Citation Nr: 22012610 Decision Date: 03/04/22 Archive Date: 03/04/22 DOCKET NO. 18-23 286 DATE: March 4, 2022 REMANDED Entitlement to service connection for non-alcoholic steatohepatitis (NASH) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1971 to September 1974. This matter was previously before the Board in August 2020, whereupon entitlement to service connection was denied. Following the Veteran's appeal, the United Stated Court of Appeals for Veterans Claims (Court) issued an August 2021 Joint Motion for Remand (Joint Motion) vacating the Board's prior denial of service connection and returning the case to the Board for action commensurate with the terms of the Joint Motion. The Board is now further remanding this matter in order to effectuate the development requested for by the Court. As a reminder, the Veteran testified at a March 2020 videoconference hearing before the undersigned Veterans Law Judge. The Court in the Joint Motion found fault with the Board's failure to secure medical records pertaining to the Veteran's course of treatment with a Dr. J.B., who provided the Veteran with care concerning his NASH symptomatology beginning in 2013. Specifically, the Court noted that the Veteran submitted a March 2018 correspondence from Dr. J.B., wherein Dr. J.B. opined that the NASH was potentially attributable to the Veteran's in-service exposure to certain hazardous chemicals. As a prerequisite to dismissing the probative value of this correspondence, the Court held, the Board should have first attempted to secure copies of the records pertaining to Dr. J.B.'s treatment of the Veteran and his NASH symptomatology. Without this potentially positive evidence, the Court found that the Board could not adequately evaluate the probative value of Dr. J.B.'s opinion. Accordingly, the Court requested that the Board make an attempt to secure these records or explain why the failure to do so did not violate VA's duty to assist the Veteran in the furtherance of his claim. Pursuant to the Court's Joint Motion, the Board is therefore remanding this case in order to have the AOJ attempt to secure records pertaining to the Veteran's course of treatment with Dr. J.B. beginning in 2013. As this new documentary evidence may provide further support for the Veteran's claim, the AOJ should then secure an addendum opinion for a qualified VA examiner regarding the likely etiology of the claimed NASH condition. The matters are REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence regarding the Veteran's treatment for his NASH. To that end, the Veteran should also be invited to submit additional evidence in support of his claim, to include statements from friends and relatives. Based on his response, the AOJ must attempt to procure copies of all records which have not previously been obtained from identified treatment sources. Specifically, the AOJ must attempt to obtain copies of treatment records from Dr. J.B. beginning in 2013 that have been detailed by the Veteran and his representative. Furthermore, regardless of how the Veteran responds, the AOJ must obtain and associate any heretofore unavailable treatment records from any VA medical center at which the Veteran has received treatment, pursuant to the provisions of 38 C.F.R. § 3.159(e). 2. Following this requested development, the claims file should be provided to a qualified VA medical professional in order to elicit an addendum opinion concerning the likely etiology of the claimed NASH condition. The claims file must be reviewed by the examiner, and the examiner must note that they have reviewed the claims file prior to issuing any opinion. After review of the entire record, the examiner is asked to opine as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that NASH had onset during service or is otherwise related to active service. In setting forth this opinion, the examiner must consider, and comment upon as necessary, the March 2018 correspondence from Dr. J.B. in which he suggested that pesticide exposure could lead to the development of NASH. The examiner is also asked to comment upon the multiple research articles submitted by the Veteran which further suggest that chemical exposures can lead to the development of NASH later in life. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion expressed. The examiner is also asked to assume as true that the Veteran was exposed to the chemicals he purports to have been exposed to while in service. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Collins, 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.