Citation Nr: 18121498 Decision Date: 07/26/18 Archive Date: 07/25/18 DOCKET NO. 16-41 424 DATE: July 26, 2018 REMANDED Entitlement to service connection for hepatitis, to include hepatitis B and hepatitis C, and to include as secondary to the service connected posttraumatic stress disorder and opioid use disorder with alcohol use disorder in remission, is remanded. REASONS FOR REMAND The Veteran had active military service from November 1969 to September 1971. This issue is on appeal from July 2014, September 2014, and February 2016 rating decisions. This issue has been characterized by the Agency of Original Jurisdiction (AOJ) as new and material evidence. However, the Veteran submitted a timely Request for Reconsideration in July 2014 in response to the July 2014 rating decision. The Veteran then submitted a timely Notice of Disagreement (NOD) in August 2015 in response to the September 2014 rating decision. As such, the Board has recharacterized the claim as an original claim for service connection as the Veteran has consistently appealed his claim since the original service connection claim in September 2013. Additionally, the AOJ has characterized the claim as service connection for hepatitis B. However, in a July 2015 statement, the Veteran argued that his hepatitis B is related to his hepatitis C. The medical evidence suggests current hepatitis B and hepatitis C diagnoses. Thus, the Board has recharacterized the claim to include both hepatitis B and hepatitis C. In an October 2016 statement, the Veteran requested a Board hearing. However, in December 2016, January 2017, February 2017, and March 2017 statements, he withdrew his Board hearing request. REFERRED The issue of entitlement to a disability rating in excess of 70 percent for posttraumatic stress disorder and opioid use disorder with alcohol use disorder in remission was raised in an August 2016 VA 21-526EZ and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. 1. Entitlement to service connection for hepatitis, to include hepatitis B and hepatitis C, and to include as secondary to the service connected posttraumatic stress disorder and opioid use disorder with alcohol use disorder in remission, is remanded. Evidence indicates that there may be outstanding relevant VA treatment records. In an August 2014 statement, the Veteran reported that he was hospitalized at the VA Medical Center (VAMC) in Lyons, New Jersey, for four weeks post-service in 1971 for his hepatitis B. The claims file currently contains the 1971 VA Hospital Summary from this hospitalization, but the VA hospital treatment records are not of record and attempts to obtain them have not been made. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. In a January 2014 statement, the Veteran reported pertinent treatment at the VAMC in East Orange, New Jersey, in 1972 and 1991. In a July 2015 VA 21-526EZ, the Veteran reported pertinent treatment at the East Orange VAMC from January 2013 to the present. In an October 2015 Report of General Information, the AOJ determined that the East Orange VAMC did not have any treatment records for the Veteran from January 2013 to February 2014. Attempts to obtain the East Orange VAMC treatment records dated in 1972, 1991, and since February 2014 have not been made and these records are not in the claims file. A remand is required to allow VA to obtain them. In a January 2014 statement, the Veteran identified outstanding private treatment records pertinent to his hepatitis claim. Specifically, he reported attending an alcohol rehabilitation program in Summit, New York, in 1991. A remand is required to allow VA to obtain authorization and request these records. The Board cannot make a fully-informed decision on this issue because the Veteran has not yet been afforded a VA examination and medical opinion. The medical evidence suggests current hepatitis B and hepatitis C diagnoses. The Veteran was diagnosed with hepatitis in service in August 1971, and his STRs document drug dependence. The Veteran’s July 2014 Hepatitis Risk Factors Questionnaire documents both tattoos and drug use in service. In an August 2015 statement, the Veteran reported that he received intravenous fluids in service for the treatment of dehydration. The Veteran is also service-connected for posttraumatic stress disorder and opioid use disorder with alcohol use disorder in remission. Upon remand, a VA examination and medical opinion addressing the aforementioned evidence must be obtained. The matter is REMANDED for the following actions: 1. Obtain the Veteran’s hospital treatment records from Lyons, New Jersey, VAMC from August 1971 to September 1971. 2. Obtain the Veteran’s treatment records from East Orange, New Jersey, VAMC from 1972, 1991, and February 2014 to the present. 3. Ask the Veteran to complete a VA Form 21-4142 for the alcohol rehabilitation treatment he received in Summit, New York, in 1991. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 4. After making attempts to obtain the above records, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hepatitis B and hepatitis C. The examiner must opine whether any currently diagnosed hepatitis B or hepatitis C is at least as likely as not related to an in-service injury, event, or disease, including in-service tattoos, in-service intravenous fluids received for dehydration, and/or in-service drug use. If possible, the examiner should opine as to whether it is at least as likely as not that tattoos or IV fluids resulted in infection, as opposed to in-service drug use. The examiner must also opine as to whether any currently diagnosed hepatitis B or hepatitis C is at least as likely as not (1) proximately due to, or (2) aggravated beyond its natural progression by the service-connected posttraumatic stress disorder and opioid use disorder with alcohol use disorder in remission. (Continued on the next page)   6. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. WILLIAM H. DONNELLY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Shauna M. Watkins, Counsel