Citation Nr: 20026270 Decision Date: 04/16/20 Archive Date: 04/16/20 DOCKET NO. 14-24 526 DATE: April 16, 2020 ORDER Entitlement to service connection for hepatitis C is denied. FINDING OF FACT The Veteran’s hepatitis C is not etiologically related to an in-service injury, event, or disease, nor did it have its onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for hepatitis C have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from August 1965 to September 1971, which included service in the Republic of Vietnam. In April 2018, the Board remanded the present matter for further development. The Board finds that there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, 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 preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Here, there is no dispute as to whether the Veteran had a diagnosis of hepatitis C during the appeal period. The Veteran asserts that he contracted hepatitis C during his military service. He posits that he contracted hepatitis C via immunizations that were administered using air guns during basic training. See, e.g., November 2010 statement; February 2011 statement. He further asserts that there is a strong likelihood that he contracted hepatitis C after being tattooed in 1965 while also on active duty. See February 2011 statement. Notably, the Veteran has denied using intravenous drugs, intranasal cocaine or engaging in high-risk sexual activity. See January 2011 Risk Factors for Hepatitis Questionnaire. He also denied receiving hemodialysis, sharing a toothbrush or razor blade, undergoing acupuncture with non-sterile needs, or receiving a blood transfusion. See id. The Board notes that the Veteran’s service treatment records (STRs) are silent as to complaints, treatment, or diagnosis related to hepatitis C. During an April 2014 VA examination, the Veteran self-reported that he was first diagnosed with hepatitis as early as January 1988, which was when he attempted to donate blood. The examiner noted, however, that VA medical records first note hepatitis C in March 2010. During the April 2014 examination, the Veteran reported that he received air gun inoculations and that he got a tattoo while in service, photographs of which were submitted by the Veteran and are associated with the claims file. The VA examiner clarified that although tattoos are a risk factor for hepatitis C, the medical literature is very clear that the overwhelming risk factors for hepatitis C are intravenous drug use and prison tattoos. The examiner disclosed that he found no evidence of polysubstance abuse including intravenous drug use, homelessness, incarceration, overseas sex, or blood transfusions. In light of the foregoing, the examiner concluded that the Veteran’s hepatitis C was less likely than not incurred in or caused by the in-service injury, event, or illness. According to the VA examiner, the probability of the Veteran having contracted or acquired hepatitis C from a tattoo or body piercing was about two percent. The VA examiner emphasized that roughly 22 years have passed between the Veteran’s 1965 tattoo and the earlier 1988 date of diagnosis as self-reported by the Veteran. Statistically speaking, the VA examiner opined that given the fact that the Veteran was in service for only 27.2 percent of the time during which he was at risk (1966-1988), and given that tattoos comprise only two percent of the overall risk for acquiring hepatitis C, it was the examiner’s opinion that it was less likely than not that the Veteran acquired hepatitis C during service. Conversely speaking, the VA examiner opined that it was more likely that the Veteran contracted hepatitis C not during service, but following his separation from service in September 1971, through some other, unknown means in the course of his post-service life. The Board finds that the VA examiner’s opinion adequate, as the examiner reviewed the Veteran’s claims file; considered the relevant evidence, to include the relevant lay evidence; and provided rationale to support their ultimate conclusion. Although the Veteran believes his hepatitis C is directly related to his active military service, this issue is medically complex. A lay person is certainly competent to report matters within his own personal knowledge, such as the presence of symptoms, but a lay person without appropriate medical training and expertise is not competent to opine on more complex medical questions, such as the etiology of hepatitis. Accordingly, the Board finds that the VA examiner’s opinion is the only competent evidence of record that addresses the etiology of the claimed condition. Here, the competent evidence of record does not demonstrate that the Veteran’s hepatitis C began during service, that he had symptoms related to this condition in service, or that this condition is etiologically related to his period of service. Based on the foregoing, the Board finds that the evidence is against the claim of service connection for hepatitis C and the appeal must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. M. C. WILSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Harrell 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.