Citation Nr: 18142856 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-31 857 DATE: October 17, 2018 REMANDED Entitlement to service connection, to include under 38 U.S.C. § 1151, for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to February 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs Regional Office (RO). 1. Entitlement to service connection, to include under 38 U.S.C. § 1151, for hepatitis C is remanded. The Veteran asserts entitlement to service connection for hepatitis C. Specifically, the Veteran asserts that following active duty service he underwent surgical procedures in 1971 and 1972 that required blood transfusions. In a March 2014 statement, the Veteran denied other hepatitic C high risk activities, including drug use, but did report that he received inoculations during service. Thus, the record raises entitlement to service connection on a direct basis. While the Veteran has denied high risk activities other than blood transfusions, a December 2011 VA medical record shows that he reported the following risk factors: 1971 blood transfusion; greater than 10 sexual partners; intranasal cocaine use in 1968; military exposure in 1968; and a history of high risk employment. A review of the claims file shows that the Agency of Original Jurisdiction (AOJ) attempted to obtain VA treatment records from the Kansas City VA medical center with regard to the Veteran’s reported 1971-1972 surgical procedures. However, despite reported surgical procedures in 1971 and 1972, a development letter dated August 2014 shows that VA medical records were only requested dating from June 1972 to August 1972. Accordingly, further efforts should be made to obtain any outstanding treatment records. The Board also notes that a VA examination report was obtained in August 2015. The examiner was notified that the record did not contain evidence of a blood transfusion in 1972, but was asked to assume that such procedure took place. Based on that assumption, the examiner was asked to opine whether the Veteran’s hepatitis C was caused by or became worse as a result of VA treatment. Based on a review of the claims file and the historical change in medical standards of care for hepatitis C, the examiner was unable to provide a medical opinion without resorting to mere speculation. In this regard, the examiner noted he/she was unable to opine on the given hypothetical without adequate medical records documenting the event. In an addendum opinion, the examiner did determine that it was less likely than not that in 1972 a hospital or medical provider could have determined that blood provided in a transfusion might have been infected with hepatitis C. In a April 2018 brief, the representative asserted that the August 2015 VA examination was inadequate as the examiner was not shown to have any particular expertise, experience, training or competence in commenting on hepatology disorders. Specifically, the representative noted that credentials of the examiner were not noted. Indeed, a review of the examination report reveals that neither the August 2015 VA examiner’s name or credentials were identified. Additionally, while the record raised a theory of entitlement to service connection on a direct basis, no such medical opinion addressing that theory was requested by the AOJ. Accordingly, the Board finds the August 2015 VA examination report incomplete and, thereby, currently inadequate to adjudicate the issue on appeal and a new VA examination should be obtained. VA’s duty to assist a claimant includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d)(1); 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran’s VA treatment facilities, to include records relating to surgical procedures conducted at the Kansas City VA medical center between January 1971 and December 1972. Archived records should be requested. If the requested records are not available, or if the search for any such records otherwise yields negative results, a memorandum of unavailability should be prepared and associated with the claims file, and the Veteran should be notified. 2. Identify the name and credentials of the author of the August 2015 VA hepatitic C examination report. 3. Following completion of step 1 above, schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of the diagnosed hepatitis C. All risk factors for contracting hepatitis C should be identified, including risk factors reported by the Veteran in a December 2011 VA medical record. For the claim of entitlement to service connection on a direct basis, the examiner should provide the following opinion: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed hepatitis C is etiologically related to his period of service, to include as due to in-service inoculations. Please explain why or why not. For the claim of entitlement to compensation under 38 U.S.C. § 1151, the examiner should provide the following opinions: (a) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran contracted hepatitis C as a result of the medical care, or a lack thereof, received at a VA medical center, to include as a result of surgeries performed. Please explain why or why not. (b) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran contracted hepatitis C as a result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA’s part (i.e. did VA fail to exercise the degree of care that would be expected of a reasonable healthcare provider)? Please explain why or why not. (c) Based upon the specific facts and circumstances of this Veteran’s case, was the Veteran’s contracted hepatitis C a reasonably foreseeable outcome of the treatment received? Please explain why or why not. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination, including this Remand. All indicated studies should be completed. Reasons should be provided for any opinion rendered. If the examiner cannot provide an opinion without resorting to mere speculation, please provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that you have exhausted the limits of current medical knowledge in providing an answer to that particular question. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lamb, Associate Counsel