Citation Nr: 21002117 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-57 890 DATE: January 12, 2021 REMANDED Entitlement to service connection for the Veteran's hepatitis C disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to January 1976. This matter comes before the Board of Veteran’s Appeal (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In April 2015, the VA advised the Veteran that he should contact the VA if he wanted to be represented. Subsequently, in May 2015, the Veteran requested that VA provide him a list of representatives/Veterans Service Organizations. To date, VA has not responded to the Veteran’s request. Entitlement to service connection for the Veteran's hepatitis C disability is remanded. This matter was previously remanded in February 2019 for further development to include a VA examination. The case has now returned to the Board for appellate review and, although it again regrets further delay, the Board finds that additional remand is required. Following the February 2019 Board remand, the Veteran was afforded a VA examination in October 2019. The October 2019 medical opinion and the August 2020 addendum opinion, however, are inadequate. Specifically, the examiner failed to determine whether the Veteran had any service-related hepatitis C risk factors because the Veteran’s risk factors were unknown. However, the Veteran stated that he had a blood transfusion in the 1970s and that he shared razors while in service. See October 2014 VA Treatment Record; see also January 2015 VA Form 21-4138 Statement in Support of Claim. Therefore, the Board finds that October 2019 and August 2020 VA medical opinions are inadequate for adjudicative purposes. See Nieves-Rodriguez v. Peake , 22 Vet. App. 295, 304 (2008). As the opinions obtained on remand are inadequate, the Board finds that a VA addendum opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  The VA addendum opinion should comment on whether the Veteran underwent any procedures during service that required a blood transfusion. See October 2014 VA Treatment Record. The examiner should also address the Veteran’s contention that he shared razors during service and state the relative probability that the hepatitis C infection is etiologically related to this risk factor. See January 2015 VA Form 21-4138 Statement in Support of Claim. The examiner should also approximate when the Veteran’s may have contracted hepatitis C based on the severity of the Veteran’s cirrhosis of the liver as shown by the September 2014 liver biopsy. See November 2014 VA Treatment Record. In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran’s lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran’s own descriptions of the history of his hepatitis C disability. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. The RO should provide the Veteran with a list of available representatives and the Veteran should clarify with VA whether he would like the assistance of a representative. 2. Schedule the Veteran for an examination to determine the nature and etiology of the Veteran’s hepatitis C disability. Following review of the file and this remand, the examiner is to address the following: (a.) A history of all the Veteran's potential risk factors for hepatitis C should be detailed in full. The examiner must list and discuss all documented and reported pre-service, in-service, and post-service risk factors. The examiner should then rank the documented risk factors relative to the probability that any hepatitis C infection is etiologically related to the service-related risk factors; (b.) Please ascertain from the Veteran whether he underwent any procedures during service that would require a blood transfusion and document the Veteran’s response; (c.) Please approximate when the Veteran most likely contracted hepatitis C based on the severity of the Veteran’s cirrhosis of the liver as shown by the September 2014 liver biopsy; (d.) Based on the information provided in paragraphs (a.) through (c.), please state whether it is at least as likely as not (50 percent probability or more) that the Veteran’s hepatitis C disability, had its onset in, was caused by, or is otherwise related to service; (e.) For the purpose of providing the opinion requested, please accept as valid the Veteran’s statement that he shared razors in service, and state whether a nexus between the Veteran’s hepatitis C disability and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the examiner should consider both medical and lay evidence dated both prior to and since the filing the claim including but not limited to VA treatment records dated July 2014, October 2014 September 2014 and the October 2019 medical opinion.   The examiner should provide a complete rationale for any opinion rendered. If the examiner’s opinion is negative, he or she must clearly explain why, to include a discussion of why the evidence does not support a finding that the Veteran’s hepatitis C disability is related to service. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Foster 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.