Citation Nr: 21003117 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 12-00 757 DATE: January 19, 2021 REMANDED The appeal for service connection for hepatic steatosis/fatty liver is remanded. REASONS FOR REMAND The Veteran appellant had active military service in the United States Navy from April 1968 to April 1972, including combat service in the Republic of Vietnam, and his decorations include the Combat Action Ribbon. The Veteran also served at Camp Lejeune from November 5 to December 6, 1968. The issue on appeal initially came before the Board as an appeal of the May 2010 rating decision by the agency of original jurisdiction (AOJ) which denied a request to reopen a claim for service connection. In May 2012, a hearing was held before a former Veterans Law Judge at the Board. A transcript of the hearing has been associated with the claims file. In November 2020, the Board advised the Veteran that the Veterans Law Judge who presided over the hearing was no longer employed by the Board and offered the Veteran the opportunity to request another Board hearing. The Veteran was informed that if he did not respond to the letter within 30 days, the Board would assume that he wished to proceed without another hearing. The Veteran did not respond and thus, the Board will proceed. By way of background, in a decision issued in April 2014, the Board, reopened the claim of entitlement to service connection for a liver disorder and remanded for development and adjudication on the merits. At that time, the claimed liver disorder included Gilbert’s disease and hepatic steatosis. The appeal was remanded again in January 2015 and September 2016 due primarily to development regarding Gilbert’s disease. In July 2017, the Board denied the claim with respect to Gilbert’s disease and remanded the appeal for hepatic steatosis for further development. Entitlement to service connection for hepatic steatosis/fatty liver. The Veteran asserts that his hepatic steatosis/fatty liver is either due to water contamination while stationed at Camp Lejeune, exposures to herbicide agents in Vietnam, or is secondary to his service-connected diabetes mellitus, type II. As an initial matter, the VA opinions obtained prior to July 2019, to include an April 2016 independent medical opinion, only addressed Gilbert’s disease which the Board denied in July 2017. Since the July 2017 remand, pertinent VA opinions were obtained in July 2019, June 2020, and August 2020. The July 2019 VA opinion determined that the Veteran’s hepatic steatosis was not directly related to service to include exposures at Camp LeJeune but did not specifically address whether the hepatic steatosis was due to herbicide exposures. Rather, the July 2019 VA examiner also indicated that it was much more likely that the hepatic steatosis was related to the Veteran’s obesity and diabetes mellitus type II. Thus, the AOJ sought an addendum opinion. The June 2020 VA opinion determined that the Veteran’s disorder was not caused by service-connected diabetes mellitus, type II, but did not address whether it was aggravated by the same. The AOJ also sought a VA addendum opinion regarding a nexus to herbicide agent exposure. The August 2020 VA examiner determined that the Veteran’s disorder was not related to herbicide agent exposure. Although multiple VA opinions have been obtained, the question remains as to whether the Veteran’s hepatic steatosis was aggravated by his service-connected diabetes mellitus, type II. Additionally, the Board notes that the July 2019 VA opinion regarding direct service connection may have been based on inaccurate facts. In this regard, the July 2019 VA examiner noted in the Veteran’s factual background that the Veteran’s father had Gilbert’s disease, when in fact, there is no evidence of the same. The Veteran has explained how the misunderstanding regarding his family medical history occurred. See July 2016 statement. The Veteran explained that the service clinician’s finding that the Veteran’s father had Gilbert’s disease was based on the Veteran’s own statement that his father had health problems, not any actual medical evidence of a specific liver problem. Id. Further, given the Veteran’s Camp Lejeune service, the Board notes that VA hospital care and medical services are available for Camp Lejeune Veterans for covered diseases that include hepatic steatosis. See 38 C.F.R. § 17.400. Indeed, for these purposes,VA will assume that a covered illness or condition is attributable to the Veteran’s active duty service at Camp Lejeune unless it is clinically determined, under VA clinical practice guidelines, that such an illness or condition resulted from a cause other than such service. Id. Finally, pertinent VA treatment records were added to the file following the issuance of the most recent statement of the case. For all of these reasons, a remand is required. The matters are REMANDED for the following action: Obtain a VA addendum opinion to address the nature and etiology of the Veteran’s hepatic steatosis/fatty liver. The examiner must review the Veteran’s electronic claims file. The Board leaves it to the discretion of the clinician to determine whether the Veteran needs to be examined. The examiner is asked to answer the following. (a.) Is it at least as likely as notthat the disability had onset in, or is otherwise related to the Veteran’s period of service, to include contaminated water at Camp LeJeune? Clarification is requested with respect to the July 2019 VA opinion as the examiner indicated that the opinion was based in part, on an inaccurate fact that the Veteran’s father had Gilbert’s disease. In responding to this inquiry, the examiner must acknowledge and discuss the inclusion of hepatic steatosis in 38 C.F.R. § 17.400. (b.) If it is determined that the Veteran’s hepatic steatosis is not directly related to service, is it at least as likely as not aggravated by the Veteran’s service-connected diabetes mellitus, type II? The Board acknowledges the June 2020 VA opinion with respect to causation, but clarification is required as to whether the Veteran’s diabetes mellitus type II aggravates the Veteran’s hepatic steatosis. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Donna D. Ebaugh, 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.