Citation Nr: 21000646 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 18-37 152 DATE: January 5, 2021 ORDER Entitlement to a compensable rating for service-connected Hepatitis C is denied. FINDING OF FACT The Veteran’s hepatitis C has not caused symptoms such as intermittent fatigue, malaise, and anorexia, or any incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). CONCLUSION OF LAW The criteria for a compensable rating for service-connected Hepatitis C have not been met. 38 U.S.C. § §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7354. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from December 1969 to October 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran and his son presented sworn testimony at a hearing before the undersigned. This matter was previously remanded by the Board in an April 2020 decision for further development. Entitlement to a compensable rating for service-connected Hepatitis C In a December 2017 rating decision, the RO granted service connection for Hepatitis C and assigned a noncompensable rating, effective May 22, 2017, under Diagnostic Code (DC) 7354. Under DC 7354, a 10 percent rating is warranted when there is intermittent fatigue, malaise, and anorexia or incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period. Note 2 under DC 7354 provides that for purposes of evaluating conditions under DC 7354, "incapacitating episode" means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. See Note 2 following 38 C.F.R. § 4.114. The Veteran asserts that he should be rated higher for his Hepatitis C because he reports that he has suffered from periods of fatigue and not being able to eat and has lost a lot of weight due to the loss of appetite. See February 2018 Notice of Disagreement. These periods can last a week or more at times, and sometimes he is unable to eat because of severe nausea or only able to eat one meal a day. See July 2018 Form 9. At his March 2020 Board Hearing, the Veteran testified that he has constant and daily fatigue, nausea, decreased appetite, and arthralgia as symptoms of his Hepatitis C. See March 2020 Hearing Transcript. Further, he testified that he has fatigue “all the time” and stated he had pain in his joints, “arthralgia,” and that due to the fatigue, he is forced to take several breaks during the day because he feels too tired to continue; he also reported abdominal pain along with the nausea. The Veteran’s son testified at the hearing and stated he has noticed the effects of fatigue on the Veteran, as he says he is too tired for activities such as hunting and fishing that he used to do regularly. The Veteran also testified that at the last VA examination done for hepatitis C in December 2017, the Veteran was found asymptomatic; however, he contends that the examination was not a good reflection of the disability picture because he was “feeling fairly good that day,” and he was not suffering from any of the symptoms he is feeling at this time. The Board remanded the claim for a new VA examination to assess the current and worsening symptomatology of the Veteran’s Hepatitis C. See April 2020 BVA Decision. The Veteran was afforded a post-remand VA examination in July 2020. The evidence review showed that Veteran was last treated for Hepatitis C starting in February 2015, and he was assured that he was cured by October 2015; he was discharged thereafter, and consult was discontinued. The Veteran’s was noted to deny any current symptoms, and the last known treatment was “a few years ago with medication over the course of about 8 weeks.” The Veteran did not have any incapacitating episodes during the past 12 months, no other pertinent physical findings or conditions were found, no other significant diagnostic test findings or results were found, and the Veteran’s liver condition was not noted to impact his ability to work. See July 2020 C&P Exam. The VA examiner opined that there is no change in the diagnosis for Veteran’s Hepatitis C. Significantly, in response to the Board’s remand instructions, the examiner indicated that the Veteran’s hepatitis C was not productive of intermittent or daily fatigue, malaise, and anorexia, requiring dietary restriction or continuous medication, or incapacitating episodes. The examiner reported that the Veteran’s Hepatitis C, which has been treated, was not productive of symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and upper right quadrant pain. The examiner also indicated there is no documentation of weight loss, hepatomegaly, and malnutrition due to Hepatitis C, and Veteran’s complaints are more likely due to his current medical conditions which include syncope episode in December 2019, a type II diabetes mellitus diagnosis in January 2017, stage three chronic kidney disease (CKD), hypoproliferative anemia, and abdominal pain. Veteran was also diagnosed with gout in July 2017 and is recommended to take medication for GI problems such as gastritis and gastric chronic inflammation. Veteran also has a history of smoking for over 50 years and quit tobacco in January 2017. A review of the Veteran’s symptoms revealed that he denied fever, chills, sweats, fatigue, weight loss/gain, and stated he “overall feels good.” Based on the foregoing evidence, the Board finds that the preponderance of the evidence shows that the criteria for a compensable rating for the Veteran’s hepatitis C have not been met. Evidence suggestive of a 10 percent rating for hepatitis C includes intermittent fatigue, malaise, and anorexia, or incapacitating episodes, including nausea, vomiting, arthralgia and right upper quadrant pain. However, the most probative evidence of record, including the December 2017 and July 2020 VA examination reports, shows the Veteran’s hepatitis C has been treated effectively and is asymptomatic. (Continued on the next page)   In sum, the medical evidence of record suggests the Veteran’s hepatitis C is asymptomatic. As such, the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. Accordingly, a compensable rating for hepatitis C is not warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.