Citation Nr: 22018652 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 13-15 477 DATE: March 30, 2022 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 The Veteran served on active duty from September 1997 to May 2006. In December 2021, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a liver disability is remanded. In December 2021, the Board remanded the claim for a medical opinion, to diagnose all liver disabilities found or shown during the pendency of the appeal and determine if any claimed liver disability was the result of or aggravated by any service-connected disability, medication for a service-connected disability, or obesity due to physical inactivity due to a service-connected disability. A December 2021 VA examination did not diagnose any liver disability. The examiner stated that fatty liver was reversible and that 2017 imaging did not show any current liver disability. The examiner opined that a liver disability was not the result of service or aggravated by a service-connected disability because the Veran's service medical records did not show any liver disability prior to service. Therefore, "nothing w[ould] be 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 Board finds the opinion incomplete because the examiner applied the incorrect standard for secondary service connection based on aggravation. The examiner applied the aggravation standard applicable to the presumption of aggravation, in which service connection may be warranted for an injury or disease which pre-existed service and was aggravated by service. 38 C.F.R. § 3.304(a). Secondary service connection, which is the issue at hand, does not require that the disability be aggravated during service. Instead, secondary service connection based on aggravation only requires a showing that a nonservice-connected disability was aggravated beyond the normal progression by a service-connected disability. 38 C.F.R. § 3.310(b). Further, the December 2021 opinion is incomplete because the examiner did not provide an opinion on whether any liver disability was caused by a service-connected disability or treatment for a service-connected disability. The examiner did not provide an opinion addressing any relationship between any service-connected disability or medication for a service-connected disability, obesity, and a liver disability. The Board notes that a remand confers on the Veteran the right to compliance with the terms of that remand. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand for a VA examination is necessary. The matter is REMANDED for the following action: 1. After obtaining any necessary releases, obtain all relevant VA and private medical records not already associated with the claims file. All attempts to locate records must be documented in the claims file. 2. Then, schedule the Veteran for a VA examination by a medical doctor who has not previously examined the Veteran in conjunction with this claim. A clearly stated rationale with references to the record, diagnostic tests, general medical knowledge, and medical literature should be provided. The examiner should: (a.) Diagnose all liver disabilities found or shown during the pendency of the appeal. Reconcile that finding with the other evidence of record. (b.) 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. (c.) Opine whether it is at least as likely as not (50 percent or greater probability) that a liver disability is due to, the result of, or caused by (1) any service-connected disability, to specifically include IBS and GERD; (2) medication used to treat a service-connected disability; or (3) obesity caused by physical limitations or deconditioning and weight gain, due to a service-connected disability or medication used to treat a service-connected disability. (d.) 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 (1) any service-connected disability, to specifically include IBS and GERD; (2) medication used to treat a service-connected disability; or (3) obesity caused by physical limitations or deconditioning and weight gain, due to a service-connected disability or medication used to treat a service-connected disability. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.O., 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.