Board reasoning
The Board continues to remand for additional development and medical opinions addressing the nature and etiology of the claimed allergy disorder and liver disorder. It notes prior remand directives were not substantially complied with and references a prior understanding that examinations are needed to determine direct etiologies, including possible MUCMI considerations, and to assess any relation to service, including burn pit exposure. The reasoning emphasizes that further examination and opinions are necessary to resolve whether symptoms are attributable to known diagnoses, to MUCMIs, or to service, and to determine any linkage to in-service exposures, while acknowledging prior board actions and pending development.
Citation Nr: 26001375
Decision Date: 01/30/26 Archive Date: 01/30/26
DOCKET NO. 11-17 892A
DATE: January 30, 2026
REMANDED
Service connection for an allergy disorder other than under the provisions of the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) or as presumptively related to burn pit exposure is remanded.
Service connection for a liver disorder is remanded.
REASONS FOR REMAND
The Veteran served on active duty from May 2005 to July 2009. The case is on appeal from a June 2010 rating decision which in pertinent part, denied service connection for an allergy disorder, and denied service connection for a claimed liver disorder, manifested by elevated liver enzymes.
In an April 2025 decision, the Board granted service connection for rhinitis under the provisions of 38 C.F.R. § 3.320, based on exposure to particulate matter. The Board also took note of multiple issues that were no longer on appeal due to the RO granting the benefits in full. This April 2025 Board decision remanded the issues of service connection for an allergy disorder other than under the provisions of the PACT Act or as presumptively related to burn pit exposure, and service connection for a liver disorder for further development. Such has been completed, and this matter is returned to the Board for further consideration.
1. Service connection for an allergy disorder other than under the provisions of the PACT Act or as presumptively related to burn pit exposure is remanded.
2. Service connection for a liver disorder is remanded.
Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding these issues of service connection for an allergy disorder other than under the PACT Act or presumptively related to burn pit exposure or for a liver disorder. Another remand is therefore required. Stegall v. West, 11 Vet. App. 268, 271 (1998).
Of note, the Board in its April 2025 remand directed that VA examinations be conducted addressing the nature and etiologies of these claimed disorders.
Regarding the allergy disorder, the Board remanded this claim to afford the Veteran a new VA examination to determine the nature and etiology of the Veteran's allergy disorders on a direct, non-presumptive basis, referencing Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (holding that service connection is available on a direct, non-presumptive basis when a presumptive provision is not applicable). The Board noted that prior examination reports failed to adequately address the evidence and/or provide adequate opinions addressing the nature and etiology of his allergy disorder (diagnosed differentially as allergic rhinitis, vasomotor rhinitis and acute sinusitis).
Regarding the liver disorder, the Board found that additional examination was necessary to obtain clear explanations of the nature and etiology of any liver disorder which might be present and remanded the appeal to obtain such examination.
Despite this remand, no action has been taken by the AOJ to obtain such requested examinations. Potentially confusing this matter is the fact that a supplemental statement of the case (SSOC) was issued in April 2025 a few days after the Board remand. This SSOC discussed evidence that was of record prior to the April 2025 remand.
Accordingly, the Board finds that remand is necessary to afford compliance with the Board's previous remand directives.
The matters are REMANDED for the following action:
1. Afford the Veteran a new VA examination to determine the nature and etiology of his allergy disorder (diagnosed as allergic rhinitis, vasomotor rhinitis, and acute sinusitis). Specifically, the examiner should opine as to the following:
(A) Whether the Veteran has allergy symptoms not attributable to his rhinitis that are sinusitis.
(B) Whether the Veteran's rhinitis (and other allergy symptoms) constitute an undiagnosed illness or a sign or symptom of a medically unexplained chronic multi symptom illness (MUCMI) that is compensable to a degree of 10 percent or more? Please explain why or why not.
(C) If all allergy symptoms are attributable to a known diagnosis, whether the Veteran's rhinitis/other allergy disorder have both an etiology or pathophysiology that is not partially or fully understood. Please explain why or why not.
(D) If the Veteran's rhinitis/allergy symptoms are attributable to a known diagnosis with an etiology and pathophysiology that is at least partially understood, whether it is at least as likely as not that the Veteran's rhinitis/allergy symptoms onset during service or are in any way related to service other than the harmful effects of tobacco products.
A complete rationale should be provided for any opinion rendered. Please note the Veteran's reports regarding exposure to burn pits and other exposures in Afghanistan and Iraq and the rationale in the March 2024 medical opinion that the Veteran trained in the desert with grenades and was exposed to sand, dust particulates, and carbon from the grenades. Please also note that the Veteran reported smoking a pack per day during service.
2. Obtain a new medical opinion as to the etiology of the Veteran's claimed liver disorder. Whether to conduct an examination is left to the discretion of the examiner. Specifically, the examiner should opine as to the following:
(A) Whether any diagnosed liver disorder has been present since separation from service.
(B) If no diagnosed liver disorder has been present, whether any liver symptoms are an undiagnosed illness or a sign or symptom of a MUCMI that is compensable to a degree of 10 percent or more. Please explain why or why not
(C) If liver dysfunction was present and attributable to a known diagnosis, whether any liver dysfunction or diagnosed liver disorder has both an etiology and pathophysiology that is not partially or fully understood. Please explain why or why not.
(D) If the liver dysfunction has both an etiology and pathophysiology that is at least partially understood, whether it is at least as likely as not that the Veteran's liver disorder is related to service, to include exposure to burn pits or other irritants during service but not due to the harmful effects of tobacco products.
A complete rationale should be provided for any opinion rendered. Please note reports from 2010 regarding elevated liver enzymes, that the Veteran is service connected for multiple acquired psychiatric disorders including PTSD, the VA medical opinions of record, and the reports that the Veteran smoked a pack per day during service.
Eric S. Leboff
Veterans Law Judge
Board of Veterans' Appeals
Attorney for the Board Eckart, C.
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.