Citation Nr: 20003099 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 14-30 707 DATE: January 14, 2020 ORDER Service connection for hepatitis C is denied. FINDING OF FACT The evidence of record does not establish that the Veteran’s hepatitis C was incurred in or caused by his service. CONCLUSION OF LAW The criteria for establishing service connection for hepatitis C have not been met. 38 U.S.C. §§ 1131, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1976 to August 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). A videoconference hearing was held before the undersigned Veterans Law Judge (VLJ) in January 2018. A transcript of that hearing is of record. This matter was previously before the Board in March 2018. The Veteran’s claims for entitlement to service connection for hepatitis C and dysthymia were remanded for additional development. Subsequently, service connection for dysthymia was granted. As this represents a full grant of the benefit sought, that claim is no longer in appellate status. 1. Entitlement to service connection for hepatitis C. Service Connection-Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also 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). In order to prevail on the issue of service connection, there must be medical evidence of current 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 present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1990). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1990); 38 C.F.R. § 3.303 (a). The Board has reviewed all the evidence in the Veteran’s claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence where appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Merits The Veteran seeks service connection for hepatitis C. He contends he was exposed to tainted blood through vaccinations given in the military either given with reused needles or via an air gun system, See October 2012 VA 21-4138 Statement in Support of Claim and November 2017 Hearing Transcript. He also contends he contracted the hepatitis C virus while on active duty as a result of surgery and dental work in 1977 through 1978. See October 2012 VA 21-4138 Statement in Support of Claim. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of hepatitis C, and evidence, including his lay statements, shows that he may have received vaccinations and underwent surgical and dental procedures during active duty, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of hepatitis C began during service or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show a test for hepatitis C was ordered because the Veteran acknowledged having several risk factors including a history of multiple partners and a history of intranasal cocaine usage. See Goose Creek Outpatient Clinic February 2001 Infectious Disease Note. The Veteran was first told of his hepatitis C in June 2001, as it was noted that he was unaware of the diagnosis at that time. See June 2001 Physician Emergency Department Note, Charleston VA Medical Center (VAMC). VA treatment records further indicate that he believed he was infected through injectable drug use during the 1980’s. See June 2014 Infectious Disease Pharmacy Evaluation, Charleston VAMC. The Veteran testified at the Board hearing that he believed his hepatitis C was diagnosed about a year after separation at the Manhattan VAMC. See Hearing Transcript, November 2017. However, exhaustive efforts were undertaken to develop for any such records and the only treatment record returned was dated September 1979 and showed the Veteran being treated for possible venereal disease, not hepatitis C. The remainder of the Veteran’s treatment records support a finding that his hepatitis C was not diagnosed until many years after his separation from service, and that he was not made aware of the hepatitis C diagnosis until June 2001. Notably, it is not the Veteran’s contention that his hepatitis C had its onset in service and has continued since then. Rather, as previously discussed, he contends that it is related to the vaccinations or medical procedures he received in service. Despite this belief, the Veteran as a lay person is not competent to opine as to the etiology of his hepatitis C. The question of whether his hepatitis C is related to the vaccinations or to medical procedures during service is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In that regard the Veteran was afforded a VA examination on September 2019. The VA examiner reviewed the claims file and opined that the Veteran’s hepatitis C was less likely than not related to an in-service injury, event, or disease. The VA examiner noted that intravenous drug use had the highest risk of acquiring hepatitis C, and that absent any evidence to the contrary the probative evidence supported a finding that hepatitis C was most likely the result of intravenous drug use (speedballing), and not due to immunizations, dental procedures or surgery. The examiner noted with significance that there was no record of the Veteran receiving a blood transfusion during active duty and that post-service treatment records also indicated that the Veteran was sharing needles in the 1980’s, a fact testified to by the Veteran at the hearing before the Board. The examiner further pointed out that although a VA treatment record from 1986 showed that the Veteran had been speedballing cocaine and heroin for six months, there was no hepatitis C diagnosis of record at that time. Instesad, hepatitis C was not diagnosed until after the Veteran’s history of speedballing. The VA examiner thus concluded that the documented correlation between the Veteran’s immunizations, dental and other surgery during service and the development of hepatitis C after separation was lacking. The examiner’s opinion is probative, because it is was provided by a physician (who is competent to provide such an opinion), based on an accurate medical history, and includes an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for hepatitis C, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Alexander 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.