Citation Nr: 21075754 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 07-21 502 DATE: December 21, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for a back disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1979 to June 1981, with additional service in the Army Reserve. These matters come before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA), and have been advanced on the Board's docket pursuant to 38 U.S.C. § 7107. These matters have an extensive procedural history dating back to 2003. In June 2020, the Board denied entitlement to service connection for hepatitis C and a back disorder. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In May 2021, the Court granted a Joint Motion for Remand in which the parties agreed that the Board erred in failing to "properly address" relevant evidence. Specifically, the Board did not address a diagnosis of degenerative changes of the thoracic spine, and relied, in part, on a May 2019 VA examination that opined solely on a nexus between the Veteran's lumbar spine and service. The parties further agreed that the Board failed to address the Veteran's in-service reports of persistent lower back pain and urethral discharge in May 1981. Additionally, they found that the Board should consider whether the Veteran's hepatitis C is secondary to his service-connected acquired psychiatric disorder, given that a May 2019 VA examiner found that the Veteran's most important risk factor for hepatitis C was drug abuse. Given the parties agreement, the Board finds that these matters must be remanded for further development, to include obtaining addendum VA examinations and medical opinions. See 38 U.S.C. § 5103A(d). The matters are REMANDED for the following actions: 1. Obtain copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorders on appeal. 2. Obtain an addendum medical opinion from a suitably qualified clinician regarding the nature and etiology of the Veteran's back disorder. If the clinician believes that a VA examination is necessary to answer the questions below, then one should be scheduled. The clinician is asked to review the claims file and opine as follows: (a) Is it at least as likely as not that any of the Veteran's current back disorders had its onset during or is causally related to military service? A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical evidence, to specifically include: Service medical records, including reports of persistent back pain and urethral discharge spanning 5-6 days on May 15, 1981, and motor vehicle accident in January 1980 resulting in a "contusion, mid posterior thorax" Diagnosis of degenerative changes of the thoracic spine, given in a March 27, 2014, Physician Emergency Department Note Letter from Dr. A.H. dated January 2, 2009, showing that the Veteran had several post-service back injuries, including a fall at work in 2006 Appellate Brief with contentions relating to back. See Third Party Correspondence, October 2021. The Veteran's lay contentions that his back pain began during service and continued since that time The clinician is reminded that the term "at least as likely as not," does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. 3. Obtain an addendum medical opinion from a suitably qualified clinician regarding the nature and etiology of the Veteran's hepatitis C. If the clinician believes that a VA examination is necessary to answer the questions below, then one should be scheduled. The clinician is asked to review the claims file and opine as follows: (a) Is it at least as likely as not that hepatitis C had onset during or is causally related to military service? (b) Is it at least as likely as not that hepatitis C is proximately due to or a result of a service-connected acquired psychiatric disability? (c) Is it at least as likely as not that hepatitis C underwent any incremental increase in disability, regardless of its permanence, due to a service-connected acquired psychiatric disability? The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Any "incremental increase in disability" need not be permanent. A complete rationale should be provided for all opinions. The clinician is asked to consider and discuss relevant lay and medical evidence, to specifically include: Appellate brief with contentions relating to hepatitis C. See Third Party Correspondence, October 2021. The Veteran's lay contentions that his hepatitis C is causally related to acquired psychiatric disability, because the psychiatric disability led to an increase in drug abuse, which is a risk factor for hepatitis C (Continued on the next page) The clinician is reminded that the term "at least as likely as not," does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against. MARGARET M. LUNGER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Reed, 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.