Citation Nr: 20029482 Decision Date: 04/28/20 Archive Date: 04/28/20 DOCKET NO. 15-14 639 DATE: April 28, 2020 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for cirrhosis of the liver, to include as due to hepatitis C, is remanded. Entitlement to service connection for ascites, to include as due to hepatitis C, is remanded. Entitlement to service connection to hepatic encephalopathy, to include as due to hepatitis C, is remanded. Entitlement to service connection for thrombocytopenia, to include as due to hepatitis C, is remanded. Entitlement to service connection for cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to May 1971 and July 1976 to August 1994. The Veteran died in May 2012 and the appellant is the Veteran’s surviving spouse. In October 2019, the appellant appeared at a rescheduled videoconference hearing before the undersigned. Because the appellant was scheduled for a hearing in the present matter, the Board presumes the Veteran’s surviving spouse has been substituted as the appellant in the present appeal. Additionally, the Board notes the appellant was invited to submit more evidence during the appeal period. See, e.g., April 2013 and July 2013 Rating Decision narratives. 1. Entitlement to service connection for hepatitis C is remanded. 2. Entitlement to service connection for cirrhosis of the liver, to include as due to hepatitis C, is remanded. 3. Entitlement to service connection for ascites, to include as due to hepatitis C, is remanded. 4. Entitlement to service connection to hepatic encephalopathy, to include as due to hepatitis C, is remanded. 5. Entitlement to service connection for thrombocytopenia, to include as due to hepatitis C, is remanded. The appellant asserts that the Veteran’s hepatitis C began in service due to a blood transfusion and/or skin graft, shared razors, shared toothbrushes, and air gun vaccinations. See April 2015 VA Form 9; October 2019 Hearing Transcript. Although service treatment records do not show a diagnosis or treatment for hepatitis C, the appellant asserts that the Veteran began to experience symptoms around the time of his discharge from service in 1994. See October 2019 Hearing Transcript. In addition, a February 1996 Red Cross blood test revealed the Veteran’s hepatitis C diagnosis – less than 2 years after separation. The appellant further asserted that a 1985 service treatment note indicating the Veteran suffered from hair loss that his barber suggested may be related a blood disease is indicative of hepatitis C symptoms. Although a VA physician opined in August 2011 that it was more than likely that the Veteran acquired hepatitis C during service, this opinion was not supported by any rationale and is, therefore, inadequate. The Board finds that an adequate medical opinion that addresses whether the Veteran’s hepatitis C had its onset in service, or is otherwise related to service, should be obtained on remand. In addition, it was asserted that the Veteran had a blood transfusion at Long Beach Naval Hospital in the 1970s while on active duty and he received a skin graft at that hospital in 1970. See April 2015 VA Form 9. On remand, the AOJ should attempt to obtain records of this treatment. In light of the assertion that the claims for service connection for cirrhosis of the liver, ascites, hepatic encephalopathy, and thrombocytopenia developed secondary to hepatitis C, the Board finds the issues are inextricably intertwined with the claim for service connection for hepatitis C, which remains undecided and pending; thus, a remand is required. See generally Harris v. Derwinski, 1 Vet. App. 180 (1991). 6. Entitlement to service connection for cause of death is remanded. The Veteran’s death certificate lists hepatitis C and cirrhosis as two causes of the Veteran’s death. As a result, the issues of service connection for cause of death and service connection for hepatitis C and cirrhosis are also inextricably intertwined. Thus, a decision on service connection for cause of death must be deferred pending the outcome of the aforementioned service connection claims. The matters are REMANDED for the following action: 1. Make reasonable efforts to obtain service-era clinical and hospitalization records pertaining to a blood transfusion and/or skin graft the Veteran reportedly underwent at Long Beach Naval Hospital in the 1970s. 2. After completing the development requested above, obtain a medical opinion from an appropriate clinician to address the following: (a.) Whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s hepatitis C had its onset in service or is otherwise related to service. In providing the requested opinion, the reporting clinician is asked to address the fact that hepatitis C was indicated within two years of the Veteran’s separation from service, the 1985 service treatment note suggesting the Veteran’s hair loss may be due to a blood disorder, and the lay assertions that his hepatitis C developed due to a blood transfusion and/or skin graft, shared razors, shared toothbrushes, and air gun vaccinations. (b.) Whether it is at least as likely as not that the Veteran had cirrhosis of the liver, ascites, hepatic encephalopathy, and/or thrombocytopenia that was caused by hepatitis C. (c.) Whether it is at least as likely as not that the Veteran had cirrhosis of the liver, ascites, hepatic encephalopathy, and/or thrombocytopenia that was aggravated by hepatitis C. (Continued on the next page)   The reporting clinician is asked to explain the reasons behind any opinions expressed and conclusions reached. M. C. WILSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Williams, 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.