Citation Nr: 20079494 Decision Date: 12/16/20 Archive Date: 12/16/20 DOCKET NO. 16-02 862 DATE: December 16, 2020 ORDER Entitlement to service connection for hepatitis C is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran’s hepatitis C is the result of in-service vaccinations. CONCLUSION OF LAW The criteria for entitlement to service connection for hepatitis C have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1986 to May 1988. In September 2020, the Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing. A transcript of that hearing is of record. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be established for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence or other competent 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 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for hepatitis C The Veteran contends that he contracted hepatitis C while in service. Specifically, the Veteran contends that while in service, he received inoculations multiple times with air guns, with each person being inoculated in line, and their arms were doused in blood. See Hearing Transcript at 3. The Veteran believes he was inoculated two to three times, and recalls severe bleeding and bruising of the arm. Id. at 4. Nonetheless, he did not go to sick call; he waited for the bleeding to stop and went back to work. Id. In addition, this was not reported at the time of his separation examination because he had no symptoms of hepatitis C until after service. Id. The Veteran reported that he did not know he had hepatitis C until approximately 1989 or 1990 when he went to give blood. Id. at 5. The Board acknowledges that the Veteran has a current diagnosis of hepatitis C. In addition, the Board acknowledges that the Veteran was provided immunizations in service. As such, the remaining question for the Board is whether there is a relationship between the Veteran’s current hepatitis C and his active service. The Veteran’s medical records confirm that he received treatment for hepatitis C from January 2011 through November 2015. In an August 2013 note from an infectious disease consultation, an examiner provided that based on the Veteran’s reports, he had hepatitis C very close to the time of discharge from the military. The Veteran submitted an August 2013 nexus opinion in support of his claim. The examiner confirmed the Veteran’s hepatitis C diagnosis and noted that the use of an air gun for immunization in the military was a risk factor for hepatitis C. The examiner opined that the Veteran’s hepatitis C was more likely than not caused by or a result of the air shot gun used for immunization in the military and blood transfusions in 1989. The examiner reasoned that the Veteran’s positive test for hepatitis C and referral by blood donation service was proximal to discharge from active duty, as per the aforementioned August 2013 infectious disease consultation note. The Veteran underwent a VA examination in May 2014 for hepatitis, cirrhosis, and other liver conditions. The examiner opined that the Veteran’s hepatitis C was less likely than not incurred in or caused by an in-service injury, event, or illness. The examiner reasoned that the Veteran’s service treatment records were silent for hepatitis C or any blood transfusions. The examiner also explained that medical literature did not support a causal relationship between air-gun vaccinations and subsequent hepatitis C. There were no medically documented blood transfusions prior to 1992. The Veteran reported that he may have had a blood transfusion associated with his back surgery in 1989, and was advised to find documentation if possible. At the Veteran’s Board hearing in September 2020, he was also advised to obtain his private medical records from 1989 or 1990, as he testified that he was diagnosed with hepatitis C at that time. While the Veteran has not provided those records, he has consistently reported the discovery of his hepatitis C to be within a year of service. In addition, the Veteran has also submitted a medical article arguing that there is a connection between immunizations received in military service using jet injectors and the high rate of injection with hepatitis C among Veteran’s. Upon review of the evidence of record, the Board finds that the August 2013 VA opinion finding a nexus between the Veteran’s hepatitis C and service, and the May 2014 VA examination denying a nexus between the Veteran’s hepatitis C and service, taken together with the other evidence of record, place the evidence in relative equipoise. In consideration of the above, the Board resolves all doubt in favor of the Veteran and finds the probative evidence of record demonstrates that the Veteran’s hepatitis C was caused by his active service. Thus, service connection for hepatitis C is warranted. See 38 U.S.C. § 5107(b); see also 38 C.F.R. §§ 3.102, 3.303; Gilbert v. Derwinski, 1 Vet. App. at 53-56 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vosburgh, 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.