Citation Nr: 21062881 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 16-15 420A DATE: October 12, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for hepatitis B is remanded. REASONS FOR REMAND The Veteran had active service from October 1972 to October 1975. Entitlement to service connection for both hepatitis C and hepatitis B is remanded. Unfortunately, another remand is required in this case. Although the Board of Veterans' Appeals (Board) sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the claims. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for posttraumatic stress disorder (PTSD) with major depressive disorder and alcohol and drug abuse disorder and sleep apnea. The Board notes that the hepatitis C virus was not discovered until 1989. See Hepatitis C: 25 Years of Discovery, CDC, https://www.cdc.gov/knowmorehepatitis/timeline.htm. A September 2020 Department of Veterans Affairs (VA) evaluation states that the Veteran was diagnosed with both hepatitis C and hepatitis B. The examiner concluded that: "there is no evidence in the service treatment records to indicate that a hepatitis B or C condition developed;" "nor is there evidence in post-service medical records to indicate continuity of symptoms until 2001 when Veteran was diagnosed with hepatitis B and C;" and "thus, there is a lack of a nexus between the symptoms in the service and the current condition." The physician assistant did not note or otherwise address that hepatitis C was first identified by the medical community in 1989 and could not have been diagnosed during active service or for many years thereafter. Therefore, the Board finds that the examination report is of essentially no probative value. A July 2021 psychological evaluation conducted for VA conveys that "hepatitis C is transmitted primarily by infected blood, for example by sharing needles when injecting illicit drugs." The examiner concluded that "from the records review, the Veteran's hepatitis was diagnosed well after his military service (2001)" and "since hepatitis is a viral infection, it is not caused or exacerbated by a mental disorder including PTSD, depression or alcohol use disorder. The psychologist did not note or otherwise address that hepatitis C was first identified by the medical community in 1989 and could not have been diagnosed during active service or for many years thereafter. Further, she advanced no findings as to whether the service connected alcohol and drug abuse disorder was related to the Veteran's in service drug use and the onset of hepatitis C. Therefore, the Board finds that the examination report is of essentially no probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA hepatitis examination, conducted by the appropriate physician, to assist in determining the nature and etiology of the diagnosed hepatitis C and hepatitis B and any relationship to active service and the service connected disabilities. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hepatitis disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any hepatitis disability, to include hepatitis C and hepatitis B, had its onset during active service or is related to any incident of service, including the Veteran's in service sexual behavior and drug use. The examiner should specifically discuss the fact that hepatitis C virus was not discovered by the medical community until 1989. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any hepatitis disability, to include hepatitis C and hepatitis B, is due to or the result of the alcohol and drug abuse disorder and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any hepatitis disability, to include hepatitis C and hepatitis B, has been aggravated (increased in severity beyond the natural progression of the disorder) by the alcohol and drug abuse disorder and the other service-connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Casula 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.