Citation Nr: 18146583 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-33 405 DATE: October 31, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an increased initial rating for service-connected anxiety disorder, currently evaluated at 10 percent disabling. REASONS FOR REMAND The Veteran, who is the appellant in this case, had active service from October 1967 to June 1969. He received the Combat Action Ribbon, among other decorations, for this service. These matters come to the Board of Veterans' Appeals (Board) on appeal from a November 2013 decision of the Regional Office (RO) in Detroit, Michigan. 1. Entitlement to service connection for Hepatitis C is remanded. The Veteran contends that service connection is warranted for hepatitis C based on two theories. First, the Veteran has stated hepatitis C may have been caused by in-service exposure to blood borne pathogens when handling wounded soldiers in Vietnam. In the alternative, the Veteran contends that while undergoing a surgery for his service-connected coronary artery disease, he contracted hepatitis C. The Veteran’s service treatment records, including the entrance and exit examination are silent for any diagnosis of hepatitis C. An October 2014 letter from a private physician indicated that the Veteran was receiving care for hepatitis C. Of note, record associated with the Veteran’s 1996 heart surgery are not part of the record, nor are any VA treatment records. As such, remand is necessary to further develop the record. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. Floyd v. Brown, 9 Vet. App. 88, 93 (1996). VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to make a decision on his or her claim. 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.159(c)(4) (2017). To date, the Veteran has not been provided with a VA examination. 2. The Claims Regarding Anxiety and PTSD are Remanded. The Veteran contends that the service-connected anxiety disorder is more severe than is reflected by the currently assigned 10 percent rating.Separately, the Veteran contends that service connection is warranted for PTSD. Further development is necessary for both claims to allow the Board to make a fully informed decision. Regarding the Veteran’s claim for an increased rating for service-connected anxiety, the Veteran last underwent a VA examination in August 2013. While the passage of time alone does not warrant a new examination, given the Veteran’s complaints of worsening, and contention that a separate diagnosis and rating for PTSD is warranted, the Board finds that a current examination is necessary. Palczewski v. Nicholson, 21 Vet. App. 174 (2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007). Next, in September 2014 correspondence, the Veteran indicated that he had difficulties communicating with the August 2013 VA examiner. When VA undertakes to provide an examination, it must ensure it is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Given the Veteran’s statements about the previous VA examination, a new examination is necessary. Finally, in a January 2017 correspondence, the Veteran’s representative indicated that the Veteran underwent recent treatment for the service-connected anxiety and PTSD at the Ann Arbor VA Medical Center. These records are not part of the electronic claims file and a remand is necessary to attempt and obtain them. The matters are REMANDED for the following action: 1. Contact the Veteran and his representative and ask them to provide sufficient information and necessary authorization in order to obtain copies of any outstanding records of treatment by VA or non-VA health care providers for any Hepatitis C, Anxiety, or PTSD Treatment. The letter should specifically ask for the date and location of the 1996 heart surgery so attempts can be made to obtain those records. The letter should invite the Veteran or his representative to submit any pertinent medical evidence in support of the claims. If the Veteran or his representative provide the necessary information and authorizations, obtain any outstanding clinical records and incorporate them into the electronic claims file. 2. Associate all VA treatment records with the electronic claims file. 3. Then, schedule the Veteran for a VA examination by a physician, preferably one with expertise in infectious diseases. The entire claims file, to include a complete copy of this remand, should be made available to, and reviewed by, the designated examiner. The examiner should examine the Veteran and conduct all necessary laboratory testing. The examiner should discuss the etiology and the onset of the Veteran's hepatitis C. A history of all of the Veteran's potential risk factors of hepatitis C infection should be detailed in full and the examiner must list and discuss all documented and reported pre-service, in-service, and post-service risk factors. The examiner should then rank the documented risk factors relative to the probability that any hepatitis C infection is etiologically related to the risk factor. The examiner is then requested to provide the following opinions: a) Is it at least as likely as not that any diagnosed hepatitis C is related to the Veteran's active military service, to include the Veteran's contention that he contracted hepatitis C disease through the handling of injured soldiers during service. The bases for the opinion provided should be explained in detail. b) Is it at least as likely as not that any diagnosed hepatitis C is related to a surgery for the Veteran’s service-connected heart condition. The bases for the opinion provided should be explained in detail. c) Is it at least as likely as not that any diagnosed hepatitis C is aggravated by a surgery for the Veteran’s service-connected heart condition. The bases for the opinion provided should be explained in detail. If the examiner determines that he/she cannot provide an opinion on the issue at hand without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be rendered because the limits of medical knowledge have been exhausted regarding the etiology of the diagnosed disorder or whether additional testing or information could be obtained that would lead to a conclusive opinion. (The AOJ should ensure that any additional evidentiary development suggested by the examiner should be undertaken so that a definitive opinion can be obtained.) 4. Schedule the Veteran for a VA psychiatric examination to ascertain the severity of the service-connected anxiety and the nature and etiology of any and all other acquired psychiatric disorders. The complete record, to include a copy of this remand, and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. Any medically indicated tests should be accomplished, and all pertinent symptomatology and findings must be reported in detail. The examiner is asked to address the following questions: a) Does the Veteran have a current diagnosis of PTSD separate from the service-connected anxiety disorder? b) If so, is it at least as likely as not (50 percent probability or more) that the Veteran's PTSD is related to a verified in-service stressor. The examiner must provide a complete rationale for any opinion expressed. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Teague, Associate Counsel