Citation Nr: 18146988 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 16-12 247 DATE: November 2, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for residuals of a liver transplant, to include as secondary to hepatitis C, is remanded. REASONS FOR REMAND The Veteran had active military service in the Marine Corps from June 1972 to May 1979. This appeal comes to the Board of Veterans’ Appeals (Board) from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. 1. Entitlement to service connection for hepatitis C is remanded. 2. Entitlement to service connection for residuals of a liver transplant, to include as secondary to hepatitis C, is remanded. The Veteran contends that his hepatitis C is due to air gun immunizations during service. In March 2017, a VA examination was performed for the Veteran’s hepatitis C condition. The VA examiner opined that it was less likely than not that the Veteran’s hepatitis C was caused by or the result of service. The VA examiner explained that he spoke with the infectious disease doctor at the Richmond VA and was told that “in theory, it may be possible, but it would be speculative to come to this conclusion.” The VA examiner explained that he was unable to locate data on causation of hepatitis C related to air gun vaccine. He performed a literature search, but was unable to find any data on this as the causal agent. The March 2017 VA examiner’s opinion is speculative and he only relies on his own inability to find supporting medical literature to justify his opinion. Therefore, his rationale is inadequate. See Jones v. Shinseki, 23 Vet. App. 382 (2010) (holding that the conclusion should reflect the limitations of knowledge in the medical community at large and not those of a particular examiner). Additionally, the VA examiner failed to consider the various medical articles submitted by the Veteran that discussed the link between air gun injections and the transmission of diseases. See August 2011 Web/ HTML Documents. Therefore, on remand, a new VA examination should be afforded to the Veteran to address these matters. With regard to the Veteran’s claim for residuals of a liver transplant, to include as secondary to hepatitis C, the Board finds this to be inextricably intertwined with his claim for service connection for hepatitis C. Therefore, since the Veteran’s claim for hepatitis C is being remanded, it should also be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (providing that two or more issues are inextricably intertwined if one claim could have significant impact on the other). Further, there is no medical opinion of record regarding whether the Veteran’s residuals of a liver transplant are related to his military service. Therefore, an opinion should also be provided on this matter. The matters are REMANDED for the following action: 1. Obtain any pertinent outstanding VA or non-VA treatment records and associate with the claims file. 2. Following completion of the above, schedule the Veteran for a VA examination to determine the nature and etiology of his hepatitis C and residuals of a liver transplant. The claims file must be made available to and pertinent documents therein reviewed by the examiner in conjunction with the examination. All necessary tests should be completed. The VA examiner should address the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C is of service onset or otherwise related to his military service, to include his receiving air gun immunizations and contraction of gonorrhea. The VA examiner should consider the medical articles submitted by the Veteran that discuss the link between air gun injections and disease. See August 2011 Web/ HTML Documents. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a liver transplant are of service onset or otherwise related to his military service. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a liver transplant are caused by his hepatitis C. (d.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a liver transplant are aggravated (any worsening beyond normal progression of the disability) by his hepatitis C. If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of observable symptoms over time. (e.) A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in the medical community at large and not those of the particular examiner. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Crawford, Associate Counsel