Citation Nr: 18114228
Decision Date: 06/26/18	Archive Date: 06/26/18

DOCKET NO. 15-18 530
DATE:	June 26, 2018
REMANDED
Entitlement to service connection for hepatitis C is remanded.
REASONS FOR REMAND
The Veteran had active service from December 1968 to February 1972.  In June 2018, he testified at a videoconference hearing before the undersigned Veterans Law Judge.  A transcript of the hearing is of record.
1. Entitlement to service connection for hepatitis C is remanded.
The Veteran initially contended his hepatitis C resulted from immunizations in service.  He now contends his hepatitis C may also have resulted from exposure to blood products in service.  In his April 2015 VA Form 9, substantive appeal, he reported he was involved in many firefights during his Vietnam service, but the worst was an attack on the supply depot at Camp Radcliff in March 1969 and he reported being tasked with cleanup after the attack.  He reported that during the cleanup he was exposed to blood products due to the open wound he had on his hands and legs resulting from being cut up by the brush in the jungle.  In June 2018, the Veteran testified to the same exposure.  He also testified he had no other risk factors.  
Of record is a December 2014 letter from a private physician, Dr. P. who noted that the Veteran’s primary diagnosis was chronic hepatitis C, that he underwent a combined liver/kidney transplant in December 2011, and that it was unclear when he was infected with HCV (hepatitis C virus), but indicated that this “may have been 20-40 years ago which includes his time in the service in Vietnam”.  
To date, the Veteran has not been provided a VA examination addressing whether hepatitis C may be related to service.  In light of the foregoing, as well as the competent evidence of record, a medical nexus opinion is necessary to assist in determining the probable etiology of his hepatitis C, especially in terms of the likelihood it results from the exposure to blood products/dead bodies he reported during his service in Vietnam.  McLendon v. Nicholson, 20 Vet. App. 79 (2006).
The matter is REMANDED for the following action:
Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his hepatitis C.  The examiner should be asked to provide an opinion as to whether it is at least as likely as not that the Veteran’s hepatitis C is related to his military service, to include his immunizations and/or exposure to blood and dead bodies therein.  The examiner must identify all of the Veteran’s potential risk factors for contracting hepatitis C, to include whether those risk factors occurred prior to, during, or subsequent to service. 
The examiner must explain the rationale for any opinion(s) given, and if unable to provide the requested opinions without resorting to speculation, the examiner should clearly and specifically so specify, along with an explanation as to why that is so.  If the examiner feels the requested opinion cannot be rendered without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training).
 
A. ISHIZAWAR
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	D.M. Casula, Counsel