Citation Nr: 18111197
Decision Date: 06/14/18	Archive Date: 06/14/18

DOCKET NO. 15-06 577
DATE:	June 14, 2018
REMANDED
Entitlement to service connection for hepatitis C with liver damage is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 1973 to August 1976.
In November 2017, the Veteran testified at a Board hearing in Washington, D.C. before the undersigned Veterans Law Judge. A hearing transcript has been associated with the record.  
Entitlement to service connection for hepatitis C with liver damage is remanded.
The Board finds that remand is necessary to obtain an addendum opinion regarding etiology of the Veteran’s hepatitis C.  The Veteran was afforded a VA examination in July 2014.  The examiner found that it was less likely as not that hepatitis C was incurred in service through inoculation with jet gun injectors.  The examiner simply rationalized that jet gun injectors were safe and given under strict sterile conditions.  However, the examiner failed to adequately address Fast Letter 04-13 and the biological plausibility of the Veteran having contracted hepatitis C via air gun transmission.  During the pendency of the appeal, all VA Fast and Training Letters were rescinded and summaries incorporated into VA’s Adjudication Manual, M21-1.  The Adjudication Manual currently contains a provision similar to the Fast Letter cited above. See M21-1, III.iv.4.H.2 (January 11, 2018).  The examiner also failed to address the Veteran’s competent report that he has not experienced any other known risk factors for hepatitis C.  
The matter is REMANDED for the following action:
1. Obtain VA treatment records dated from September 2017 to the present.   
2. Obtain an addendum opinion from the same examiner who conducted the September 2015 VA examination to ascertain whether it is as likely as not (i.e., to at least a 50-50 degree of probability) that causation of the Veteran’s hepatitis C is related to service.  If that examiner is unavailable, the appellant should be afforded a new VA examination.  The examiner is requested to review all pertinent records associated with the claims file.
The examiner is advised that VA concedes that transmission of hepatitis C via air gun injector is at least biologically plausible despite lack of supporting scientific evidence.  
 
All opinions are to be accompanied by a rationale consistent with the evidence of record. 
 
L. M. BARNARD
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J.N. Moats, Counsel