Citation Nr: 21001359 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 13-23 153 DATE: January 7, 2021 ORDER Service connection for hepatitis C is granted. VETERAN’S CONTENTIONS The Veteran contends that he incurred hepatitis C as a result of in-service risk factors including tattoos, drug use, and/or high-risk sexual activity. FINDING OF FACT The Veteran had several risk factors for hepatitis C both in service and after service, and the evidence is in equipoise as to whether the Veteran’s hepatitis C was incurred in service. CONCLUSION OF LAW The criteria for service connection for hepatitis C are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1977 to July 1978. This matter is before the Board following his appeal of a July 2007 rating decision. In July 2016, the Veteran testified before the undersigned Veterans Law Judge. In March 2017 and March 2020, the Board remanded this appeal for further development. Service Connection for Hepatitis C Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Regulations also provide that service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Following a review of the record, the Board finds that the evidence is at least evenly balanced as to whether the Veteran’s hepatitis C was incurred as a result of an in-service risk factor or a post-service risk factor. Affording the Veteran the benefit of the doubt, the Board will grant the Veteran’s claim. In support of this determination, the Board notes that a history of hepatitis was noted as early as May 1998, and the record supports numerous in-service risk factors for hepatitis C, including a razor blade laceration, multiple tattoos, high-risk sexual activity, and intravenous drug use. In this regard, service treatment records (STRs) document that the Veteran sustained multiple superficial lacerations to his left wrist in June 1978, and also that he received multiple tattoos in service, as indicated by a comparison of a February 1977 entrance examination and a July 1978 separation examination. Additionally, in September 2006, February 2010, and July 2010 statements, the Veteran provided competent lay testimony that he engaged in intravenous drug use and high-risk sexual activity in service, and there is nothing that expressly contradicts that testimony. The Board is cognizant that the record also shows a number of post-service risk factors for hepatitis C as well, including tattoos, drug use, and a lengthy prison sentence. However, the Veteran reported in a July 2010 statement that the only time he used needles with drugs was in service in Germany, and he also denied significant high-risk sexual activity post service, noting that he was married soon after separation and then spent over 20 years in prison. Given the presence of both in-service and post-service risk factors, the Veteran was afforded examinations to address the etiology of his hepatitic C, but the Board has yet to obtain an adequate nexus opinion. Nevertheless, it finds that the evidence is sufficient for a grant at this time given a July 2017 opinion and September 2020 addendum. In this regard, the July 2017 and September 2020 VA examiner noted that the Veteran had many risk factors for hepatitis C with the most likely being IV drug use, tattoos, and multiple sexual partners. Of note, in September 2020, the examiner stated that IV drug use was risk factor most likely to result in infection. Notably, all three of the most likely listed risk factors are service-related. Thus, resolving doubt in favor of the Veteran, the foregoing opinions support that it is at least as likely as not that the Veteran’s hepatitis C was caused by a service-related risk factor, even excluding intravenous drug use. Accordingly, in light of the above, the Board finds that entitlement to service connection for hepatitis C is warranted. As such, the Board will grant the Veteran’s claim. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). S. C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fagan, Aileen 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.