LIVER CIRRHOSIS OF

Summary

The veteran, who served from March 1966 to March 1969, appeals the denial of service connection for a liver disability, specifically an enlarged liver, claimed to be due to herbicide exposure or chemicals related to his military occupational specialty as a missile crewman. The Board previously remanded the issue for clarification on whether the veteran had a current liver diagnosis and its relation to service. The veteran's service treatment records were silent regarding liver issues. VA treatment records from July 2011 noted a positive Hepatitis A test, but later records from July 2007, June 2009, and October 2007 indicated no Hepatitis or negative Hepatitis C antibodies. The veteran denied having Hepatitis in December 2013. A September 2024 VA examination diagnosed Hepatitis A, B, C, and hepatomegaly, opining it was less likely than not service-related, but failed to address the MOS chemicals or reconcile conflicting records. A subsequent September 2025 VA examination determined the veteran had no current liver disability, stating the prior diagnoses were in error due to negative Hepatitis testing and lack of objective evidence for hepatomegaly. However, this second opinion did not explain the earlier positive Hepatitis A notation. A final January 2026 VA addendum opinion concluded the veteran has no current diagnosable liver disability, finding the September 2024 diagnoses erroneous based on negative laboratory testing and lack of objective findings for hepatomegaly. The Board found no competent evidence of a current liver disability, thus denying service connection.

Rationale

No competent evidence of current liver disability; Service treatment records silent for liver issues; Conflicting VA examinations regarding diagnosis and service connection

Full Decision Text

Citation Nr: 26003912
Decision Date: 03/27/26	Archive Date: 03/27/26

DOCKET NO. 17-11 931
DATE: March 27, 2026

ORDER

Entitlement to service connection for a liver disability, claim as an enlarged liver, to include as due to exposure to herbicide agents and/or as due to smallpox vaccination, is denied.

FINDING OF FACT

The evidence persuasively weighs against finding that the Veteran has a current diagnosed liver disability.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a liver disability, claimed as an enlarged liver, to include as due to exposure to herbicide agents and/or as due to smallpox vaccination, have not been met.  38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1966 to March 1969.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The Board last remanded the issue in December 2025 for additional development.  Specifically, the Board requested the RO obtain an addendum medical opinion to clarify whether the Veteran has a current diagnosis for a liver disability, and, if so, whether it is at least as likely as not etiologically related to his active duty service, to include exposure to chemicals related to his military occupational specialty.  In January 2026, the RO obtained the requested addendum medical opinion.  As such, a review of the claims file demonstrates substantial compliance with the Board's remand directives.  Stegall v. West, 11 Vet. App. 268, 271 (1998).  Therefore, the Board will proceed with adjudication of the appeal. 

Entitlement to service connection for enlarged liver, to include as due to exposure to herbicide agents and/or as due to smallpox vaccination.

The Veteran contends that he has a diagnosis of a liver disability, claimed as an enlarged liver, that is due to his active duty service, to include exposure to herbicide agents and/or chemicals related to his military occupational specialty as a missile crewman.  See February 2012 statement in support of claim; March 2012 statement in support of claim.  

Service connection may be granted if there is a disability resulting from personal injury or disease incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may 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).  To establish service connection, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 

The requirement for a current disability is satisfied if the disability is present at any point proximate to the claim, or during the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown in service,

subsequent manifestations of the same chronic disease are generally service

connected; if a chronic disease is noted in service but chronicity in service is not

adequately supported, a showing of continuity of symptomatology after separation

is required.  Entitlement to service connection based on chronicity or continuity of

symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability

for which the veteran is claiming compensation is due to a disease enumerated on

the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a),

including diabetes mellitus, leukemia
), where a chronic disease is shown in service,

subsequent manifestations of the same chronic disease are generally service

connected; if a chronic disease is noted in service but chronicity in service is not

adequately supported, a showing of continuity of symptomatology after separation

is required.  Entitlement to service connection based on chronicity or continuity of

symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability

for which the veteran is claiming compensation is due to a disease enumerated on

the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a),

including diabetes mellitus, leukemia, and organic diseases of the nervous system

such as peripheral neuropathy.  Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

In addition, such chronic diseases are presumed to have been incurred in service if

they manifested to a compensable degree within one year of separation from

service.  38 U.S.C. §§ 1101(3), 1112, 1113; 38 C.F.R. §§ 3.307(a), 3.309(a).

Service connection can also be established based on herbicide exposure for specific

diseases listed in 38 C.F.R. § 3.309(e).  However, the evidence, as discussed below, does not demonstrate that the Veteran is diagnosed for a disability listed in 38 C.F.R. § 3.309(e).  

In regard to the first element of service connection, the evidence of record does not show that the Veteran has a current diagnosis of a liver disability proximate to the claim or during the appeal period.

The Veteran's service treatment records are silent for any complaints, symptoms, or diagnoses related to a liver disability.    

VA treatment records note the Veteran underwent lab tests that appear to indicate a positive test result for Hepatitis A.  See July 2011 VA treatment records.  However, July 2007 laboratory results demonstrate that the Veteran did not have Hepatitis B or any Hepatitis C antibodies.  See July 2007 VA treatment records.  In December 2013, the Veteran denied having Hepatitis.  See December 2013 VA treatment records.  A June 2009 VA treatment record notes the Veteran did not have liver disease and that there was no history of hepatitis.  See June 2009 VA treatment records.  

