Citation Nr: 21014196 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-26 477 DATE: March 11, 2021 REMANDED Entitlement to service connection for esophageal varices is remanded. Entitlement to service connection for hepatic steatosis is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1962 to August 1964. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision of the Louisville, Kentucky Department of Veterans Affairs (VA) Regional Office (RO). A videoconference hearing was held before the undersigned Veterans Law Judge (VLJ) in January 2019. A transcript of the hearing has been associated with the record. In a May 2019 decision, the Board denied entitlement to service connection for esophageal varices and hepatic steatosis. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (“Court” or “CAVC”), and the CAVC issued a memorandum decision in June 2020 that vacated the Board’s May 2019 decision and remanded the matters for adjudication consistent with the instructions outlined in the memorandum decision. Entitlement to service connection for esophageal varices and hepatic steatosis. In the June 2020 memorandum decision, the CAVC found that that the Board erred by not discussing a June 2015 medical opinion by Dr. S. The CAVC further instructed the Board to consider whether the Veteran raised a challenge to the December 2013 VA subject matter expert’s competence in the July 2015 correspondence. Additionally, the CAVC noted that the December 2013 VA examiner did not explain how being overweight was a risk factor in providing an opinion as to the etiology of the Veteran’s liver condition. Accordingly, the Board finds that remand for a VA medical opinion conducted by a hepatologist is necessary to address the evidence of record, specifically to include the December 2013 VA medical opinion drafted by a pulmonologist, who was a Camp Lejeune Contaminated Water Subject Matter Expert; the June 2015 medical opinion by Dr. S. and found in the Veteran’s VA treatment notes; and the December 2018 private medical opinion. The hepatologist is further asked to address how being overweight with a body mass index of 27 is a risk factor of developing hepatic steatosis. The matters are REMANDED for the following action: Forward the Veteran’s claims file to a hepatologist, if available. If a hepatologist is not available, then the Veteran’s claims file should be provided to an examiner well-versed in Camp Lejeune Contaminated Water matters. The examiner must review the claims file, specifically to include the June 2020 CAVC memorandum decision and this remand. The examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hepatic steatosis and esophageal varices were caused by or related to his active duty service, including exposure to contaminated water while stationed at Camp Lejeune? In doing so, the examiner must address the December 2013 VA medical opinion drafted by a pulmonologist, who was a Camp Lejeune Contaminated Water Subject Matter Expert; the June 2015 medical opinion by Dr. S. and found in the Veteran’s VA treatment notes; and the December 2018 private medical opinion. The examiner is further asked to address how being overweight with a body mass index of 27 is a risk factor of developing hepatic steatosis. The examiner is advised that a negative opinion cannot be based solely on the fact that hepatic steatosis and esophageal varices are not on the list of diseases that are presumptively associated with exposure to contaminants in the water supply at Camp Lejeune. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffin, Associate 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.