Citation Nr: 20034053 Decision Date: 05/15/20 Archive Date: 05/15/20 DOCKET NO. 13-33 599 DATE: May 15, 2020 ORDER Entitlement to service connection for hepatitis C is granted. REMANDED Entitlement to service connection for acid reflux is remanded. Entitlement to service connection for a disability manifested by chest pain is remanded. FINDING OF FACT The Veteran’s hepatitis C is related to in-service exposure to shared razors and combat-related injuries. CONCLUSION OF LAW The criteria for service connection for hepatitis C are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from December 1966 to December 1968, to include service in Vietnam. His decorations include the Combat Infantryman Badge, the Air Medal, and the Bronze Star Medal with “V” device. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In February 2017 and January 2019, the Board remanded the claims currently on appeal for additional development. The case now returns to the Board for further consideration. 1. Entitlement to service connection for hepatitis C The Veteran contends that he has hepatitis C from service as a result of shared razors, donating blood, and receiving stitches in the field. The Board concludes that the Veteran has hepatitis C that is related to insert in-service exposure to shared razors and receiving stitches in the field. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA and private treatment records show the Veteran has a current diagnosis of hepatitis C. See, e.g., May 2002 private treatment record; February 2017 VA examination report. The Veteran’s service treatment records do not show a diagnosis of hepatitis C. However, the service treatment records show that he had stitches in his forehead in January 1967 (at Fort Bragg) removed. His treatment records also noted a laceration to the lateral aspect of the right thumb in March 1968 (in Vietnam) with stitches. He is presently service connected for laceration scar of the right thumb; and residuals of shrapnel injury to right calf sustained in combat in Vietnam. The Veteran’s service personnel records show that his military occupational specialty was Light Weapons Infantryman and that, as noted, he earned, in pertinent part, the Combat Infantryman Badge, the Air Medal, and the Bronze Star Medal with “V” device. He also had one year of service in Vietnam. As the Veteran was in combat in Vietnam in which he sustained injuries and his service treatment records also show that he had stitches for injuries, at least one of which occurred in Vietnam in 1968, the evidence supports his contention that he had blood exposure from injury in service. See 38 U.S.C. § 1154(b). In addition, the Veteran is competent to state that he shared razors. Thus, the question becomes whether the current disability is related to service. On this question there are opinions in favor of and against the claim. The evidence against the claim includes VA examinations dated in August 2013 and July 2017, which found that the Veteran’s hepatitis C was not related to service because there was no diagnosis in service, and no documentation of any risk factors, such as donating blood, shared razors, and stitches, while in service. Significantly, however, January 1967 and April 1968 service treatment records indicate the Veteran had received stitches. He also is shown to have been in combat and is presumed to have had some exposures from injury and stitches. Because the examiners based the medical opinions, in part, on an inaccurate reading of the record, these opinions are not probative. The evidence in favor of the claim includes a July 2019 VA examination report, which found that the Veteran’s hepatitis C is at least as likely as not incurred in or caused by in-service injury. The examiner noted that without documentation of the date of onset of the acute phase of the disease, it was difficult to know when the Veteran contracted the disease. The examiner found, however, that if the Veteran shared shaving razors in service it was difficult to argue against the fact that he might have contacted the disease in service. The record does not show any post-service risk factors for contracting hepatitis C. A May 2017 VA examination report shows that the Veteran denied a history of alcohol or drug abuse. The report also noted a work history for 30 years after service with the Secretary of State in Illinois. U.S. Social Security Administration records show a work history from 1975 to 2005 of working as an archivist, on the assembly line for a lighting distributor, and mail sorter for an insurance company. Thus, there is no clear and convincing evidence to rebut service connection for hepatitis C, as a result of sharing razors and/or injuries including from combat. See 38 U.S.C. § 1154(b). Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current hepatitis C diagnosis is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hepatitis C is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for acid reflux is remanded. 2. Entitlement to service connection for a disability manifested by chest pain is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of service connection for acid reflux. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In previous remands, the Board has requested an opinion as to whether the Veteran’s acid reflux was related to his active service. In July 2017, a VA physician opined that it was less likely than not that the Veteran’s currently diagnosed gastroesophageal reflux disease (GERD) was incurred in or caused by service. As rationale, the VA physician explained that the service treatment records were silent for symptoms or diagnosis of GERD or reflux. However, the examiner did not address the Veteran’s competent lay statements and did not thoroughly discuss his in-service symptoms; most specifically, 1967 records noting nausea, vomiting, and pain in the right lower quadrant while on active duty. In addition, a December 2008 private consult further indicated gastritis, as being “possibly related to underlying nonsteroidal anti-inflammatory drugs.” He likewise had heartburn dating back to year 2000. A July 2019 VA examination report was provided that the Veteran’s GERD was not related to the nausea and vomiting that the Veteran had in service in October 1967. However, there was no rationale provided for this opinion other than to note that there was no diagnosis of GERD in service. Given that the Veteran has complaints related to nausea and vomiting in service, and has complained of chest pain since service, another medical opinion is warranted with sufficient rationale. The July 2019 VA examination report noted that the Veteran’s chest pain was described as a burning retrosternal pain like heartburn due to reflux. To the extent that the Veteran’s chest pain is related to his GERD, this matter is deferred pending resolution of the GERD claim. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s acid reflux is at least as likely as not related to his military service, with consideration of the service treatment records showing complaints of nausea and vomiting in 1967 and the Veteran’s complaints of chest pain since service. A complete rationale for the opinion must be provided. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sarah B. Richmond, 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.