Citation Nr: 21002666 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 15-22 922 DATE: January 14, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to July 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in April 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board most recently remanded the issues on appeal for additional development in May 2020, and a medical opinion was obtained in November 2020. As such, the directives have been substantially complied with and the matter is again properly before the Board. D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in August 2018. A transcript of the hearing is of record. 1. Entitlement to service connection for hepatitis C. In accordance with the May 2020 Board remand, VA obtained a medical opinion concerning the etiology of the Veteran’s hepatitis C. In the examination report, the examiner noted two diagnoses: 1) hepatitis C with a diagnosis date of 2005; and 2) viral hepatitis with a diagnosis date of November 1978. The examiner then proceeded to state that the Veteran’s current hepatitis C was less likely than not related to his in-service diagnosis of viral hepatitis, the current viral hepatitis was at least as likely as not related to the Veteran’s period of service. The examiner then explained that as to hepatitis C, he was unable to state whether the disability was due to service, noting that prior to the 2005 diagnosis there is no evidence of chronic care following service or lab results showing a diagnosis of hepatitis C in service or prior to 2005. The examiner further stated that “hepatitis” refers only to an infection of the liver, and that many things cause hepatitis including hepatitis viruses, with A, B and C being the most common. While the Board notes that the examiner attempted to diligently provide an explanation for the provided opinion, ultimately the Board finds that the opinion is unclear. Specifically, the examiner stated that it was less likely than not that hepatitis C was related to the Veteran’s in-service viral hepatitis, but then further stated that it was at least as likely as not that viral hepatitis was related to service. First, it is unclear if the notation of viral hepatitis, as separate from hepatitis C, was a diagnosis by history or a diagnosis of a current disability separate from hepatitis C. Second, in the rationale supporting the negative opinion concerning hepatitis C specifically, the examiner notated that hepatitis C is a type of viral hepatitis. In light of this fact, the examiner’s statements that the current hepatitis C is not related to the Veteran’s service but that the viral hepatitis is related to service appear to directly contradict each other. As the May 2020 opinion is ultimately unclear, the Board must remand the appeal so that another opinion concerning the etiology of the Veteran’s hepatitis C can be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s hepatitis C. The examiner should answer the following: a) Identify all current disabilities. b) For each disability so identified, is it at least as likely as not (a fifty percent probability or greater) that the disability, to include hepatitis C, is causally related to the Veteran’s active service? Attention is invited to a January 1979 service treatment record assessing that the Veteran was status post viral hepatitis, probably type A, and noting factors considered in such diagnosis and a May 1979 separation report of medical history noting an October 1978 diagnosis of hepatitis (labelled “STR – Medical” – pgs. 5, 15 – uploaded 8/13/14). The examiner is also requested to reconcile the conflicting opinions provided in May 2020, particularly as to the discussion provided above as to viral hepatitis and hepatitis C. A detailed rationale for the opinion must be provided. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Wendell, 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.