Citation Nr: 18128735 Decision Date: 08/22/18 Archive Date: 08/22/18 DOCKET NO. 13-21 900A DATE: August 22, 2018 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for cirrhosis as secondary to hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to February 1971. In March 2018, the Veteran was afforded a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. 1. Entitlement to service connection for hepatitis C and entitlement to service connection for cirrhosis as secondary to hepatitis C are remanded. The Veteran contends that his hepatitis C is the result of being exposed to blood through air guns and direct contact during active military service. The Veteran testified to being in constant contact with blood while serving in the military. See Board hearing transcript at 6. The Veteran testified that he first noticed hepatitis symptoms in service. Id at 4. The Veteran’s service treatment records show that in August 1970, the Veteran reported pain under his rib cage. In addition, the Veteran reported flu-like symptom in January 1971. The Veteran’s claims file includes an October 1971 hospital summary report noting hepatitis. The Veteran was afforded a VA examination in February 1994. The Veteran was diagnosed with hepatitis with antibodies to the type C virus. No VA opinion was provided. In an April 2018 correspondence, Dr. T.L. expressed that the Veteran’s hepatitis C infection may theoretically come from jet gun vaccinations. Dr. T.L. stated that the existing literature does not have a definitive answer on the etiologic nature of the spread of hepatis C. VA’s duty to assist includes providing a medical examination when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. As the February 1994 VA examination did not provide an opinion regarding the Veteran’s hepatitis C and cirrhosis as secondary to hepatis C, a remand is necessary for a VA examination with an opinion etiology. In addition, VA also has a duty to assist the Veteran in obtaining potentially relevant records. The Veteran has expressed that VA treatment records from Loch Raven Medical Center, Hampton VA Medical Center, and treatment records from Johns Hopkins have not been requested. See December 2012 VA Form 9. Therefore, a remand is necessary in order to attempt to obtain such relevant records. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records to include treatment records from Loch Raven Medical Center and Hampton VA Medical Center. 2. Contact the Veteran to determine whether there are any outstanding private treatment records relating to his hepatitis C and cirrhosis. If any records are identified, ask the Veteran to authorize the release of these records to VA and make reasonable efforts to obtain them and associate them with the Veteran’s claims file. 3. After completing the development directed above, schedule the Veteran for appropriate VA examination to determine the nature and etiology of his hepatitis C and liver cirrhosis. After review of the record, and a thorough examination and interview of the Veteran, the VA examiner should offer an opinion addressing the following questions: Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s hepatitis C had its clinical onset during active service or is otherwise related to any in service disease, event, or injury. The examiner must discuss the Veteran’s contention that his hepatitis C is the result of being exposed to blood through air guns and direct blood contact during active military service. Whether it is it at least as likely as not (50 percent or greater probability) that cirrhosis of the liver is (1) caused or (2) aggravated beyond the normal progression of the disease by the Veteran’s hepatitis C? All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.D., Associate Counsel