Citation Nr: 19196251 Decision Date: 12/26/19 Archive Date: 12/26/19 DOCKET NO. 14-06 216 DATE: December 26, 2019 ORDER Service connection for hepatitis C is granted. FINDING OF FACT Resolving all doubt in the Veteran’s favor, hepatitis C was as likely as not incurred in service. CONCLUSION OF LAW The criteria for service connection for hepatitis C are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1966 to May 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran’s application to reopen the claim of entitlement to service connection for hepatitis C. In an April 2018 decision, the Board reopened the claim of entitlement to service connection for hepatitis C and remanded the claim for additional development. Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Current VA policy provides that hepatitis A was previously called infectious hepatitis; hepatitis B was previously called serum hepatitis; and hepatitis C was previously called non-A non-B hepatitis. Hepatitis C is clinically asymptomatic as an acute disease; chronic disease develops in 80 percent of cases following the acute phase; and diagnosis is generally made incidentally many years later. Current VA policy provides risk factors for development of hepatitis C include transfusion of blood or blood product before 1992, organ transplant before 1992, or hemodialysis; tattoos, body piercing, and acupuncture with non-sterile needles; intravenous drug use; high-risk sexual activity; intranasal cocaine use; accidental exposure to blood by percutaneous exposure or on mucous membranes; sharing of toothbrushes or shaving razors; and immunization with a jet air gun injector. It is clarified that, despite the lack of any scientific evidence to document transmission of hepatitis C with air gun injectors, it is biologically possible. As an initial matter, the Veteran has current diagnoses of hepatitis C and associated cirrhosis. Multiple VA treatment records and medical examinations and opinions also reflect that the Veteran was diagnosed with hepatitis C in the late 1980s. The Veteran contends that service connection for hepatitis C is warranted as a result of air gun injections that occurred during service. The Board concedes that the Veteran received injections via air gun in service based on his period of service. The Veteran also admitted to one instance of unprotected sexual intercourse when he was stationed at Fort Bliss from 1966 to 1967. A review of the Veteran’s service treatment records shows that in November 1966 the Veteran sought treatment for urethral discharge and he was diagnosed with gonorrhea, indicating that the Veteran may have engaged in unprotected intercourse during service. The Veteran also asserted that his hepatitis C is related to his combat experiences while serving in the Republic of Vietnam. The Veteran has denied any history of other significant risk factors such as tattoos, piercings, blood transfusions, and intravenous or intranasal drug use. The Veteran did not otherwise endorse a history of risky sexual behavior outside of service. The medical evidence of record also does not reflect any history of intravenous drug use. Thus, the record shows the Veteran experienced two risk factors for hepatitis C during service and none since. The Veteran was afforded a VA examination in connection with this claim in March 2017. The examiner determined that it is less likely as not that the Veteran contracted hepatitis C from air gun inoculations, but did not reference any medical literature in support of this opinion. Because the VA examiner did not cite any medical literature to support the conclusion, and also did not address the risk factors experienced during service, the Board finds this opinion to lack probative value. The Veteran was again afforded a VA examination in May 2018. This examiner recognized the Veteran’s reported unprotected sexual intercourse in service and his in service treatment for gonorrhea. The VA examiner also acknowledged that sexual activity provided a lower risk compared to shared needles, razors, or actual blood contacts, but that unprotected sexual intercourse could possibly have resulted in hepatitis C. The examiner was unwilling to state whether the unprotected sex definitively caused, or did not cause, the hepatitis C, as such a definite determination would be resorting to speculation. The examiner did not provide an opinion as to the multiple in-service risk factors, to include immunization with a jet air gun injector and unprotected sex; however, the Board does not find a remand is necessary to decide this claim. The VA examiner indicated some level of possibility that the unprotected sex caused the hepatitis C, and the evidence shows the Veteran did not have post-service risk factors present. Resolving all doubt in the Veteran’s favor, the Board finds the evidence sufficient for a finding that it is at least as likely as not that the Veteran’s hepatitis C is causally connected to his active service. The claim of entitlement to service connection for hepatitis C is, therefore, granted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.102; see generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). A. ADAMSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Bilstein The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.