Citation Nr: 20024491 Decision Date: 04/09/20 Archive Date: 04/09/20 DOCKET NO. 11-26 557A DATE: April 9, 2020 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1976 to February 1980. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran was scheduled for a Board hearing in the Central Office in Washington, DC, but canceled. Thus, his hearing request is considered withdrawn. 38 C.F.R. § 20.704 (e). Entitlement to service connection for hepatitis C is remanded. While the VA Adjudication Procedures Manual (M21-1) is not binding on the Board, the Board, however, must address relevant provisions of the M21-1 and conduct an independent analysis before determining whether the provisions may be relied upon as a factor to support its decision. Overton v. Wilkie, 30 Vet. App. 257, 265 (2018). Under the M21-1, risk factors for hepatitis C include intravenous drug use, blood transfusions before 1992, hemodialysis, intranasal cocaine, high-risk sexual activity, accidental exposure while a healthcare worker, and various kinds of percutaneous exposure such as tattoos, body piercing, acupuncture with non-sterile needles, and shared toothbrushes or razor blades and immunization with a jet air gun injector. The evidence of record shows that in August 2009, the Veteran was diagnosed with hepatitis C, as a part of transplant workup. He contends it is a result of service; specifically, from being held as a Prisoner of War (POW) and forced to use the same razor and toothbrush, like the other ten detainees. He also reported “nicking” himself several times while quickly shaving during his detainment. As the Veteran has credibly and competently reported in-service risk factors for the possible cause of his hepatitis C, and he has a diagnosis of hepatitis C during the appeal period, the low threshold of McLendon is triggered, and an examination is required to resolve the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Accordingly, the matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the etiology of his hepatitis C. Even if the examiner determines that hepatitis C has resolved, an etiology opinion must be provided because the disability was present during the appeal period. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner must take a detailed history from the Veteran to include prior surgeries, IV drug use, giving blood during, tattoos, body piercing, and high-risk sexual activity. If there is any clinical or medical basis for corroborating or discounting the credibility of the history provided by the Veteran, the examiner must so state, with a complete explanation in support of such a finding. Although an independent review of the claims file is required, the examiner’s attention is drawn to a February 03, 2010 treatment note indicating that the Veteran’s hepatitis C risk factors included military travel to the Gulf; shellfish; and prostitutes/STDs. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C either first manifested in service or resulted from an in-service risk factor. The examiner must identify all the Veteran’s potential risk factors for contracting hepatitis C, to include whether those risk factors occurred before, during, or after service. To the extent possible, the examiner must explain which of the reported hepatitis C risk factor is the most likely cause of the Veteran’s hepatitis C. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above-requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such a conclusion. (Continued on next page)   2. Then, readjudicate the claim. If any decision is adverse to the Veteran, issue a supplemental statement of the case, and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Stevens, 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.