Citation Nr: 21063188 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-11 474 DATE: October 13, 2021 ORDER Entitlement to service connection for Hepatitis C is granted. Entitlement to service connection for bilateral lower extremity peripheral neuropathy is granted. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, his Hepatitis C was as likely as not due to needle sticks in service. 2. The Veteran's bilateral lower extremity peripheral neuropathy was caused by his Hepatitis C. CONCLUSIONS OF LAW 1. The criteria for service connection for Hepatitis C have been met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2021). 2. The criteria for service connection for bilateral lower extremity peripheral neuropathy are met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1968 to June 1971. This matter came before the Board of Veterans Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during an October 2021 hearing. 1. Entitlement to service connection for Hepatitis C The Veteran contends that his Hepatitis C was due to needle sticks in service. For the reasons that follow, the Board finds that service connection is warranted. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). Service treatment records are silent for symptoms, treatment or diagnosis of Hepatitis C or any other liver disease. The Veteran's DD-214 shows a military occupational specialty of dental assistant. A September 1992 letter from the Red Cross advised the Veteran that a "recent blood donation" showed a positive test for Hepatitis C, noting that the Red Cross had tested all blood for antibodies to Hepatitis C since 1990. The letter did not identify the date of the referenced blood donation. December 2011 VA treatment records noted a diagnosis of Hepatitis C. A May 2011 statement from fellow servicemember A.R. reported that he served with the Veteran and trained with him as a dental assistant. He stated that he remembers multiple occasions where he personally observed the Veteran being stuck by used needles while performing job duties. He noted that this was a job hazard that he experienced as well, as part of their job was to place the cover on the needle after it was used. He also stated that they did not wear protective equipment during training and that even when gloves were worn, they did not protect against needle sticks. The Veteran submitted a July 2014 statement contending that he contracted Hepatitis C while working as a dental assistant in service. He stated that he had never done drugs, was never treated with blood products and his first tattoo was completed after his diagnosis. The Board notes that A.R. and the Veteran are competent to report lay observable events, such as a needle stick, as well as job duties, and assigns their statements significant probative weight. A May 2016 VA examination diagnosed Hepatitis C but found it was not likely due to service. As a rationale, the examiner stated that inoculation with air guns had not been clinically documented to be a cause of Hepatitis C and the "self-reported" needle sticks in service were of unknown significance. The examiner then stated that the Veteran reported donating blood beginning in 1991 and said that he donated several times before the Red Cross notified him that he was hepatitis positive in 1992. The examiner noted that the letter from the Red Cross indicated that testing of donated blood began in 1990. The Veteran submitted a September 2021 opinion from his private provider, who opined that his Hepatitis C was likely due to needle sticks in service. As a rationale, she noted that blood-borne transmission of Hepatitis C was well documented and was common for health care workers with needle stick injuries. She also noted that the Veteran had no other risk factors for Hepatitis C, such as drug use or incarceration. The Board finds that the VA and private examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds them entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30205 (2008). Resolving all doubt in favor of the Veteran, the Board finds that the evidence is at least in equipoise regarding whether the Veteran's Hepatitis C was likely due to needle sticks in service. The DD-214 shows that the Veteran worked as a dental assistant, he reported multiple needle sticks in service and an absence of other risk factors, and his reports are corroborated by competent lay evidence from his fellow service member. The September 2021 private opinion found that Hepatitis C was likely due to those needle sticks, noting the absence of all other risk factors and as well as the common transmission of Hepatitis C to health care workers through needle sticks. While the May 2016 VA examiner found that Hepatitis C was not likely due to service, relying on the Red Cross letter, that letter did not identify the date of the donation that tested positive. Thus, even if the Veteran began donating blood at some point in 1991 as reported at the VA examination, the record does not contain clear evidence of prior negative tests as there is no evidence showing which blood donation resulted in the positive test. Given that ambiguity, the evidence is at least in equipoise. Therefore, resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's Hepatitis C was at least as likely as not caused by the Veteran's in-service needle sticks and service connection is warranted. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to service connection for bilateral lower extremity peripheral neuropathy The Veteran contends that his bilateral lower extremity peripheral neuropathy was caused by his Hepatitis C. Service connection for Hepatitis C has been granted above. For the reasons that follow, the Board finds that service connection for bilateral lower extremity peripheral neuropathy is warranted. Secondary service connection may be granted for disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). January 2010 private treatment records noted bilateral lower extremity paresthesias consistent with peripheral neuropathy and stated that there was a question regarding whether the neuropathy was due to Hepatitis C. January 2011 private records showed that nerve conduction tests were completed and showed evidence of peripheral neuropathic changes. The provider noted the Veteran's Hepatitis and noted that peripheral neuropathy may be related, noting that the Veteran's Hepatitis was in a chronic inflammatory state and another reversible cause was unlikely. A May 2016 VA examination found that the signs/symptoms of the Veteran's chronic liver disease included bilateral lower extremity peripheral neuropathy. A September 2021 opinion from the Veteran's private provider found that bilateral lower extremity peripheral neuropathy was likely due to Hepatitis C. The provider stated that such neuropathy was commonly associated with Hepatitis C and also noted that in the Veteran's case his neuropathy predated his diabetes diagnosis. For these reasons, the provider found neuropathy was highly likely due to Hepatitis C. The Board finds that the VA and private examinations are adequate for appellate review. There is no evidence that the examiners were not competent or credible, and as the reports are based on the Veteran's statements, in-person examinations and the examiners' observations, the Board finds they are entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30205 (2008). The competent evidence therefore shows that the Veteran has bilateral lower extremity peripheral neuropathy that was caused by his service-connected Hepatitis C. Private treatment records show diagnosis after nerve conduction studies and noted that the Veteran did not have other likely causes, the VA examiner characterized neuropathy as a sign/symptom of the Veteran's liver disease, and the private examination found that neuropathy was caused by Hepatitis C. Service connection is therefore warranted. 38 C.F.R. § 3.310(a). E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Arnold 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.