Citation Nr: 20029869 Decision Date: 04/28/20 Archive Date: 04/28/20 DOCKET NO. 16-22 680 DATE: April 28, 2020 ORDER Entitlement to service connection for hepatitis C is denied. FINDING OF FACT Hepatitis C did not manifest during service and is etiologically not related to service. CONCLUSION OF LAW The criteria for service connection for hepatitis C are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1971 to April 1974. Entitlement to service connection for hepatitis C. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). In his May 2016 substantive appeal, and in correspondence dated in November 2016, June 2017, and January 2018, the Veteran and his representative identified possible risk factors in service that may have resulted in his hepatitis C, including exposure to multi-use air injectors for vaccinations, using a shared razor, having a barracks mate who was treated for hepatitis, and engaging in unprotected heterosexual sex. Service treatment records do not document complaints, findings or treatment for hepatitis C. On VA examination in August 2019, the examiner noted that the Veteran was diagnosed with hepatitis C in 2013 and had no recurrence thus far. The examiner noted that the medical history shows that the Veteran had a roommate in service with hepatitis and turned yellow. He and the Veteran sometimes shared a razor and also used the same pipe to smoke hash. The Veteran also had unprotected sex with four different women during service. The examiner also noted that the Veteran was given vaccinations by multiuse air injectors. The examiner opined that the Veteran’s hepatitis C was less likely than not incurred in or caused by the claimed in-service injury, event or illness. As to the Veteran’s barrack mate having hepatitis A, the examiner explained that hepatitis A is common at that age and resolves without any residuals. If it does get transmitted that would happen at the time of contact and the patient would be symptomatic with yellow jaundice. Thus the examiner opined that hepatitis C was less likely than not incurred in or caused by the barrack matte having yellow jaundice, hepatitis A. The examiner also noted that per guidance from the Center for Disease Control (CDC) hepatitis A is a vaccine-preventable communicated disease of the liver. It is usually transmitted through the fecal-oral route or consumption of contaminated food or water. Hepatitis A is a self-limited disease that does not result in chronic infection. Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice, that usually resolve within 2 months of infection. Antibodies produced in response to hepatitis A infection last for life and protect against reinfection. The examiner also explained that per CDC guidance, alcohol abuse is a risk factor for baby boomers, and that as the Veteran was born in July 1951 alcohol abuse is a risk factor for hepatitis C. The examiner noted that the Veteran had a history of alcohol abuse for over 40 years, to include drinking 8 beers daily and 4 ounces of whiskey straight. Thus alcohol abuse and being a baby boomer were his risk factors for hepatitis C. The examiner also explained that according to up to date medical literature, sharing a razor and sharing a pipe to smoke hash were not sexual modes of transmission and the data did not support non-sexual transmission of hepatitis C. As to unprotected heterosexual sex during service, the examiner explained that up to date medical literature shows sexual transmission in heterosexual partners is very low or none. The examiner further explained that per up to date medical literature exposure to multi-use air injections was not a risk factor for hepatitis C infection especially in the Veteran’s case, with documented hepatitis C risk factors including date of birth and decades of alcohol abuse. Lastly, the examiner explained that medical literature shows that hepatitis C is spread through the blood, to include injection drug use, blood transfusions, needlestick injury, and many more ways. Other risk factors include being born to a mother with hepatitis C. The examiner noted that although VA organizations have expressed considerable interest in the possible relationship between hepatitis C and immunization with jet injectors, there has never been a documented case of hepatitis C by a jet injector. The Board finds this opinion to be highly probative as it was based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The examiner considered the nature of the Veteran’s hepatitis C in proffering the opinion. The opinion is uncontroverted by the other competent evidence of record. In an April 2020 statement the Veteran stated that the August 2019 VA was opinion inadequate because he did not consume 8 beers and 4 ounces of whiskey per day, however he acknowledged that he consumed alcohol. He also noted that the examiner was not accurate by stating that he shared a razor once in service as he shared the razor with the same person on multiple occasions in service. The Veteran also stated that he did not know the sexual history of his heterosexual partners. The Veteran contended that CDC and VA have acknowledged multi-use jet injectors as being unsafe. However, the Veteran’s contentions do not controvert the April 2019 VA opinion as the facts remain that the Veteran had a history of alcohol abuse and was a baby boomer, which the examiner explained were the main risk factors for his hepatitis C. Notably, VA treatment records including in March 2015 and April 2015 show that the Veteran a history of alcohol abuse and was drinking alcohol for forty years. VA regulations provide that compensation shall not be paid if a disability is the result of the Veteran’s own willful misconduct as a result of abuse of alcohol or drugs. 38 C.F.R. § 3.301. The other risk factors that the Veteran raised were acknowledged and considered by the VA examiner. To the extent that the Veteran is contending that the VA examiner did not accurately quantify the extent of these risk factors, the Board finds that the examiner thoroughly reviewed the Veteran’s medical history and risk factors for hepatitis C and articulated detailed opinions supported by rationales based one medical literature. Moreover and of significant import the examiner explained that data did not show that sharing a razor was a risk factor, sexual transmission in heterosexual partners was very low, and cases of hepatitis C by a jet injector have not been documented. As a lay person, the Veteran is competent to report symptoms pertaining to his hepatitis C. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the etiology of hepatitis C falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran’s hepatitis C is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).   The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached. Accordingly, the preponderance of the evidence is against the claim of service connection for hepatitis C, and there is no reasonable doubt to be resolved. 38 U.S.C. § 5107 (b). Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.