Citation Nr: 18130276 Decision Date: 08/29/18 Archive Date: 08/28/18 DOCKET NO. 11-27 558 DATE: August 29, 2018 ORDER Entitlement to service connection for hepatitis C is granted. FINDING OF FACT It is at least as likely as not that the Veteran’s diagnosed hepatitis C is etiologically related to the Veteran’s active service. CONCLUSION OF LAW The criteria for service connection for hepatitis C, have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1967 to June 1969. 1. Entitlement to service connection for hepatitis C The Veteran seeks service connection for hepatitis C due to the Veteran’s active service. Specifically, the Veteran contends that he contracted hepatitis C due to appendectomy surgery he had during his service. A review of the complete medical evidence of record, to include several VA examinations and opinions, and an independent medical opinion, show that the Veteran’s claimed hepatitis C is at least as likely as not etiologically related to surgery during active service. Therefore, the claim for service connection must be granted. In order to establish service connection, three elements must be established. There must be medical evidence of a disability; medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; Hickson v. West, 12 Vet. App. 247 (1999). The Veteran claims that currently diagnosed hepatitis C was contracted during active service when he underwent surgery to remove his appendix in Vietnam. The Veteran recalls being brought to a busy field hospital in Vietnam where he received an IV and was immediately sent into surgery for an appendectomy. During a hearing, the Veteran noted that he remembered the hospital to be very busy and filled with other patients, and generally unclean. The Board notes that, with regard to the Veteran’s claim of an in-service surgery for an appendectomy, attempts to obtain service medical records from the Veteran’s active duty have been unsuccessful. Inquiries to the appropriate military repositories have returned with a determination that those records were unavailable. Therefore, the Board has conceded the Veteran’s accounts of having an appendectomy during active service, as he has not only been consistent reporting that event, but also is competent to report the fact that he underwent surgery during active duty. With specific regard to the etiology of hepatitis C, the Veteran was initially diagnosed with hepatitis C in 2002, more than three decades after he separated from active service. Prior to that diagnosis, the record is silent on any symptoms or manifestations related to Hepatitis C, or an actual diagnosis. The Veteran has continuously and consistently noted that his exposure to most high-level risk factors for Hepatitis C were limited. Specifically, he notes that he has had less than six sexual partners after service, two of which were his wife and ex-wife, he did not have surgeries prior to his diagnosis, and has never had blood transfusions. The record does not show any intravenous drug use. However, the Veteran does have tattoos he obtained prior, during, and after active service. Additionally, the Veteran was noted to be incarcerated for a short time, after service. Several attempts have been made to acquire opinions from VA examiners that speak to the etiology of hepatitis C. VA examination reports and opinions were obtained in February 2017 and November 2017. Both examiners were unable to definitively speak to the etiology of Hepatitis C, providing only speculative opinions. Specifically, in the February 2017 examination, the VA examiner noted that while the Veteran fell under some risk factors for contracting hepatitis C after service, such as obtaining tattoos, different sexual partners, and being in jail, it would be mere speculation to attach the etiology of hepatitis C to any of those risk factors, in lieu of the Veteran’s in-service surgery. The November 2017 VA examiner noted that while the Veteran indicated risk factors such as sexual partners, jail, and tattoos, the asymptomatic period after contracting Hepatitis C, in some cases, can be in excess of 20 to 30 years, where no symptoms manifest. Again, the VA examiner noted that any opinion would be mere speculation. In April 2018, the Board determined that another medical opinion was required to resolve the remaining questions with regard to the Veteran’s claims, and sought an independent medical opinion with regard to the nature and etiology of the claim on appeal. In July 2018, the Board obtained an opinion from a specialist in infectious diseases, Dr. N. B. The opinion letter noted a review of the entire claims file, to include past examination and opinions, and concluded that the Veteran’s hepatitis C was at least as likely as not due to his in-service surgery. In arriving at the private examiner’s conclusion, Dr. N. B., noted comprehensive consideration of the Veteran’s risk factors for contracting hepatitis C during and after service; and in considering the totally of the Veteran’s risk factors after the Veteran’s separation from service, the physician ultimately found that those factors were outweighed by the Veteran’s appendectomy surgery during service. Therefore, as the most recent April 2018 independent medical opinion found positively that the Veteran’s hepatitis C was related to his service, the Board finds that positive opinion to be highly probative. The Board finds that it is at least as likely as not that hepatitis C is etiologically related to service. Therefore, the Board must find that service-connection is warranted, and service connection must be granted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Zi-Heng Zhu, Associate Counsel