Citation Nr: 20076722 Decision Date: 12/02/20 Archive Date: 12/02/20 DOCKET NO. 11-29 666 DATE: December 2, 2020 ORDER Entitlement to service connection for hepatitis C is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his hepatitis C is casually related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for hepatitis C have been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. § 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from October 1969 to April 1972, to include service in the Republic of Vietnam. For his service, he was awarded the Purple Heart Medal and Combat Infantryman Badge (CIB). This case originally came before the Board of Veterans’ Appeals (Board) on appeal of a December 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board. In June 2018, the Board denied the issue of entitlement to service connection for hepatitis C. The Veteran appealed that decision to the United States of Court of Appeals for Veterans Claims (Court). In an April 2019 Order, the Court granted a Joint Motion of the parties, vacated the Board’s decision, and remanded the case back to the Board for action consistent with the Joint Motion. The case was remanded by the Board in August 2019 for additional development. The case has now been returned to the Board for further appellate action. Service Connection – Hepatitis C The Veteran asserts that his hepatitis C is related to his service, to include his service in the Republic of Vietnam. Service treatment records (STRs) are negative for any complaint of, treatment for, or diagnosis of hepatitis C, or symptoms that could be associated with a later diagnosis of Hepatitis C. However, the Veteran’s STRs reveal that on several occasions, from March 1970 to March 1972, he was treated for urethral discharge, burning sensation on urination, and non-specific urethritis (NSU); all indicative of venereal disease associated with sexual activity. The Veteran’s post-service treatment records reveal that in January 1995 he tested positive for hepatitis C. Additionally, in April 2005, the Veteran was assessed as having hepatitis C, and, in June 2005, the Veteran was also found to have hepatitis C during a liver biopsy. In a June 2005, the Veteran was referred to Dr. G.P. after a preoperative hepatitis panel, performed for a cardiac catheterization and stent placement, was positive for hepatitis C. At that time, the Veteran reported having multiple sexual partners while in Vietnam, but denied intravenous (IV) drug abuse, receiving blood products, or knowing anyone in his family with hepatitis C. Dr. G.P. assessed that the Veteran had a diagnosis of hepatitis C, and stated that his hepatitis C was possibly acquired when he served in Vietnam. In a December 2005 treatment note, the Veteran was noted as completing a 16-week round of treatment for his hepatitis C. In January 2020, the Veteran was afforded a VA examination. At that time, the VA examiner noted that the Veteran did not have current symptoms of, or receive treatment for his hepatitis C. The VA examiner also noted that the Veteran was exposed to blood and bodily fluids in combat. However, the VA examiner opined that the Veteran’s hepatitis C was less likely than not incurred in or caused by his claimed in-service injury or event. The VA examiner reasoned that the Veteran was not diagnosed with hepatitis C until 2005, but noted that an estimated 70 percent of people did not have symptoms when the disease was initially acquired. The VA examiner also assessed that the Veteran’s repeat treatment for sexually transmitted diseases indicated high risk sexual contact that could result in the transmission of hepatitis C, and that many hepatitis C cases had no known risk factor. The VA examiner further stated that the transmission of hepatitis C by immunization guns had not been documented. The Board acknowledges the January 2020 VA examination report contains a negative etiological opinion. However, the examiner did provide a positive link between the Veteran’s current diagnosis of Hepatitis C and his high-risk sexual activity during service. That association, when combined with the June 2005 private opinion from Dr. P.G., is sufficient to establish a positive etiological relationship between the Veteran’s active service and his current diagnosis of Hepatitis C. The Board notes that there is a VA medical opinion from September 2017 of record that is against the claim. However, it was determined in the Joint Motion of the parties that the September 2017 opinion was inadequate. As such, it will not be discussed further in this decision. Accordingly, the Board finds that the evidence for and against the claim is at least in equipoise. Therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for hepatitis C is warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Byrd, Associate Counsel 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.