Citation Nr: 21005482 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 15-28 697 DATE: February 1, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for a liver condition, to include liver cancer is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1982 to August 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified at a hearing before the undersigned. This matter was previously remanded by the Board in January 2020. The case has been returned to the Board at this time for further appellate review. 1. Entitlement to service connection for hepatitis C is remanded. Pursuant to the January 2020 Board remand, the Veteran was afforded a VA examination in February 2020. The February 2020 VA examiner opined that the Veteran’s hepatitis C was at least as likely as not incurred in or caused by the in-service injury, event, or disease, including exposure to blood while rendering first aid during combat service in Operation Desert Storm from September 1990 to March 1991 and inoculations he received with air guns during service. The VA examiner went on to acknowledge that the Veteran admitted to IV drug use, cocaine use, and multiples sex partners before service, as well as some drug use during service. Finally, the VA examiner noted that the Veteran had cirrhosis of the liver and a liver transplant due to cirrhosis and cancer, which develop after about 30 years, and his long military service is within the time frame to develop cirrhosis and cancer. The February 2020 VA examiner was asked to provide an addendum to their opinion in June 2020. The addendum states that the Veteran’s liver cancer is a direct result of hepatitis C infection. The VA examiner again noted that the Veteran admitted to occasional recreational drug use not found on drug screening while in the service, but that the Veteran served from 1990-91 which is 12-13 years prior to liver his transplant. The VA examiner explained that cirrhosis of the liver from hepatitis C is a 30 years disease that occurs most commonly from IV drug use, intranasal cocaine use, tattoos, and sexual activity. Finally, the VA examiner opined that it is less likely than not related to an in-service injury, event, or disease, including exposure to blood while rendering first aid during combat service in Operation Desert Storm from September 1990 to March 1991 and inoculations he received in service with air guns. The Board finds that the February 2020 VA examination, as amended in the June 2020 addendum is inadequate because it is internally inconsistent, contains an insufficient rationale, and is based on an inaccurate factual premise. The opinion is obviously internally inconsistent because in February 2020, the VA examiner provided a positive nexus opinion, and then in June 2020, the VA examiner provided a negative nexus opinion. In addition, both opinions are not based on a sufficient rationale, rather, the VA examiner appears to just have copied the text from the Board’s remand without sufficiently addressing which in-service injury, event, or disease more likely than not resulted in the Veteran’s hepatitis C. Finally, the June 2020 addendum states that the Veteran served from 1990-91 and that the Veteran had his liver transplant 12-13 years later. These statements are incorrect as the Veteran served from 1982 to 2004, and his liver transplant took place in 2013. Accordingly, remand for a new VA examination is warranted. 2. Entitlement to service connection for a liver condition, to include liver cancer is remanded. The evidence of record shows that the Veteran’s liver conditions are related to his hepatitic C. Because this claim is dependent upon the outcome of the Veteran’s claim for service connection for hepatitis C, the issues are inextricably intertwined, and remand of the claim for a liver condition to include liver cancer is required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The matters are REMANDED for the following action: Obtain an opinion with a qualified clinician who has not previously provided an opinion regarding the Veteran’s claim for service connection for hepatitis C. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. Following review of the claims file, and examination of the Veteran if deemed necessary, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C began in or is otherwise caused by the Veteran’s active service. In doing so the VA examiner must address which in-service injury, event, or disease is at least as likely as not the cause of the Veteran’s Hepatitis C. The opinion must address (1) the Veteran’s in-service exposure to blood while rendering first aid during combat service in Operation Desert Storm from September 1990 to March 1991; (2) the inoculations he received in service with air guns; (3) the Veteran’s contentions regarding his IV drug use and intranasal cocaine use, noting that the Veteran has testified that his drug use in service was not common and that he did not test positive for drugs while in service; and (4) the February 2014 letter from the Veteran’s VA physician noting that the Veteran’s service-related risk factors for hepatitis C included a bloody fist fight, helping to rescue a wounded American soldier in Desert Storm, and a tattoo in 2003. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Elias, 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.