Citation Nr: 18119834 Decision Date: 07/19/18 Archive Date: 07/19/18 DOCKET NO. 13-35 590 DATE: July 19, 2018 ORDER Service connection for Hepatitis C is denied. FINDING OF FACT The Veteran’s Hepatitis C did not begin in service and is unrelated to events in service, including unprotected sexual relations and air gun inoculations. CONCLUSION OF LAW The criteria for service connection for Hepatitis C have not been met. 38 U.S.C. §§ 1110, 5103, 5103A (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran contends that he is entitled to service connection for hepatitis C because he contracted it through sexual relations with prostitutes in Korea and/or through air gun inoculations. He further contends he began to experience fatigue symptoms in 1973, or two years after separation from service. After consideration of the lay and medical evidence, the Board finds that service connection is not warranted for the Veteran’s hepatitis C disorder. In making this determination, the Board relied on VA’s Adjudication Procedures Manual (M21-1), service treatment records, private medical records, VA medical opinions, and the Veteran’s submissions. The M21-1 lists the following medically-recognized risk factors for Hepatitis C: transfusion of blood or blood product before 1992; organ transplant before 1992; hemodialysis; tattoos; body piercings; intravenous drug use (with the use of shared instruments); high-risk sexual activity; and immunization with jet air gun injectors. See M21-1, III.iv.4.H.2 (Jan. 11, 2018). The M21-1 notes, however, that the transmission risk from high-risk sexual activity is “relatively low” but increases with multiple sexual partners. It also notes that there is one documented case of hepatitis B transmission through air gun injections and, while transmission of hepatitis C was “biologically plausible,” there is no scientific evidence that documents transmission of hepatitis C with air gun injectors. The Veteran’s service treatment records confirm that he served in Korea, but do not show treatment for sexually transmitted diseases in service or symptoms relevant to Hepatitis C. In fact, the Veteran was not diagnosed with Hepatitis C until January 2000 by his private physician, approximately 30 years after separation from service. In 2007, a different private physician from the same medical office noted that the Veteran had a “history of hepatitis B that is known, likely from previous injection drug use.” While the physician wrote Hepatitis B, it is clearly a typo as the medical records document regular treatment for Hepatitis C from 2000 to 2005. Subsequent VA medical records similarly show a history of alcohol and drug abuse. Thus, the Veteran’s service and post-service records weigh against a finding that his Hepatitis C began in or is related to service.   The Board also finds that the September 2013 and October 2016 VA opinions are probative evidence that his Hepatitis C is not related to in-service events. In September 2013, the examiner noted that the Veteran did not contract any sexual transmitted disease in service, including gonorrhea, which is an extraordinarily contagious sexually transmitted disease. It is notable because the “sexual transmission of Hepatitis C virus is far less efficient than that of other sexually transmitted diseases.” He determined that, “based on the presence of multiple risk factors and lack of any evidence of STDs while in service, it is less likely than not that the diagnosed Hepatitis C is related to his reported sexual history in service.” Instead, the examiner concluded that the Hepatitis C was more likely due to his other risk factors, including a history of intranasal drug abuse. In October 2016, the examiner further concluded that the Hepatitis C is less likely than not related to the air gun inoculations in service. He cited a VA Fast Letter on Hepatitis C, which stated that, based on a study of veterans with Hepatitis C, “while air gun injection remains a theoretical[] possibility for transmission, there is no sound scientific data showing evidence of an actual association.” He also addressed a favorable medical opinion from December 2015, discussed below, but noted it was not based on actual medical or scientific evidence and it is contradicted by the January 2007 medical record. The Board finds that these medical opinions are probative because they are based on an accurate factual history, consider the Veteran’s contentions and medical records, rely on current medical knowledge, and include an alternative theory of etiology. The Board also considered the evidence favorable to the Veteran’s claim but finds that it is outweighed by the VA medical opinions, current medical literature, service treatment records, and post-service records. In December 2015, a physician’s assistant from the same office opined that the Veteran’s Hepatitis C is most likely due to vaccinations “based off a history . . . by the patient.” She noted that the Veteran reported multiple sexual partners overseas and air jet inoculations upon entrance into the military as risk factors, and denied other needle use. The Board finds that this opinion is not probative because it is based on an inaccurate factual background (“denied other needle use”) and therefore did not address the Veteran’s history of drug use, as noted in the January 2007 private medical record and a March 2012 VA medical record. While the Veteran has denied intravenous drug use during the appeal, the Board finds that the January 2007 medical record is more probative in this regard because it was based on his statements made seeking medical treatment rather than disability compensation, like the December 2015 opinion. The fact the Veteran changed his story when he filed his VA claim, now denying a history of drug use, weighs heavily against his credibility. While the Veteran contends his Hepatitis C is related to service, his contention is not probative evidence as he does not have the medical knowledge, training, or expertise to render such an opinion. This is particularly true considering the extensive period between separation from service and diagnosis. Similarly, the Veteran’s contention that diagnostic testing revealed elevated liver enzymes in 1984 is not competent evidence that he had Hepatitis C in 1984 or that he contracted it in service. Finally, the Board considered the evidence provided by the Veteran, including the HCVets.com article and buddy statement, but finds that this evidence is outweighed by the VA medical opinions, which were rendered by a medical professional relying on the present facts and current medical literature. The article he submitted is general in nature and not particular to the facts of his case. The VA examiner did consider the possibility of transmission from injections, but, as discussed above, did not find that a likely cause of this Veteran’s hepatitis. The Board thus finds that the preponderance of the evidence weighs against the Veteran’s claim for service connection for Hepatitis C and the claim is denied. Neither the Veteran nor his representative has raised any issues with the duty to notify, the duty to assist, or the conduct of his Board hearing as to the duties discussed in Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist or Bryant hearing deficiency argument). Thus, the Board need not discuss any potential issues in this regard. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Lavan, Associate Counsel