Citation Nr: 18150690 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 17-57 596 DATE: November 15, 2018 REMANDED The claim of entitlement to service connection for hepatitis C is remanded. The claim of entitlement to service connection for liver cancer, to include as secondary to hepatitis C, is remanded. REASONS FOR REMAND The Veteran had active duty service from January 1969 to March 1971, including service in the Republic of Vietnam. The Veteran passed away in March 2018. In September 2018, his surviving spouse was substituted as the Appellant in the instant appeal. 1. The claim of entitlement to service connection for hepatitis C is remanded. The Board cannot make a fully informed decision regarding the claim of entitlement to service connection for hepatitis C as the medical opinion of record is insufficient for adjudicative purposes. The Veteran reported the he received “air gun” injections during his entrance examination from a device shared with other servicemembers. The Veteran recalled witnessing blood run down each person’s arm after the injection as the air gun moved down the line. He also reported engagement in sexual behavior during service, which required subsequent treatment for venereal diseases, as reflected in his service treatment records. The Veteran’s service treatment records also indicate complaints of: weakness, dizziness, backaches, anxiety, depression, weight loss, and amnesic episodes. The Veteran’s January 1971 separation examination noted situational maladjustment. The Veteran reported that he also experienced spider-like blood vessels in his skin during service. He believed that these symptoms were indicative of hepatitis C. The Veteran was formally diagnosed with hepatitis C in 1994, and underwent extensive treatment for the condition. He was diagnosed with liver cancer related to his hepatitis C in April 2017, and underwent radiation treatments for the condition. The March 2017 VA medical examination report, unfortunately, is inadequate for adjudicative purposes. The examiner noted both that his hepatitis C was at least as likely as not related to service and less likely than not related to service. The examiner reported that hepatitis C was not caused by spider angiomas or acne, which was not the Veteran’s contention. The examiner then stated that the Veteran reported no history of high risk behaviors, which was untrue as the Veteran reported sexual activity. He also denied other risk behaviors such as intravenous drug use and blood transfusions, which are commonly associated with contracting hepatitis C. The remainder of the opinion provided statistics regarding infection rates, but did not specifically address the Veteran’s assertions. As the opinion addressed the wrong contentions regarding causation, and did not discuss the Veteran’s lay reports of observable behaviors and symptomatology, it is inadequate for adjudicative purposes. On remand, a new etiological opinion must be obtained that thoroughly addresses the etiology of the Veteran’s hepatitis C. 2. The claim of entitlement to service connection for liver cancer, to include as secondary to hepatitis C, is remanded. As the Veteran is asserting entitlement to service connection for liver cancer caused by hepatitis C, the Board finds that this issue is inextricably intertwined with the resolution of the remanded issue. Additionally, the March 2017 VA examination report concluded that the Veteran’s liver cancer was at least as likely as not caused by his hepatitis C. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, this issue is remanded for readjudication following evidentiary development. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an examiner with appropriate expertise, preferably one who has not previously offered an opinion in the current appeal, regarding the etiology of the Veteran’s hepatitis C. The electronic claims file should be made accessible to the examiner. The examiner should opine as to the following: (a.) Is it at least as likely as not (i.e. a probability of 50 percent or more) that the Veteran’s hepatitis C had its onset during active service or within one year of separation from service, or, otherwise resulted from active military service, to include air gun injections and/or sexual activity? (b.) Please discuss whether the symptoms listed in the Veteran’s service treatment records are reflective of undiagnosed hepatitis C. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 2. Following completion of the foregoing, the AOJ should review the record and readjudicate the claims on appeal. If any remain denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Fisher, Associate Counsel