand directives, the July 2021 VA examiner provided a medical opinion on the question of whether current liver disability was related to service or to the service-connected psoriasis medication on either a secondary causation or secondary aggravation basis but did not discuss the following: the December 1997 service treatment records showing a slight elevation in liver function tests; the role of post-service obesity in causing the current liver disability; the November 2009 abdominal ultrasound findings showing mild fatty infiltration of the liver; December 2009 and May 2010 VA treatment records showing an assessment of elevated LFTs; a July 2010 VA treatment record showing an assessment of elevated LFTs probably secondary to fatty liver; or the May 2016 VA medical opinion. For this reason, another remand is warranted. Stegall v. West, 11 Vet. App. 268 (1998). Because the July 2021 VA examiner opined that the Veteran was currently diagnosed with NASH, specific discussion of the February 2017 VA treatment record showing a history of NASH with stage 3 fibrosis, and April 2017, April 2019, and December 2019 VA treatment records confirming the diagnosis of NASH is no longer needed. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the current liver disability is at least as likely as not: (1) causally or etiologically related to service; (2) caused by the medications used for treatment of service-connected psoriasis; and (3) worsened in severity beyond a normal progression by (aggravated by) medications used to treat the service-connected psoriasis. When providing the medical opinion, the examiner must discuss the following evidence: December 1997 service treatment record documents showing elevated PFTs. The role of post-service obesity in causing the current NASH. November 2009 abdominal ultrasound findings showing mild fatty infiltration of the liver. December 2009 and May 2010 VA treatment records showing an assessment of elevated LFTs. A July 2010 VA treatment record showing an assessment of elevated LFTs probably secondary to fatty liver. (Continued on the next page) The May 2016 VA medical opinion. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.