The Veteran was afforded a VA examination in September 2024.  The VA examiner diagnosed the Veteran with Hepatitis A, B, and C, and hepatomegaly.  See September 2024 VA examination.  The VA examiner noted the Veteran's report that his conditions began years prior due to his compromised immune system.  Id.  The

VA examiner opined that the Veteran's claimed condition was less likely than not

caused by his active duty service.  See September 2024 VA medical opinion.  As

rationale, the VA examiner noted the Veteran's TERA memo did not indicate

exposure to herbicide agents; the Veteran has a documented significant history of

hepatomegaly; that hyperlipidemia, or high cholesterol, can contribute to an enlarged liver, or hepatomegaly; and there is no medical or scientific evidence available that provides any indication of a relationship between the development of the conditions at issue and the TERA.  Id.  However, the VA examiner did not address the Veteran's contention that he was exposed to chemicals related to his MOS.  Additionally, the VA examiner did not address the Veteran's VA treatment records that show the Veteran did not have a diagnosis of Hepatitis.  

The Veteran was afforded a second VA medical opinion in September 2025.  The VA examiner determined the Veteran was not diagnosed with a current liver disability.  See September 2025 VA medical opinion.  The VA examiner acknowledged the September 2024 VA examination and opined that the diagnoses noted were rendered in error.  Id.  The VA examiner noted the Veteran's September 2024 laboratory panel clearly indicated no antibodies to Hepatitis A, B, or C; although there were past medical history reports that stated Hepatitis A, this laboratory evidence definitely demonstrates there was no prior Hepatitis A; there was no evidence in the file to support a diagnosis of hepatomegaly; a primary care note dated in November 2023 did not show hepatomegaly found on examination; and the VA examiner was unable to locate any liver-specific diseases in the claims file. However, the VA examiner did not address July 2011 VA treatment records that appear to indicate a positive test for Hepatitis A.  Additionally, the VA examiner does not explain why the test results from September
 The VA examiner noted the Veteran's September 2024 laboratory panel clearly indicated no antibodies to Hepatitis A, B, or C; although there were past medical history reports that stated Hepatitis A, this laboratory evidence definitely demonstrates there was no prior Hepatitis A; there was no evidence in the file to support a diagnosis of hepatomegaly; a primary care note dated in November 2023 did not show hepatomegaly found on examination; and the VA examiner was unable to locate any liver-specific diseases in the claims file. However, the VA examiner did not address July 2011 VA treatment records that appear to indicate a positive test for Hepatitis A.  Additionally, the VA examiner does not explain why the test results from September 2024 do not indicate the diagnoses that were rendered by the September 2024 VA examiner. 

The Board previously determined the September 2024 and September 2025 VA medical opinions inadequate for decision making purposes.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008).  In December 2025, the Board remanded the issue for further development to obtain an addendum medical opinion clarifying whether the Veteran has a current diagnosis for a liver disability and reconciling the conflicting evidence. 

The RO obtained a January 2026 VA addendum medical opinion.  The VA clinician determined the Veteran did not have a current diagnosis of a liver disability.  See January 2026 VA medical opinion.  The VA clinician noted review of the Veteran's entire claims file, including service records, VA treatment records, laboratory data, prior VA examinations, and medical opinions.  Id.  The VA clinician acknowledged that thought the September 2024 VA examiner listed diagnoses for Hepatitis A, B, C, and hepatomegaly, the Veteran's contemporaneous objective testing does not support those diagnoses.  Id.  The VA clinician noted the Hepatitis panel laboratory results dated in September 2024 were negative for Hepatitis A, B, and C antibodies, and a June 2025 VA note again documented negative Hepatitis testing.  Id.  The VA clinician acknowledged that earlier records were inconsistent, including the July 2011 note that appears to be a historical notation without confirmatory laboratory evidence.  Id.  The VA clinician noted a June 2009 note explicitly states no history of Hepatitis; an October 2007 test was negative for Hepatitis C; and there was no objective documentation of prior acute Hepatitis A infection.  Id.  The VA clinician stated later definitive laboratory testing indicates no prior exposure.  Id.  The VA clinician also noted there was no objective evidence of hepatomegaly on examination or imaging, and a primary care examination dated in November 2023 specifically noted no hepatomegaly.  Id.  The VA clinician stated that the most medically accurate conclusion is that the September 2024 liver diagnoses were rendered in error, and the Veteran did not have a current diagnosable liver disability.  Id.  Based on the foregoing, the VA examiner opined that there was no nexus to service or toxic exposure that can be medically supported.  Id.   

The Veteran is competent to provide lay evidence of the existence of symptoms that are capable of lay observation and may provide sufficient support for a claim of service connection.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465, 470 (1994).  However, the Board notes the Veteran has not been shown to have the medical training necessary to diagnose a liver disability, to include hepatitis.  Id. 

Based on the foregoing, the Board finds that there is no competent evidence of a current liver disability, and there is no valid claim.  Brammer, 3 Vet. App. at 225.  As such, the Board need not address the other elements of service connection without evidence of a current diagnosis of a disability.  As the evidence is persuasively against the claim, the benefit of the doubt doctrine does not apply, and the claim must be denied.  38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 

Neither the Veteran nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record.  See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are