Citation Nr: 21062743 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 10-40 876A DATE: October 12, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for diabetes mellitus type II, as secondary to hepatitis C is remanded. Entitlement to service connection for non-Hodgkin's lymphoma, as secondary to hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1972 to February 1975. The Board denied the claims in an August 2017 decision. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In a December 2018 Memorandum Decision, the Court set aside the Board's August 2017 decision and remanded the case to the Board for further action. The Board has since remanded the claim several times, most recently in May 2021. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for hepatitis C is remanded. The claim must be remanded again because the June 2021 opinon provided on remand is inadequate. Despite the Board's directive that it preferred an opinion from a hepatologist, the addendum opinion was provided by the same examiner who offered the previous opinions that the Board specifically determined are inadequate. The addendum opinion is inadequate for the same reasons. Board previosuly requested an addendum opinion preferably from a hepatologist. The Board finds that it is necess The opinion on remand must be obtained from a different provider and, preferably from a hepatologist. 2. Entitlement to service connection for diabetes mellitus type II, as secondary to hepatitis C is remanded. 3. Entitlement to service connection for non-Hodgkin's lymphoma, as secondary to hepatitis C is remanded These claims are remanded as inextricably intertwined with the remanded claim of service connection for hepatitis C. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a hepatologist, or if unavailable, a different examiner well versed in conditions of the liver to determine the nature and likely etiology of the Veteran's diagnosed hepatitis C. Copies of all pertinent records, including this remand, must be made available to the examiner for review. Based on the review of the record, the examiner should answer the following: Is it at least as likely as not that the Veteran's hepatitis C was incurred in or is otherwise related to service? Why or why not? The examiner must consider and discuss the following: (i) the 1974 (in service) elevated SGPT test results; (ii) the elevated liver enzyme findings recorded after the post-service 1976 motor vehicle accident, and (iii) the Veteran's assertion that he was exposed to hepatitis C by another soldier in his company who was a drug user, possibly by using a razor or accidently poking him with a syringe while shooting up. In rendering an opinion, the examiner should discuss the significance of SGPT testing with regards to hepatitis C, and consider and discuss as necessary the notation by the August 2016 VA examiner that the SGPT test was more speculative than the SGOT and LDH tests for liver damage and the notation by October 2020 VA examiner that SGPT testing was non-specific for hepatitic C. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided or cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to service connection for diabetes mellitus type II and non-Hodgkin's lymphoma. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.