Citation Nr: 18160773 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 16-63 462 DATE: December 27, 2018 ORDER Entitlement to service connection for hepatitis C is granted. Entitlement to service connection for vasculitis secondary to hepatitis C is granted. Entitlement to service connection for chronic renal failure secondary to hepatitis C is granted. Entitlement to service connection for hypertension secondary to chronic renal failure is granted. FINDINGS OF FACT 1. The record is evenly balanced as to whether the Veteran’s hepatitis C is etiologically linked to his active service. 2. The Veteran’s vasculitis is secondary to his service-connected hepatitis C. 3. The Veteran’s chronic renal failure (renal insufficiency) is secondary to his service-connected hepatitis C. 4. The Veteran’s hypertension is secondary to his service-connected chronic renal failure. CONCLUSIONS OF LAW 1. The criteria for service connection for hepatitis C have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (West 2012); 38 C.F.R. § 3.303 (2017). 2. The criteria for service connection for vasculitis secondary to service-connected hepatitis C have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.310 (2017). 3. The criteria for service connection for chronic renal failure (renal insufficiency) secondary to service-connected hepatitis C have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.310 (2017). 4. The criteria for service connection for hypertension secondary to service-connected chronic renal failure (renal insufficiency) have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.310 (2017) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from May 1989 to May 1993. The Veteran indicated in his December 2016 Form 9 that he did not want a Board hearing. In a subsequent December 2016 written statement submitted via his current representative, the Veteran indicated that he wanted a hearing. However, in a September 2017 Brief, the same representative checked the box indicating that the Veteran rests the appeal on the statement of the case and the hearing on appeal (if conducted) and has no further evidence to submit. As such, it is unclear whether the request for a hearing has been withdrawn. However, in light of the favorable decision to grant the issues on appeal, the Veteran will not be prejudiced by the Board’s adjudication of the appeals. Service Connection 1. Entitlement to service connection hepatitis C The Veteran asserts that his hepatitis C is the result of his exposure to unsanitary living conditions while deployed in Southwest Asia. The record reflects a current diagnosis for hepatitis C, and the Veteran’s military personnel records establish his deployment to Southwest Asia in the 1990s. As such, a current diagnosis and in-service incurrence are established, and the remaining issue is a nexus. The Veteran provided a private opinion dated in May 2016 wherein the examiner indicated that there is a 90 percent probability that the Veteran’s hepatitis C was contracted during his deployment to Kuwait in the 1990s. The Board acknowledges that the opinion lacks an entirely sufficient rationale. However, that the examiner considered the Veteran’s deployment in Kuwait allows for a reasonable assumption that the examiner considered the Veteran’s living conditions in Kuwait. Additionally, there is not a negative opinion of record to counter the May 2016 private opinion. In September 2015, the Veteran underwent a VA examination for Gulf War conditions. The examiner acknowledged a current diagnosis for hepatitis C as well as a number of current associated complications of the Veteran’s hepatitis C. However, the examiner did not address an etiology of the Veteran’s hepatitis C. As such, the Board finds the evidence evenly balanced as to whether the Veteran’s hepatitis C is related to his exposure in Kuwait. Resolving any reasonable doubt in the Veteran’s favor, the Board finds the May 2016 opinion adequate and probative to indicate that the Veteran’s hepatitis C is related to his exposure in Southwest Asis. As such, a nexus is established. Accordingly, in light of the evidence, the Board finds that service connection for hepatitis C is warranted. 2. Entitlement to service connection for vasculitis and chronic renal insufficiency secondary to hepatitis C As service connection for hepatitis C has been established, the Board finds that service connection for vasculitis and renal failure secondary to hepatitis C are also warranted. The record reflects current diagnoses for vasculitis and chronic renal failure. Thus, the remaining issue is a nexus. The May 2016 private opinion indicates that the Veteran’s hepatitis C has resulted in kidney and liver failure. Additionally, the September 2015 VA examination regarding Gulf War conditions indicates that the Veteran’s vasculitis and renal insufficiency are secondary to his hepatitis C. As such, the Board finds that a medical link has been established linking both the Veteran’s vasculitis and his renal insufficiency to his now service-connected hepatitis C. Accordingly, service connection for vasculitis secondary to hepatitis C is granted, and service connection for chronic renal insufficiency secondary to hepatitis C is granted. 3. Entitlement to service connection for hypertension secondary to chronic renal insufficiency The Board also finds that service connection for hypertension is warranted as secondary to the Veteran’s now service-connected chronic renal failure. The record reflects a current diagnosis for hypertension. Thus, the remaining issue is a nexus. In September 2015, the Veteran was also afforded a VA examination for kidney conditions. The examiner provided a diagnosis for chronic renal failure and also indicated that the Veteran has hypertension due to renal dysfunction or caused by any kidney condition. Additionally, the September 2015 Gulf War conditions examiner indicated that the Veteran’s hypertension has a clear and specific etiology. As such, the Board finds that a medical link has been established linking the Veteran’s hypertension to his now service-connected renal insufficiency. Accordingly, service connection for hypertension secondary to chronic renal failure is granted. T. BERRY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Smith, Associate Counsel