Citation Nr: 18157948 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-58 450A DATE: December 13, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for cirrhosis of the liver, claimed as secondary to hepatitis C, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1971 to August 1973. This matter came to the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Hepatitis C The Veteran claims that he contracted hepatitis C when he was admitted to the hospital while stationed in Germany. He asserts that the hospital admitted him to the hepatitis ward due to the lack of space. See January 2014 VA 21-526EZ Fully Developed Claim, December 2016 VA Form 9. Service treatment records indicate that the Veteran was diagnosed with pneumonia and hospitalized for 15 days in Wurzburg, Germany. A July 2010 VA clinical record notes a past history of hepatitis C, and hepatitis C diagnoses are reflected in December 2012 and January 2013 VA clinical records. VA recognizes risk factors for contracting hepatitis C that include: transfusions of blood or blood products before 1992, hemodialysis, accidental exposure to blood, intravenous or intranasal cocaine use, high risk sexual activity, and other direct percutaneous (through the skin) exposure to blood such as tattooing, body piercing, acupuncture with non-sterile needles, and shared toothbrushes or shaving razors. The Board notes that there is no medical opinion addressing the etiology of the Veteran’s hepatitis C. The Board finds that whether the Veteran’s hepatitis C is related to an in-service hospitalization, or due to another risk factor, is a medical question outside of its jurisdiction. See Colvin v. Derwinski, 1 Vet. App. 171 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). As the evidence indicates that the Veteran’s hepatitis C may be associated with his in-service hospitalization, but the evidence of record is insufficient to decide the claim, a remand is appropriate to obtain a medical opinion. See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Cirrhosis of the liver, claimed as secondary to Hepatitis C The Veteran contends that his cirrhosis of the liver is caused by his hepatitis C. The evidence of record indicates that the Veteran was diagnosed with cirrhosis in January 2013. Because the cirrhosis of the liver claim will be significantly impacted by the pending claim referenced above, the claims are inextricably intertwined. See e.g., Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that when a determination on one issue could have a significant impact on the outcome of another issue, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Thus, the claim for service connection for cirrhosis of the liver must be remanded as well and an opinion obtained on the etiology of the Veteran’s cirrhosis of the liver. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his hepatitis C and cirrhosis of the liver. The claims file, including a copy of this remand, should be reviewed by the examiner. The examiner should provide an opinion as to whether it is at least as likely as not (at least a 50 percent probability) that hepatitis C had its onset in service or is otherwise related to military service, to include consideration of the Veteran’s hospitalization in Germany for pneumonia including his statement that he was admitted to the hepatitis ward. A complete rationale should be provided for all opinions given. (Continued on the next page)   The examiner should also offer an opinion as to whether the cirrhosis of the liver is related to service or either (a) caused or (b) aggravated by the hepatitis C. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Walker, Associate Counsel