Citation Nr: 21070394
Decision Date: 11/23/21	Archive Date: 11/23/21

DOCKET NO. 17-50 128
DATE: November 23, 2021

REMANDED

Service connection for hepatitis B is remanded.

REASONS FOR REMAND

The Veteran served on active duty from July 1996 to August 2002.  The Veteran additionally served on active duty from May 2004 to July 2014, at which time he received a bad conduct discharge.  With that said, VA has found the Veteran's period of service from May 2004 to August 20, 2007, to be honorable.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of the Agency of Original Jurisdiction (AOJ).

In August 2017, a VA examiner opined that it was less likely than not that the Veteran's hepatitis B related to his active duty service.  Upon review of this opinion, in March 2019, the Board remanded the Veteran's claim to obtain an additional opinion addressing the etiology of the Veteran's hepatitis B.  The Board specifically noted that the August 2017 opinion did not address the significance, if any, of the hepatitis B vaccination that the Veteran received in October 2007.  Given the nature of the Veteran's claim, the Board specified that a VA infectious disease specialist should offer the requested opinion.  The Board additionally directed the infectious disease specialist to address the significance, if any, of the hepatitis B vaccination that the Veteran received in October 2007.

In June 2020, contrary to the Board's March 2019 remand directives, a VA internist, rather than an infectious disease specialist, opined that it was less likely than not that the Veteran's hepatitis B related to his active duty service.  Also contrary to the Board's March 2019 remand directives, the examiner did not address the significance, if any, of the hepatitis B vaccination that the Veteran received in October 2007.  As such, the Board finds that the AOJ has not substantially complied with its March 2019 remand directives, and it again remands the Veteran's claim to obtain an opinion addressing the etiology of the Veteran's hepatitis B.  

This matter is REMANDED for the following action:

An infectious diseases specialist should review the claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hepatitis B had its onset during the Veteran's honorable periods of service (July 1996 to August 2002 and May 2004 to August 20, 2007). The opinion should include discussion of the elevated liver enzyme tests in 2006 and 2008, and the fact that the Veteran received a hepatitis B vaccination in October 2007.

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A complete rationale or explanation should be provided for any opinion reached. If a date certain prior to the 2013 diagnosis cannot be identified as the onset of hepatitis B, it should be explained why this is so from a medical perspective.

 

 

Marissa Caylor

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J.A. Flynn, 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.