Citation Nr: 21016037 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 15-44 764 DATE: March 19, 2021 ORDER Entitlement to service connection for hepatic steatosis, as due to exposure to contaminated water at Camp Lejeune, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s hepatic steatosis is related to service. CONCLUSION OF LAW The criteria for service connection for hepatic steatosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1967 to August 1969. The matter come before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the proceeding is associated with the electronic claims file. Subsequently, the Board remanded the matter for further development in June 2019. Service Connection for Hepatic Steatosis Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran asserts that his hepatic steatosis is related to his exposure to contaminated water at Camp Lejeune. The record reveals a diagnosis of hepatic steatosis. See July 2020 VA examination report. A veteran who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed during that service. 38 C.F.R. § 3.307(a)(7)(iii). For purposes of this presumption, “contaminants in the water supply” means the volatile organic compounds trichlo roethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride. Under 38 C.F.R. § 3.309(f), the following disabilities are presumed to be service connected for such veterans: kidney cancer, liver cancer, Non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. The record confirms the Veteran’s presence at Camp Lejeune for longer than 30 days; thus, his exposure has been conceded. As noted above, hepatic steatosis is not presumed to be associated with exposure to contaminants in the water supply at Camp Lejeune under 38 C.F.R. § 3.309(f); therefore, service connection cannot be presumed, but a direct relationship may still be established by showing that a disorder is casually linked to exposure to contaminants in the water supply at Camp Lejeune. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran’s service treatment records (STRs) do not show any liver disorder, or symptoms suggesting hepatic steatosis, and he has not alleged that it incepted while in service. Rather, he asserts that it was caused by his exposure to contaminated water at Camp Lejeune. Specifically, he testified that he was first diagnosed with liver problems in the mid-1970s, and that he has not had alcohol or weight problems that would cause liver problems. See February 2019 Board hearing transcript. Thus, the remaining inquiry before the Board is whether there is a relationship between the Veteran’s hepatic steatosis and his exposure to contaminated water at Camp Lejeune. A July 2020 VA examiner opined that the Veteran’s hepatic steatosis is less likely as not caused by or the result of his exposure to contaminated water at Camp Lejeune. The examiner indicated that according to medical literature, the most common cases of hepatic steatosis are obesity and alcohol abuse. He noted that the Veteran has the risk factor of obesity for developing hepatic steatosis, with documented resolution following weight loss. Specifically, the examiner noted that a 2010 ultrasound documented a diffuse hyper-echoic pattern, together with hepatosplenomegaly. Follow-up tests showed normalization of those results after appropriate weight loss in 2014 and 2015 and document resolution. He further noted that the Veteran did undergo dietary intervention with little benefit for some years until approximately 2014, when the first liver injury tests available in the record reveal normal results. He also indicated that in a February 2014 treatment note, the Veteran’s treating physician documented that the Veteran’s liver injury tests and fatty liver disease normalized with weight loss. The examiner indicated that hepatic steatosis may occur during or shortly after acute exposure to solvents. In most cases, hepatic steatosis associated with solvent exposure should resolve after the exposure ceases and is unlikely to occur many months or years later. Thus, the examiner reasoned that the Veteran was not diagnosed with hepatic steatosis until 2010, and that medical literature is not consistent with the diagnosis developing approximately 42 years after exposure. He indicated that the Veteran’s condition is explained by his risk factor of obesity and possibly some consumptions of alcohol. In an August 2020 VA addendum opinion, the examiner noted that considering the Veteran’s testimony that he was diagnosed in the mid-1970s and choosing 1975 as a date for diagnosis would still provide a latency period of approximately seven to nine years since his first/last potential exposure to contaminated water at Camp Lejeune in 1967 through 1968. He noted that hepatic steatosis may occur during or shortly after acute exposure to solvents. In most cases, hepatic steatosis associated with solvent exposure should resolve after the exposure ceases and is unlikely to occur many months or years later. The examiner noted that while the exact cause of fatty liver disease is not known, obesity is the most common cause. The examiner further noted that using the Veteran’s estimated diagnosis in the mid-1970s and assumption of no significant alcohol or weight problems, the Veteran’s fatty liver disease is less likely as not caused by or a result of his exposure to contaminated water at Camp Lejeune. He indicated that the medical records simply do not correlate with a diagnosis of fatty liver disease from the mid-1970s related to contaminated water exposure at Camp Lejeune, approximately seven to nine years prior. He stated that many factors go into consideration of nonalcoholic fatty liver disease such as alcohol, drugs, diabetes, poor nutrition, and weight, all of which can explain fatty liver disease. Weight loss, proper nutrition, and a low calorie diet is accompanied by improvement in fatty change and return of liver function tests to normal. Thus, he reasoned that the alleged onset of fatty liver disease in the mid-1970s is simply too long of a period to be related to exposure to contaminated water at Camp Lejeune seven to nine years prior as hepatic steatosis may occur during or shortly after acute exposure to solvents, which is not documented nor alleged. He concluded that hepatitic steatosis associated with solvent exposure should resolve after the exposure ceases and is unlikely to occur many months or years later. After considering all of the evidence of record, the Board finds that the preponderance of the evidence is against the claim for service connection for hepatic steatosis. The evidence of record indicates that there is no relationship between the Veteran’s condition and the toxic water supply at Camp Lejeune. Specifically, the July and August 2020 VA examiner opined that the claimed condition is less likely than not caused by or the result of exposure to contaminated water at Camp Lejeune. The Board finds the July and August 2020 VA medical opinions to be probative because the opinions are based on a review of the record and medical literature as well as provide an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board notes that a July 2020 VA medical opinion is opposed to this conclusion, as the examiner opined that the Veteran’s hepatic steatosis is due to his exposure to contaminated water at Camp Lejeune. He reasoned that the Veteran did not have any medical conditions noted in the mid-1970s which would likely cause his liver disease. However, the Board does not find this contrary medical opinion to have comparable probative value, as the examiner did not base his opinion on review of relevant medical literature and failed to provide an adequate rationale for his conclusion. In reaching this decision, the Board has considered the Veteran’s lay contentions that his condition is related to exposure to contaminated water at Camp Lejeune. The Board acknowledges his sincere belief; however, he has not been shown to have the training or expertise to competently attribute his condition to that exposure. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, although the Board has carefully considered the lay contentions of record, the Board ultimately affords the probative and objective medical evidence of record, which investigated that theory and found it less likely, with greater probative weight. Specifically, the Board affords more probative weight to the competent opinion of the July 2020 and August 2020 VA examiner. Accordingly, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Robinson, 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.