A 76-year-old Caucasian male smoker with a history of Stage IB lung adenocarcinoma. A routine CT scan showed a speculated mass in the RLL, but a PET scan revealed no FDG activity. The patient was diagnosed with polycythemia vera and testing came back positive for a V617F JAK2 mutation. UGT1A1 genotyping revealed a UGT1A1*28 promoter variant present, which supported the diagnosis of Gilbert syndrome. NGS testing revealed no actionable mutations and the patient continued off treatment with routine scans showing no evidence of disease. Here, UGT1A1 is linked to acquired polycythemia vera.