Citation Nr: 18154780 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 17-15 144 DATE: November 30, 2018 ORDER Service connection for hepatitis C is denied. FINDING OF FACT The evidence of record does not establish that the Veteran’s Hepatitis C was incurred in or caused by his service. CONCLUSION OF LAW The criteria for establishing service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, served on active duty from November 1968 to November 1970. Regarding the claim of service connection for benign prostate hypertrophy, which is being claimed as due to exposure to herbicide agents, on August 16, 2018, the Federal Circuit ordered the appeal of Procopio v. Wilkie, No. 17-1821 (U.S. Fed. Cir.). The order stated that the questions before the Federal Circuit include the following: “Does the phrase ‘served in the Republic of Vietnam’ in 38 U.S.C. § 1116 unambiguously include service in offshore waters within the legally recognized territorial limits of the Republic of Vietnam, regardless of whether such service included presence on or within the landmass of the Republic of Vietnam?” As of the date of this decision, Procopio is pending. As this appeal contains at least one issue that may be affected by the resolution of Procopio, the Board will “stay” or postpone action on this matter. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, there must be medical evidence of current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303(a). The Board has reviewed all of the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Service connection for hepatitis C The Veteran contends that service connection is warranted for hepatitis C. He believes that the etiology for this disability is the vaccinations that he received while on active duty. He points out that the vaccinations were carried out using an air gun system. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of hepatitis C, and evidence, including his lay statements, shows that he may have received vaccinations in service using an air gun system, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of hepatitis C began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show the Veteran has a diagnosis of hepatitis C, but this was not diagnosed until many years after his separation from service. Notably, it is not the Veteran’s contention that his hepatitis C had its onset in service and has continued since then. Rather, as noted above, he asserts it is related to the vaccinations he received in service. Despite this belief, the Veteran (as a lay person) is not competent to opine as to the etiology of his hepatitis C. The question of whether his hepatitis C is related to the vaccinations given by an air gun system in service is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Instead, a May 2014 VA examiner reviewed the claims file and opined that the Veteran’s hepatitis C was not at least as likely as not related to an in-service injury, event, or disease, including vaccinations by air gun. The rationale was that at the present time, according to the consensus of the medical literature, there was insufficient information to provide the risk transmission percentage for hepatitis C from air gun inoculations. The closest comparable event would be that of a needle stick risk, which was an extremely low risk. The examiner noted that newer, larger surveys showed only a 0.5 percent transmission rate; although earlier, smaller studies had shown a reported rate of 1.8 percent. In addition, the examiner noted the Veteran’s history of IV drug use, which was considered to more likely have resulted in hepatitis C. The examiner’s opinion is probative, because it is was provided by a physician (who is competent to provide such an opinion) and based on an accurate medical history and includes an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). (Continued on the next page)   For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for hepatitis C, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Joseph P. Gervasio