Citation Nr: 18155401 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-27 446A DATE: December 4, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1975 to February 1978, to include overseas service in Germany. The Veteran appeals a December 2013 rating decision by the Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for hepatitis C. The AOJ denied the claim based on the lack of an in-service event, disease, or injury. Although the Veteran contends she had treatment for a pregnancy complications with a blood transfusion in service, the AOJ found the records were “negative for any treatment.” See May 2016 Statement of the Case. The Veteran contends she was treated for pregnancy complications in January 1978 at Landstuhl Hospital in Germany. See May 2014 Notice of Disagreement. She contends the doctors did an emergency surgery where she “lost a lot of blood” and as a result “was given a blood transfusion” that caused her hepatitis C. See June 2016 Form 9. The Veteran further contends she began seeking treatment for “intermittent epigastric pain and diagnosis of mildly elevated hepatitis C” in January 2008. Id. The record includes private treatment records reflecting treatment of the Veteran’s hepatitis C by Dr. D.D. from 2012-2013. The history of present illness in those records notes the Veteran had a blood transfusion in the mid-1970s. See, e.g., October 2012, September 2012, and June 2013 Dr. D.D. Private Treatment Record. The service treatment records note a possible pregnancy in May 1977. Additionally, service personnel records include an October 1977 Statement of Medical Condition that reflects the Veteran had an abdominal operation in service. The Veteran is competent to describe the circumstances surrounding her in-service ectopic pregnancy because such comes to her through her senses and requires only personal knowledge rather than medical expertise. Layno v. Brown, 6 Vet. App. 465 (1994). The Board finds the Veteran credible in her reports that she had pregnancy complications in service which required surgery and a blood transfusion. The Veteran has maintained consistently that she had a blood transfusion during her ectopic pregnancy treatment around 1977-1978. The service records also contain convincing references that such treatment took place. Therefore, the Board has no reason to doubt the Veteran received a blood transfusion while being treated for an ectopic pregnancy. As such, VA must make reasonable efforts to assist the claimant in obtaining evidence necessary to substantiate a claim and requires that VA provide medical examinations or obtain medical opinions when necessary for an adequate decision. 38 C.F.R. § 3.159. A medical examination or medical opinion is deemed to be necessary if the record does not contain sufficient competent medical evidence to decide the claim, but includes competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability, establishes that the Veteran suffered an event, injury, or disease in service, or has a disease or symptoms of a disease manifest during an applicable presumptive period, and indicates the claimed disability or symptoms may be associated with the established event, injury, or disease. 38 C.F.R. § 3.159(c)(4). Here, there is evidence that the Veteran has a diagnosis of hepatitis C. However, no medical opinion has been given regarding the etiology of the hepatitis C in connection with any active duty risk factors, including her in-service blood transfusion. In light of the foregoing evidence of record, the Board finds that an etiology opinion from a qualified clinician should be obtained on remand to determine whether it is at least as likely as not that the Veteran’s hepatitis C was caused by an in-service event, including her in-service blood transfusion. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Obtain an opinion from a qualified clinician regarding the nature and etiology of the Veteran’s hepatitis C. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. If the reviewing clinician determines that a physical examination of the Veteran is required to answer the below inquiries, such should be accomplished. The reviewing clinician is asked to respond to the following inquiry: Is it at least as likely as not that the Veteran’s hepatitis C was related to any incident of service, including her in-service blood transfusion? For the purposes of this opinion, the reviewing clinician is to assume and accept as true that the Veteran had an in-service blood transfusion. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must 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 providing an answer to that particular question(s). DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Zheng, Associate Counsel