Citation Nr: 18159095 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 15-05 742 DATE: December 18, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to nonservice-connected pension is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1986 to December 1992. The Veteran provided testimony at a May 2018 Board video conference hearing. The hearing transcript is of record. 1. Entitlement to service connection for hepatitis C is remanded. The Veteran contends that hepatitis was diagnosed in service. A September 1986 American Red Cross Blood Donor Program screen, dated during service, was negative for Hepatitis B Surface Antigen (HBsAg), but identified elevated ALT (Liver Enzymes). A January 1987 letter from the American Red Cross, associated with service treatment records, informed the Veteran of the elevated ALT level and recommended that he be evaluated for the probability of hepatitis. Lab work completed in February 1987 shows that he had nonreactive HAV AB IGM and HBS AG, but was reactive for HBS AB and HBC AB. A February 1987 written note refers to the laboratory report and the assessment was to rule out hepatitis contact. A December 2013 opinion referenced a negative September 1986 screen for hepatitis B, however, the screen did not include testing for hepatitis C and prompted a recommendation for further evaluation. A December 2014 opinion indicated that service medical records did not reveal an injury or event related to the development of hepatitis, but did not address whether currently diagnosed hepatitis C nonetheless had its onset in service, and did not discuss the significance of the lab work completed in 1987. Accordingly, a remand for a supplemental medical opinion is warranted. Additionally, in the December 2014 VA examination report, the examiner noted that the Veteran reported he had been evaluated by Dr. Beal in 1995 and underwent a liver biopsy at that time. The examiner noted that these records were not in the file, which are relevant to this issue. The Veteran will be given an opportunity to provide VA with permission to obtain these records or submit these records to VA 2. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), anxiety, depression, and bipolar disorder is remanded. A September 2018 private psychological evaluation indicates that the Veteran had past and current claims for Social Security Disability Income (SSDI). Additionally, in Board hearing testimony, the Veteran reported that he began receiving VA treatment shortly after service in 1992 or 1994. According, a remand is warranted to obtain outstanding Social Security Administration (SSA) records and VA treatment records dated prior to 2012. The Board finds, additionally, that a supplemental VA medical opinion is necessary to address the Veteran’s diagnoses of depression and anxiety identified in VA medical records and the diagnosis of bipolar disorder, recently provided by a September 2018 psychological evaluation.   3. Entitlement to nonservice-connected (NSC) pension is remanded. Finally, because a decision on the issues of entitlement to service connection could significantly impact a decision on the issue of entitlement to NSC pension, the issues are inextricably intertwined, and a remand of the pension claim is required. The matters are REMANDED for the following action: 1. The Veteran should provide VA with permission to obtain Dr. Beal’s records pertaining to treatment the Veteran underwent in the 1990s for hepatitis C or he can submit Dr. Beal’s records himself. 2. After giving time to obtain Dr. Beal’s records or after receipt of the records, if submitted by the Veteran, obtain a supplemental medical opinion from a physician in an appropriate specialty to address the etiology of hepatitis C in light of lab work completed in service. Another examination is not required. However, if the examiner finds that a physical examination is warranted, one should be scheduled. The examiner is informed of the following facts: • The Veteran contends that hepatitis C was diagnosed in service, which service dates are from March 1986 to December 1992. • The service treatment records show that based on elevated ALT levels in September 1986, he was referred for further evaluation for hepatitis. Lab work completed in February 1987 shows that he had nonreactive HAV AB IGM and HBS AG, but was reactive for HBS AB and HBC AB. Most of the service treatment records addressing these facts are in VBMS entry with document type, “STR – Medical,” receipt date 05/29/2014, with “#1” in the subject line. The documents are spread out throughout the 113 pages. • There is one service treatment record, dated in May 1987, in VBMS entry with document type, “STR – Medical,” receipt date 05/29/2014, with “#2” in the subject line, on page 18, that shows a provisional diagnosis of “? Hepatitis contact.” • There is a February 2013 letter from the