Citation Nr: 21064912 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 18-10 193 DATE: October 22, 2021 ORDER Entitlement to service connection for hepatitis C is denied. Entitlement to service connection for the cause of the Veteran's death is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran's hepatitis C was related to his active-duty service. 2. The Veteran's death certificate reflects he died in November 2014 of hepatocellular carcinoma, a disability for which he was not service connected. 3. The cause of the Veteran's death was not attributable to his active service or a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for the cause of Veteran's death have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113(b), 1310, 5107(b); 38 C.F.R. §§ 3.5, 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1982 to April 1984. He died in November 2014. The Appellant is the Veteran's surviving spouse. A Board of Veterans' Appeals (Board) hearing was held in July 2021. A transcript is of record. 1. Hepatitis C An appellant is entitled to VA disability compensation if the Veteran had a current disability resulting from personal injury or disease incurred in, or aggravated by, active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, an appellant must show the Veteran had: (1) a disability during the appeal period; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See Shedden v. Principi, 381 F.3d 1163, 1167 (2004). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Appellant generally contends that the Veteran contracted hepatis C while in service. More specifically, she argues that the Veteran contracted hepatitis C from either injections given upon entry into active duty or alternatively due to high risk-sexual activity he engaged in while in service. See Board Hearing Tr. at 4. A June 2017 VA medical opinion concluded that it was less likely than not that the Veteran's hepatitis C was incurred in or caused by sexual activity and/or air-gun injections during service. See June 2017 VA medical opinion. As part of her rationale, the VA clinician indicated that while the Veteran did indulge in risky sexual behaviors in 1983 as he was treated for gonorrhea once during his military service, the rate of sexual transmission of hepatitis C is very low, ranging from 0 percent in monogamous couples to 4 percent in prostitutes. Id. The VA clinician referenced a statement released by VA regarding the belief that air guns transmitted blood borne diseases as "plausible." However, she went on to define plausible as appearing worthy of belief; superficially fair, reasonable, or valuable but often specious (false look of truth or genuineness), ultimately opining that the scientific evidence simply does not support the belief in this case. She concluded that while the possibility of transmission of hepatitis C by air gun or sexual activity is theoretically possible, it is less likely than not that the hepatitis C infection was incurred while on active duty. Id. The Board finds June 2017 VA opinion highly probative and affords it significant weight; the VA clinician reviewed the Veteran's record and gave a well-reasoned analysis while considering the Appellant's contentions, the private medical evidence submitted, and applying objective statistics regarding the probability of contracting hepatitis C from either sexual activity or air-gun inoculations. The Appellant provided a December 2017 private medical opinion by Dr. M.S. Dr. M.S. opined that the Veteran's hepatitis C was at least as likely as not related to the Veteran's service. See December 2017 Dr. M.S. Disability Benefits Questionnaire (DBQ). Dr. M.S. stated that the timeframe for acquiring hepatitis C was during military service. He further stated that the Veteran was healthy with no prior risk factors for hepatitis C prior to military service. Thus, the Veteran obtained hepatitis C during military service. Id. Dr. M.S. also authored an October 2014 DBQ where he stated the only risk factor for hepatitis C is mass vaccination after enrollment in military in 1980s; the Veteran had no other risk factors. See October 2014 Dr. M.S. DBQ. The Board affords little probative value to the opinions of Dr. M.S. First, while Dr. M.S. identified the air-gun inoculations as a risk factor, that does not automatically imply causation. Further, without any further explanation or discussion of the facts specific to this Veteran's case or the medical literature, Dr. M.S. provided a conclusory opinion that the Veteran's hepatitis C must have been incurred in during service. The Board also acknowledges the medical literature submitted by the Appellant in support of this case. However, generic information from a medical journal, treatise, or website is too "general and inconclusive" to establish a medical nexus to a disease or injury, Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)), and without application to the specific facts of the Veteran's case, does little to support the Veteran's claims. See Sacks, 11 Vet. App. at 316-17 (holding that a medical article or treatise can provide support for a claim, but must be combined with an opinion of a medical professional and be reflective of the specific facts of a case as opposed to a discussion of generic relationships); Libertine v. Brown, 9 Vet. App. 521, 523 (1996) (finding that generic medical literature, which does not apply medical principles to the facts of an individual case, does not provide competent evidence). Overall, the Board affords more probative weight to the opinion of the June 2017 VA clinician. The opinion was based on a review of the evidence in the claims file, researched medical principles and objective statistics, and supported by adequate rationale. Thus, the preponderance of the evidence is against a finding that the Veteran's hepatitis C was related to his service, and the Appellant's claim is denied. 2. Cause of Death To establish service connection for the Veteran's cause of death, the evidence must show that a disability incurred during or as a result of service, or aggravated by service, either caused or contributed substantially or materially, to the cause of death. For a service-connected disability to be the cause of death, it must singly, or with some other condition, be the immediate or underlying cause of death, or be etiologically related thereto. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that the disability casually shared in producing death, but rather, it must be shown that there was a causal connection. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Therefore, service connection for the cause of the Veteran's death may be demonstrated by showing that his death was caused by a disability for which service connection had been established at the time of death, or for which service connection should have been established. In determining whether the disability that resulted in the death of the Veteran was the result of active service, the laws and regulations pertaining to basic service connection apply. 38 U.S.C.§ 1310(a). Here, the Veteran's death certificate reflects that he died in November 2014. The cause of the Veteran's death was listed as hepatocellular carcinoma. See November 2014 death certificate. At the time of the Veteran's death, service connection was not in effect for any disability. Further, for the reasons explained above, entitlement to service connection for hepatitis C is not warranted. The Appellant does not present any theories, to include any presumptions or exposures, apart from asserting the Veteran's fatal liver cancer was caused by hepatitis C. The medical evidence does not suggest a link between the Veteran's cause of death and active service. The Veteran's Service Treatment Records (STRs) do not show treatment for symptoms relating to the Veteran's cause of death. The Veteran's separation examination did not note any conditions or symptoms related to his cause of death. As such, the Board finds the medical evidence of record does not show a nexus between the conditions which led to the Veteran's death and his time on active duty. While the Appellant believes the Veteran's cause of death was related to active service, she lacks the medical training necessary to provide a nexus opinion in this case. The Board finds that the preponderance of the evidence is against finding that the cause of the Veteran's death was related to his active service. While the Board is certainly sympathetic to the Appellant's loss, the evidence is against the claim. Therefore, service connection for the cause of the Veteran's death is denied. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, Associate 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.