Citation Nr: 0815014 Decision Date: 05/06/08 Archive Date: 05/12/08 DOCKET NO. 03-10 731 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois THE ISSUE Entitlement to compensation under 38 U.S.C.A. § 1151 for hepatitis C claimed as due to VA hospitalization and surgery in December 1983/January 1984. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Ishizawar, Associate Counsel INTRODUCTION The appellant is a veteran who served on active duty from November 1963 to November 1967. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2002 rating decision of the Chicago, Illinois RO. In March 2008, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the veteran's claims file. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if any action on his part is required. REMAND The Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002) and the regulations implementing it apply in the instant case. While the notice provisions of the VCAA appear to be satisfied, the Board is of the opinion that further development of the record is required to comply with VA's duty to assist the veteran in the development of the facts pertinent to his claim. See 38 C.F.R. § 3.159 (2007). A review of the veteran's John Cochran VA Hospital treatment records from December 1983/January 1984 found that when he was admitted to the hospital in December 1983, he denied any history of hepatic or renal dysfunction, or bleeding. Progress notes from January 5, 1984, the day of the operation, note that the veteran had an estimated blood loss of 500 cc with 3000 cc of crystalloid fluid replacement. The operative report clarified that estimated blood loss was approximately 450 cc and total fluid replacement was approximately 2800 cc of crystalloid. Operating time was seven and a half hours. Anesthesiology records are silent for blood administration during the surgery; the preanesthetic summary notes the veteran's hematocrit as 43.5 and post-anesthesiology recovery room record notes that plasma and blood were not administered in the operation room or recovery room. Nursing notes from the operation show that there were zero transfusions administered. It is the veteran's contention that he recalls being given a blood transfusion during his January 5, 1984 operation, and that it is the source of his hepatitis C virus. He states further that prior to this operation he donated blood regularly; afterwards, when he attempted to donate blood, he was told he had hepatitis and turned away. VA outpatient treatment records show that the veteran first reported having a history of hepatitis A and/or hepatitis B in or around 1997. In July 2000, lab results were positive for Anti-HCV, and hepatitis C was diagnosed. In April 2001, the veteran was started on vaccinations for hepatitis A and B. After more testing, in May 2001, it was determined that he had hepatitis C, genotype 1a, and treatment was started. Treatment for hepatitis C concluded in May 2002; lab results were normal, indicating that treatment was successful. On March 2002 VA examination the examiner stated, "The patient historical accounts, he received blood transfusion preoperatively. However, the discharge summary of this admission does not mention any blood transfusion. He denies any other blood transfusion or any history of illicit intravenous drug use. If so, his hepatitis C infection is at least as likely as not, to have been related to this blood transfusion. This was not a foreseeable event since the technology did not exist to screen blood for hepatitis C in 1984." The examiner's opinion is self-contradictory; specifically, although he notes that there is no evidence that the veteran received a blood transfusion, he opines that the veteran's hepatitis C infection is related to a blood transfusion he received at the VA in January 1984. Consequently, the medical opinion is inadequate, and further development of medical evidence is necessary. Accordingly, the case is REMANDED for the following: 1. The RO should arrange for the veteran to be examined by an appropriate physician to determine the likely etiology of his hepatitis C, and specifically whether it is related to (was caused or aggravated by) his December 1983/January 1984 VA hospitalization and surgery. The veteran's claims file must be reviewed by the examiner in conjunction with the examination. Based on examination of the veteran and review of his claims file (specifically including the clinical records of the December 1983/January 1984 hospitalization and surgery the examiner should offer opinions (with explanation) responding to the following: (a) Do the clinical records of the veteran's December 1983/January 1984 hospitalization and surgery (i) corroborate or (ii) contradict that he received a blood transfusion in connection with the hospitalization and surgery? The examiner must identify the medical records that support the stated conclusion. (b) Is the veteran's hepatitis C at least as likely as not (50 percent or better probability) related to (resulted from or increased in severity due to) any event or procedure associated with his December 1983/January 1984 VA hospitalization and surgery? The examiner must explain the rationale for all opinions given. 2. The RO should then re-adjudicate the claim. If it remains denied, the RO should issue an appropriate supplemental statement of the case and give the veteran and his representative the opportunity to respond. The case should then be returned to the Board, if in order, for further review. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board for additional development or other appropriate action must be handled in an expeditious manner. _________________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).