American Red Cross that attached blood donation screening test restults. See VBMS entry with document type, “Medical Treatment Record – Non-Government Facility,” receipt date 03/27/2013. • The Veteran underwent a VA examination in December 2013 in connection with his claim for service connection for hepatitis. See VMBS entry with document type, “VA Examination,” receipt date 12/19/2013, beginning on page 2. • The Veteran underwent another VA examination in December 2014 in connection with his claim for service connection for hepatitis. See VMBS entry with document type, “C&P Exam,” receipt date 12/11/2014. • The Board has requested that Dr. Beal’s records be obtained and added to the record. Therefore, it is possible that these records have been obtained. The examiner is asked to provide an opinion as to whether it is at least as likely as not (50% probably or higher) that hepatitis C had its onset in service. In providing the opinion, please discuss the significance of the September 1986 referral and February 1987 findings in the service treatment records. 3. Obtain outstanding VA treatment records dated from 1992 to 2012, to include medical records from the VA medical centers in Kansas City, Kansas and Muskogee, Oklahoma. 4. Obtain SSA records relating to an application for SSDI. 5. After all outstanding medical evidence has been associated with the record, obtain a supplemental medical opinion from a VA psychiatrist or psychologist to address the etiology of the Veteran’s diagnoses of depression and anxiety identified in VA medical records, and the diagnosis of bipolar disorder provided by a September 2018 psychological evaluation. Another examination is not required; however, if the examiner finds that an examination is warranted, one should be scheduled. If an examination is scheduled, any testing deemed warranted by the examiner should be performed. The examiner is informed of the following facts: • The Veteran served on active duty from March 1986 to December 1992. • In May 2000, the Veteran was seen by VA and reported he was “very explosive.” The examiner wrote that the Veteran appeared to be controlling and that when things were not done according to how he thinks it should be done, he would blow up and become verbally intimidating and abusive. He reported that this behavior appeared to have begun approximately three years after his discharge from the Army (which would have been in approximately 1995) and intensified since diagnosed with hepatitis C. The examiner diagnosed the Veteran with an organic affective disorder secondary to chronic pain. See VBMS entry with document type, “CAPRI,” with “#2” in the subject line, receipt date 11/12/2013, on pages 162-163. • In June 2000, the Veteran was seen for a consultation. He discussed problems with his temper and flying off the handle. He was diagnosed with generalized anxiety disorder with secondarily situational disorder. See VBMS entry with document type, “CAPRI,” with “#2” in the subject line, receipt date 11/12/2013, on pages 161-162. • The Veteran underwent a VA psychiatric examination in October 2013. The examiner found that the Veteran did not meet the criteria for PTSD under DSM-IV criteria and that the Veteran did not have a mental disorder that conformed with DSM-IV criteria. See VBMS entry with document type, “VA Examination,” receipt date 10/24/2013. • VA treatment records show diagnoses of PTSD, depression, and anxiety. • A July 2018 private psychiatric evaluation shows that the examiner found that the Veteran had bipolar disorder, presently manic with psychotic features and poly substance dependence in partial remission. See VBMS entry with document type, “Medical Treatment Record - Non-Government Facility,” receipt date 09/12/2018. • The July 2018 private psychologist found that the Veteran had “clearly polysubstance dependency dating back to [the Veteran’s] time in Saudi Arabia, as evidenced by records, positive drug screens, and [the Veteran]’s narratives.” The Veteran had claimed he received an Article 15 in service due to drug abuse; however, the Board finds that such statements of drug abuse while in service are not supported by the service records. Therefore, the Board does not find as fact that the Veteran was abusing drugs while in service. The examiner is asked to provide an opinion as to whether a currently diagnosed acquired psychiatric disorder is at least as likely as not (50% probability or higher) related to service, which period of service was from March 1986 to December 1992. In providing a rationale, the examiner should discuss relevant evidence of record and should address the September 2018 private psychological evaluation. 6. After the above development has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to non-service-connected pension.   A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christine C. Kung