Back to BVA DecisionsGRANTEDService Branch ARMY Special Benefit NO SPECIAL BENEFIT Docket No. 210330-149273
LIVER CIRRHOSIS OF
CYNTHIA M. BRUCE · 2026 · Case ID: A26025298
Summary
The Veteran, an Army and Air Force Veteran who served from September 1979 to November 1979 and August 1985 to March 1989, appeals the denial of service connection for a liver condition. The Veteran claimed that his fatty liver disability was caused or aggravated by his service-connected PTSD with alcohol use disorder. The Board reviewed the evidence, including VA treatment records showing a diagnosis of fatty liver and an independent medical opinion from Dr. C.N.B. This private opinion linked the Veteran's liver disease to his psychiatric disability, including PTSD and alcohol dependence, noting that alcohol use in service due to psychiatric symptoms likely worsened liver function. A subsequent VA PTSD examination diagnosed PTSD with alcohol use disorder, though the examiner could not differentiate symptoms. The Board found Dr. C.N.B.'s opinion highly probative due to its sound reasoning and alignment with other evidence, including the Veteran's lay statements. Applying the benefit of the doubt, the Board found service connection for fatty liver as secondary to PTSD with alcohol use disorder warranted. Service connection for fatty liver, secondary to PTSD with alcohol use disorder, is granted.
Rationale
Current disability established by VA treatment report (ultrasound); Service-connected PTSD with alcohol use disorder acknowledged; Independent medical opinion linked liver disease to psychiatric disability and alcohol use
Full Decision Text
Citation Nr: A26025298 Decision Date: 03/20/26 Archive Date: 03/20/26 DOCKET NO. 210330-149273 DATE: March 20, 2026 ORDER Entitlement to service connection for fatty liver, as secondary to service-connected posttraumatic stress disorder (PTSD), with alcohol use disorder, is granted. FINDING OF FACT The most probative medical evidence demonstrates that the Veteran's currently diagnosed fatty liver is caused or aggravated by his service-connected PTSD with alcohol use disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for fatty liver as secondary to service-connected PTSD, with alcohol use disorder, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty for the United States Army from September 1979 to November 1979 and the United States Air Force from August 1985 to March 1989. This matter is before the Board of Veterans' Appeals (Board) on appeal from April 2020 Higher-Level Review Department of Veterans Affairs (VA) Regional Office (RO) rating decision, in which the agency of original jurisdiction (AOJ) denied entitlement to service connection for a liver condition. The Veteran submitted a VA Form 10182 notice of disagreement (NOD) which was received in March 2021. The Veteran selected the Hearing docket review option. The Veteran appeared at a hearing before a Veterans Law Judge (VLJ) in December 2024. As the Veteran selected the hearing docket, the Board is limited to review of the evidence of record at the time of the underlying December 2019 rating decision, as well as evidence received within 90 days of the December 2024 Board hearing. 38 C.F.R. § 20.302(a). Entitlement to service connection for fatty liver, as secondary to service-connected posttraumatic stress disorder (PTSD) with alcohol use disorder, is granted. The Veteran contends that his fatty liver disability was either caused or aggravated by his service-connected PTSD with alcohol use disorder disability. Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). To prevail on the issue of entitlement to secondary service connection, there must be evidence of (1) a current disability; (2) a service-connected disability; and (3) a nexus establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Thus, a disability which is the result of a service-connected disease or injury, or a disability which would have been less severe but-for a service-connected disabilities, shall be service-connected. See 38 U.S.C. § 1131; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023). Further, the cause or aggravation of one disability by a service-connected condition need not be the only factor contributing to the disability, but rather there can be multi-causal links affecting the disability. See Spicer, 61 F.4th at 1364. Here, the AOJ made two favorable findings. First, the Veteran has a diagnosed liver condition. See December 2019 Rating Decision. The Board acknowledges that the AOJ overturned this favorable finding within the April 2020 rating decision concluding instead that the claims file lacks evidence of a diagnosed liver condition. However, as the December 2020 VA treatment report shows an ultrasound confirmed diagnosis of fatty liver, a current disability has been established. The AOJ has also favorably found the Veteran's PTSD with alcohol use disorder is an adjudicated service-connected disability. See April 2020 Rating Decision. The Board is bound by these prior favorable AOJ findings as they are not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c). Given the competent evidence of a current fatty liver disability and the claimed service-connected disability, the dispositive issue becomes whether there is competent evidence relating the two. On review, the Board finds that service connection on a secondary basis is warranted. Turning to the evidence, VA treatment records include diagnosis of alcoholic liver disease. See July 2010 Past Medical History; see also August 2017 Physician Progress Note. In July 2013, the Veteran submitted an independent opinion from a Dr. C.N.B., who opined that the Veteran's liver disease is caused by his psychiatric disability, to include PTSD with alcohol dependence, generalized findings as they are not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c). Given the competent evidence of a current fatty liver disability and the claimed service-connected disability, the dispositive issue becomes whether there is competent evidence relating the two. On review, the Board finds that service connection on a secondary basis is warranted. Turning to the evidence, VA treatment records include diagnosis of alcoholic liver disease. See July 2010 Past Medical History; see also August 2017 Physician Progress Note. In July 2013, the Veteran submitted an independent opinion from a Dr. C.N.B., who opined that the Veteran's liver disease is caused by his psychiatric disability, to include PTSD with alcohol dependence, generalized anxiety disorder, and adjustment disorder. The examiner rationalized that the Veteran self-medicated with alcohol in service due to his psychiatric symptoms, which in turn caused elevated enzyme levels consistent with worsening liver function. In September 2019, the Veteran underwent a PTSD VA examination and a diagnosis of PTSD with alcohol use disorder was provided. The VA examiner concluded that it was not possible to differentiate which symptoms are attributable to each diagnosis. Based on the record, the Board finds the evidence is persuasively in support of the claim. On review, the Board assigns high probative weight to Dr. C.N.B's examination and opinion because the opinion contains sound reasoning and aligns with prior medical evidence of the record as well as the Veteran's lay statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Dr. C.N.B. specifically linked the Veteran's fatty liver to his alcohol use, which is part and parcel of the Veteran's service-connected PTSD diagnosis. Resolving any reasonable doubt in the Veteran's favor, the Board finds that service connection for fatty liver, as secondary to his service-connected PTSD with alcohol use disorder, is warranted, and the appeal is granted. Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Russell, Tangela 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.