Citation Nr: 20029611 Decision Date: 04/28/20 Archive Date: 04/28/20 DOCKET NO. 17-44 373 DATE: April 28, 2020 REMANDED The issue of service connection for hepatitis C is remanded. The issue of service connection for liver cirrhosis with severe ascites is remanded. The issue of service connection for kidney failure is remanded. The issue of service connection for bilateral edema of legs and feet is remanded. The issue of service connection for fibromyalgia is remanded. The issue of service connection for the cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1970 to August 1970; he died in August 2013. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the appellant testified at a Board hearing. The transcript of the hearing has been associated with the record. In November 2013, the appellant filed a VA Form 21-534EZ seeking compensation via DIC, death pension, and accrued benefits; additionally she provided a letter stating, “I would like to reopen his claim/case (dated 12-18-2012) in my name. I will be sending his final medical records as soon as I receive them.” The appellant’s application is deemed a request for substitution. See 38 C.F.R. § 3.1010(c)(2). Based on the foregoing, the appellant is found to be a valid substitute and will step into the Veteran’s shoes. The issues have been characterized accordingly. 1. Entitlement to service connection for hepatitis C. 2. Entitlement to service connection for liver cirrhosis with severe ascites. 3. Entitlement to service connection for kidney failure. 4. Entitlement to service connection for bilateral edema of legs and feet. 5. Entitlement to service connection for fibromyalgia. 6. Entitlement to DIC based on service connection for the cause of the Veteran’s death. The death certificate lists the cause of death as asystole, liver cirrhosis, and hepatocellular carcinoma due to chronic hepatitis C. 11/15/2013, VA 21-534EZ. An autopsy was not performed. At the time of his death, the Veteran had no service-connected disabilities. The appellant contends that the Veteran contracted hepatitis C from a contaminated pneumatic air gun vaccine injector used to administer immunizations during active service. The Board cannot make a fully-informed decision on service connection for the cause of the Veteran’s death due to hepatitis C and resulting asystole, liver cirrhosis, and hepatocellular carcinoma because no VA examiner has provided an opinion concerning the nature and etiology of the hepatitis C. The issues of kidney failure, edema, and fibromyalgia were claimed as secondary to hepatitis C; thus, the issues are inextricably intertwined. A remand of the claims for kidney failure, edema, and fibromyalgia are also required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (stating that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The matters are REMANDED for the following action: 1. Have an examiner determine the nature and etiology of the Veteran’s hepatitis C. The examiner should review the virtual file. The examiner must address the following and provide a rationale for all opinions as to Whether it was at least as likely as not (50 percent or greater probability) that the hepatitis C manifested during or was otherwise related to the Veteran’s period of active service, to include contamination through a pneumatic air gun vaccine injector. If the examiner cannot give an opinion without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. After completing directive #1, arrange for a VA examiner to determine the etiology of kidney failure. The examiner should determine Whether it was at least as likely as not (50 percent or greater probability) that kidney failure manifested during, was otherwise related to the Veteran’s period of active service, or proximately due to the Veteran’s hepatitis C. If the examiner cannot give an opinion without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing directive #1, arrange for a VA examiner to determine the etiology of edema of the bilateral legs and feet. The examiner should determine Whether it was at least as likely as not (50 percent or greater probability) that edema manifested during, was otherwise related to the Veteran’s period of active service, or proximately due to the Veteran’s hepatitis C. If the examiner cannot give an opinion without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. After completing directive #1, arrange for a VA examiner to determine the etiology of fibromyalgia. The examiner should determine Whether it was at least as likely as not (50 percent or greater probability) that fibromyalgia manifested during, was otherwise related to the Veteran’s period of active service, or proximately due to the Veteran’s hepatitis C. If the examiner cannot give an opinion without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Costa, 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.