Citation Nr: 18141724 Decision Date: 10/11/18 Archive Date: 10/11/18 DOCKET NO. 14-11 148 DATE: October 11, 2018 ORDER Entitlement to service connection for hepatitis C is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s hepatitis C is etiologically related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for hepatitis C have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from September 1974 to September 1975. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran testified at a January 2016 Board hearing before the undersigned Veterans Law Judge. The transcript is of record. The matter was previously before the Board in February 2017, at which time it issued a decision denying service connection for hepatitis C. The matter was appealed to the Court of Appeals for Veterans’ Claims (Court), which, pursuant to a Joint Motion for Remand (JMR), remanded the matter to the Board. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).. 1. Entitlement to service connection for hepatitis C Service connection may be established for disability resulting from diseases or injuries which are clearly present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1101, 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). The Federal Circuit has held that continuity of symptomatology under 38 C.F.R. § 3.303(b) applies only to chronic diseases listed in 38 C.F.R. § 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (2013). Additionally, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Veteran carries a current diagnosis of hepatitis C, which he asserts is directly related to active service, specifically to tattooing performed upon him while in service. At his Board hearing, the Veteran testified that he and several fellow servicemembers received tattoos at an off-base location, and that later in service he received a tattoo at a tattoo parlor. The Veteran further denied exposure to other risk factors for hepatitis C. He learned of his diagnosis when attempting to donate blood several years after separation. The Board forwarded the Veteran’s medical file to a medical examiner, a director of transplantation medicine in the VA healthcare system and a professor in the Division of Gastroenterology, Hepatology and Nutrition, for an etiological opinion. In an October 2016 letter, that physician indicated that the medical literature pertaining to contraction of hepatitis C through tattooing was conflicted, citing one particular study, a 1999 study by Delage, et. al., which explicitly supported a link. Although the medical expert ultimately concluded that in the Veteran’s case, hepatitis C was less likely than not service-related, the Board finds that, coupled with the Veteran’s consistent accounts of his service, his credible testimony, and the aforementioned medical study, resolving reasonable doubt in the Veteran’s favor requires a grant of service connection in this case. There is compelling evidence before the Board, in the form of the Delage study, that the Veteran’s tattooing may be etiologically related to his disability, as he has consistently argued, and he has credibly denied exposure to other risk factors. As such, the Board finds that, applying the benefit-of-the-doubt doctrine, the evidence is at least in equipoise in this case. As such, service connection for hepatitis C is granted. Gayle Strommen Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Z. Sahraie, Associate Counsel