Citation Nr: 20081690 Decision Date: 12/30/20 Archive Date: 12/30/20 DOCKET NO. 09-21 236 DATE: December 30, 2020 REMANDED Entitlement to service connection for hepatitis C with cirrhosis of the liver is remanded. REASONS FOR REMAND The Veteran served honorably with the United States Army from June 1970 to January 1973. This matter was previously remanded by the Board of Veterans’ Appeals (Board) in July 2019. The appeal has been returned to the Board for further appellate consideration. Entitlement to service connection for hepatitis C with cirrhosis of the liver is remanded. Although the Board regrets the additional delay, the Board finds that remand is once again warranted. In particular, remand is required to obtain a medical opinion that complies with the July 2019 Board remand instructions, and to consider lay statements of record when determining whether the Veteran’s hepatitis C was related to blood exposure in service. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998) (requiring substantial compliance with remand directives). . First, the June 2019 Board remand found that the Veteran’s statements were credible regarding his combat experience and conceded that the Veteran had been exposed to the blood of wounded soldiers in service; consequently, the Board directed the examiner to consider and address the Veteran’s credible lay statements that he was exposed to the blood of wounded soldiers in service. Despite this concession and directive, the resulting January 2020 examiner repeatedly asserted her belief that the Veteran was not exposed to blood in service before opining that the Veteran’s hepatitis C was unrelated to service, to include exposure to blood of wounded soldiers. In addition, the June 2019 Board remand directed the examiner to consider articles from the National Institute on Drug Abuse (NIDA) addressing narcotic and alcohol use by Army enlisted men in Vietnam, and information from the Centers for Disease Control and Prevention (CDC) referring to studies that show hepatitis C can become a long-term chronic infection before commenting as to how that applies to an April 2006 VA treatment record indicating that the Veteran’s hepatitis C could have a possible duration of 30 plus years. See July 2019 Board Decision. Although the examiner considered the CDC information, she did not consider the NIDA article when providing her opinion on the Veteran’s drug abuse in service. For the foregoing reasons, remand is required to obtain a medical opinion that complies with the prior remand instructions. See Stegall, supra; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). The matter is REMANDED for the following action: Schedule the Veteran for a new examination to ascertain the nature and etiology of the Veteran’s hepatitis C. Any indicated evaluations, studies, and tests deemed necessary should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran’s documented medical history as well as his assertions. After eliciting a history of the Veteran’s disability, the examiner should offer comments, an opinion and a supporting rationale for the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s hepatitis C had its onset in service, or is otherwise related to service, to include blood of wounded soldiers, intravenous substance abuse, or contaminated air guns from vaccinations? * The examiner must consider and address the Veteran’s credible lay statements that he was exposed to the blood of wounded soldiers in service. THE EXAMINER IS ADVISED THAT THE BOARD HAS CONCEDED THAT THE VETERAN WAS EXPOSED TO THE BLOOD OF WOUNDED SOLDIERS IN SERVICE AND SHOULD CONSIDER THAT AS A FACT WHEN RENDERING HIS/HER OPINION. See 2019 Board Remand; Feb. 2006 VA Examination. * Regarding the Veteran’s contention of exposure by intravenous drug use, the examiner should have the Veteran clarify his administration of heroin while in service. The examiner should then address an April 2006 treatment record which noted a hepatitis C diagnosis and a history intravenous drug abuse in service during Vietnam. The examiner must also address the National Institute on Drug Abuse (NIDA) Notes article submitted by the Veteran in October 2008 addressing narcotic and alcohol use by Army enlisted men in Vietnam. See December 2006 Medical Treatment Record; see also October 2008 Medical Treatment Record. *The examiner must also address the Veteran’s references to the Centers for Disease Control and Prevention (CDC) information on hepatitis C, which is found at https://www.cdc.gov/hepatitis/hcv/. The CDC webpage refers to studies that show hepatitis C can become a long-term chronic infection. THE EXAMINER MUST REVIEW THIS INFORMATION AND COMMENT ON HOW IT RELATES TO THE VETERAN’S DIAGNOSIS AND THE APRIL 2006 VA TREATMENT RECORD INDICATING THE VETERANS HEPATITIS C COULD HAVE A POSSIBLE DURATION OF 30 PLUS YEARS. See VA 646 Statement of Accredited Representative. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Emily A. Kotroco 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.