Citation Nr: 18121283 Decision Date: 07/26/18 Archive Date: 07/25/18 DOCKET NO. 15-26 204 DATE: July 26, 2018 REMANDED A disability rating greater than 10 percent for service-connected hepatitis A, B, and C, to include the question of whether separate ratings for hepatitis A, B and/or C are warranted, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1975 to November 1978. This appeal to the Board of Veterans’ Appeals (Board) arose from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York in which the RO recharacterized the Veteran’s previously service-connected hepatitis A to include hepatitis B and C and continued a 10 percent disability rating effective August 11, 2006. The Veteran disagreed with this decision, arguing that a separate rating was warranted for his newly service-connected hepatitis C. By way of history, the RO granted service connection for hepatitis A by rating decision dated in February 2010, assigning an initial 10 percent disability rating effective August 21, 2008. At the time of this award, the Veteran had perfected an appeal concerning a denial of service connection for hepatitis B and C for which he had submitted a claim on August 11, 2006. Subsequently, in March 2013, the Board granted service connection for hepatitis B and C, noting that the medical evidence was in conflict as to whether the Veteran actually had diagnoses of hepatitis B and C but affording the Veteran the benefit of the doubt. As above, by rating decision dated in July 2013, the RO recharacterized the Veteran’s previously service-connected hepatitis A to include hepatitis B and C and continued a 10 percent disability rating effective August 11, 2006. In the Veteran’s January 2014 notice of disagreement, he wrote that, by granting service connection for hepatitis B and C, the March 2013 Board decision intended to award higher/separate disability ratings for hepatitis B and C. The Veteran’s hepatitis A, B, and C is currently rated as 10 percent disabling pursuant to 38 C.F.R. § 4.114, Diagnostic Code (DC) 7345. Under DC 7345, a noncompensable rating is warranted for non-symptomatic chronic liver disease. A 10 percent rating is warranted for liver disease manifested by intermittent fatigue, malaise, and anorexia, or if there are incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. A 20 percent rating is warranted for liver disease manifested by daily fatigue, malaise and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or incapacitating episodes (with symptoms as described above) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period. A 40 percent rating is warranted with symptoms of daily fatigue, malaise and anorexia, with minor weight loss and hepatomegaly, or incapacitating episodes having a total duration of at least four weeks, but less than six weeks, during the past 12-month period. Chronic liver disease with daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12- month period, but not occurring constantly, is rated 60 percent disabling. Chronic liver disease with near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain), is rated 100 percent disabling. The Board notes that the Veteran was most recently afforded a VA examination for his service-connected hepatitis in December 2010. Significantly, this examination report shows complaints of near-constant fatigue and malaise but also indicates that the Veteran does not have chronic hepatitis. Such findings appear to be in conflict as findings of non-chronic hepatitis would support a 0 percent disability rating whereas findings of of near-constant fatigue and malaise would support a 100 percent disability rating under DC 7345. An addendum medical opinion was obtained in July 2013. Significantly, the VA examiner wrote that there was no evidence of active hepatitis and that the symptoms of near-constant fatigue and malaise reported by the Veteran were due to the Veteran’s non-service connected conditions. Unfortunately, the examiner did not provide any rationale for this opinion, to include which non-service connected conditions caused the Veteran’s near-constant fatigue and malaise. Furthermore, the Board notes that this examination is over eight years old. Moreover, since the December 2010 VA examination, service connection has been granted for both hepatitis B and C. On this record, the Board finds that further VA examination is needed to ensure that the record reflects the current nature and severity of the Veteran’s service-connected hepatitis A, B, and C. Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide a veteran with a thorough and contemporaneous medical examination). Furthermore, the Board notes that there are likely outstanding VA and/or private treatment records as the most recent VA medical records in the claims file are dated in January 2011 and the most recent private medical records in the claims file are dated in June 2009. Therefore, all outstanding VA/private treatment records should be obtained on remand. The matter is REMANDED for the following action: 1. Request that the Veteran identify any VA or non-VA healthcare provider who has treated him for hepatitis A, B, and/or C. After securing any necessary authorization from him, obtain all identified treatment records, to include all outstanding VA treatment records dated from January 2011 to the present. All reasonable attempts should be made to obtain any identified records. 2. After all records and/or responses received from each contacted entity have been associated with the claims file, arrange for the Veteran to undergo VA examination for evaluation of his hepatitis A, B, and C by an appropriate medical professional. The contents of the entire electronic file, to include a complete copy of this REMAND, must be made available to each designated individual, and each examination report should include discussion of the Veteran’s documented medical history and assertions. All indicated tests and studies should be accomplished (with all results furnished to the requesting individual), and all clinical findings should be reported in detail. The examiner should clearly identify all current symptoms associated with the Veteran’s service-connected hepatitis A, B, and C. Significantly, the examiner should reconcile the December 2010 complaints of near-constant fatigue and malaise with the findings of no chronic hepatitis. The examiner should also address the July 2013 medical opinion indicating that the symptoms of near-constant fatigue and malaise reported by the Veteran were due to the Veteran’s non-service connected conditions and indicate whether this is still the case and, if so, what non-service connected conditions result in the Veteran’s near-constant fatigue and malaise. All examination findings/testing results, along with the complete, clearly-stated rationale for the conclusions reached, must be provided. 3. After conducting any additional development deemed necessary, the Veteran’s claim should be readjudicated. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD April Maddox, Counsel