Citation Nr: 18116573 Decision Date: 07/06/18 Archive Date: 07/06/18 DOCKET NO. 15-17 667 DATE: July 6, 2018 ORDER Service connection for hepatitis C is denied. FINDINGS OF FACT 1. The Veteran had active service from April 1968 to July 1969. 2. Hepatitis C is not related to service, to include any injury or event therein. CONCLUSION OF LAW Hepatitis C was not incurred in service. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION In a May 2018 letter from the RO, the Veteran was made aware of the Rapid Appeals Modernization Program (RAMP) and in a subsequent letter, the Veteran elected to participate in RAMP, selecting the option for “Higher-Level Review.” However, as noted in the May 2018 letter, appeals that have been activated by the Board are not eligible for RAMP processing. The issue of entitlement to service connection for hepatitis C was activated by the Board in August 2016. As the issue discussed below has already been activated by the Board, the Board will continue with adjudication pursuant to current appeals procedures. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be warranted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). When all 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 preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In this case, the evidence of record clearly establishes that the Veteran has been diagnosed with hepatitis C. Specifically, VA treatment records indicate that he was diagnosed with hepatitis C in February 2013. Therefore, a current diagnosis is shown. While a current diagnosis is shown, presumptive service connection is not for application. Specifically, presumption based upon continuity of symptomatology is not warranted because hepatitis C is not one of the chronic diseases set forth in 38 C.F.R. §§ 3.307(a)(2), 3.309(a). Further, since hepatitis C is not one of the enumerated disorders, the one-year presumption is also not warranted. Moreover, the Veteran has not argued, and the record does not show, that hepatitis C is related to a service-connected disability. As such, secondary service-connection is not warranted. Therefore, the threshold question is whether there is a medical nexus between an injury or event in service and the current diagnosis of hepatitis C. Initially, his service treatment records (STRs) reveal no complaint of, diagnosis of, or treatment for, hepatitis or any symptoms that could be reasonably attributed to hepatitis. Moreover, hepatitis C was not recognized prior to the late 1980s and as he separated from service in late 1969, the absence of in-service manifestations is not dispositive of the issue. Instead, in a June 2014 statement, the Veteran asserted that his symptoms began in service and that he acquired this disease as a result of contaminated blood exposure in service. Specifically, he asserted that as he lined up to get shots while in service, the same needle was used over and over. He explicitly denied use of any illicit drugs, or high risk sexual exposure. Generally, a veteran is competent to report that which he perceives through the use of his senses, including events capable of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran is found to be a competent and credible regarding the in-service events. That said, it is not the end of the inquiry. Also relevant to this issue, several risk factors for hepatitis C have been recognized by VA, including intravenous (IV) drug use, blood transfusions before 1992, organ transplant before 1992, hemodialysis, intranasal cocaine, high-risk sexual activity, accidental exposure while a health care worker, and various kinds of percutaneous exposure such as tattoos, body piercing, acupuncture with non-sterile needles, shared toothbrushes or razor blades. See VBA letter 211B (98-110) Nov. 30, 1998. Post-service medical records indicated that the Veteran was not diagnosed with hepatitis C until February 2013. Importantly, he had several blood tests between November 2005 and February 2011 all of which revealed an unremarkable blood count and stable hepatic panels. Specifically, in February 2011, his hepatic function was found to be normal upon examination. In May 2013, the Veteran sought VA treatment after a positive hepatitis C test and diagnosis in February 2013. When asked about risk factors of exposure, he stated that he was exposed to other people’s blood through his work as a tow truck driver and helping at accident scenes. In September 2013 VA treatment notes, he listed his only pertinent risk factor as exposure during the service. He did not specify the method of his exposure at that time. Since that time, he has denied exposure to blood during his work as a tow truck driver. However, the Board afforded significant probative value to the medical evidence of record. Initially, the Veteran was not diagnosed with hepatitis C until more than forty years following his separation from service, despite several blood tests and examinations having been conducted during that time. At every treatment and examination, his results revealed no evidence of any disorder. Additionally, by his own admission, he listed a risk factor exposure during the course of his post-service employment which seemingly corroborates the medical evidence of record. Lay testimony on the etiology of current diagnoses of infectious diseases is not competent in the present case, because the Veteran is not competent to state that his current hepatitis infections resulted from in-service disease, injuries, or other incidents of service. See Davidson, 581 F.3d at 1316. He is also not competent to opine regarding a causal nexus between any incident of service and current hepatitis infections. An opinion of etiology would require knowledge of the complexities of infectious diseases, knowledge that the Veteran is not shown to possess. The Veteran has also not alleged that he was told of such a nexus by a competent expert, and such assertions have not subsequently been verified by such an expert. Accordingly, the Board has also considered the Veteran’s lay statements that a nexus exists between his injuries in service and current diagnosis of hepatitis C. However, he is not competent to provide an opinion regarding the etiology of his disability. See Jandreau, 492 F.3d at 1376-77; see also Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Thus, the Board places more probative value on the medical evidence, especially when supported by his own statements, than on his belief that a nexus between the two exists. Based on the above, the preponderance of the evidence weighs against the claim and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Yacoub, Associate Counsel