Citation Nr: 21006126 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-24 178 DATE: February 3, 2021 ORDER Entitlement to service connection for Hepatitis C is granted. FINDING OF FACT The probative evidence of record is in at least equipoise that the Veteran’s Hepatitis C is related to in-service medical treatment to included air gun inoculations. CONCLUSION OF LAW The criteria for service connection for Hepatitis C have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran has active service from June 1967 to June 1969. This case is before the Board of Veterans’ Appeals (Board) from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans’ Law Judge at a May 2019 hearing. In September 2019, the Board remanded these matters to the RO for additional development. Finding there has been substantial compliance with the Board’s remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998), the Board may proceed with appellate review. The Board notes the Veteran has filed a separate claim for residuals for Hepatitis C (10/09/2020 VA 21-4138 Statement In Support of Claim). As the AOJ has not rendered a decision with regard to residuals from Hepatitis C, the Board will not address residuals in this decision. Service connection for Hepatitis C The Veteran contends he contracted Hepatitis C while in boot camp in 1967. The Veteran recollects air guns used to administer immunizations. He recalls that some recruits bled during administration of the immunizations and the air guns were not wiped or sterilized between recruits. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Medical documentation of record confirms the Veteran has a current diagnosis of Hepatitis C, meeting the first element of service connection (6/17/2016 C&P Exam, pg. 3). Although the Veteran was not seen for hepatitis C during service, he reports having been inoculated utilizing air guns (5/10/2019 Hearing Transcript, pg. 3). Medical evidence of record confirms the Veteran received 15 vaccination from 1967 to 1968. A medical opinion of record also provides that in the 1960s the military used jet injectors to vaccinate recruits en masse, and prior to 1990 there was no test to identify hepatitis C infections (10/09/2020 Medical Treatment Record - Non-Government Facility, pgs. 2-3). Resolving doubt in favor of the Veteran, the Board finds the second element of service connection is met, that is inservice incurrence. The question remaining is whether the current disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence against the claim includes a negative nexus opinion dated in June 2016. The VA examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred from service in 1967 to 1969 based on medical records containing no clinical notes during active service to suggest such a relationship. The examiner provided as a rationale that to suggest such a connection is purely speculative. No actual evidence that a hepatitis C panel was done immediately or within the year of blood exposure to drug abuser or air gun for immunization. An October 2019 addendum opinion is of record. The examiner concluded, after review of the Veteran's medical records, lay statements, and the Board’s September remand, that the Veteran's medical records show contradicting medical history as to how Hepatitis C infection was acquired. The examiner noted in March 2002, the Veteran indicated he contracted hepatitis C while giving CPR to a drug abuser. The examiner found the medical history provided by the Veteran in 2002 did not support the lay statement of 2016 asserting that he contracted Hepatitis C through air gun inoculation. The examiner indicated there is a documented risk factor for hepatitis C infection and opined the Veteran's hepatitis C infection was less likely than not acquired through air gun inoculation/immunization during service (11/06/2019 C&P Exam, pg. 4). The evidence in favor of the claim includes a March 2016 opinion from the Veteran’s private physician who has treated him since January 2001. The physician stated that he has treated the Veteran for various medical conditions, including hepatitis C. The physician explained that it is not known how the Veteran contracted hepatitis C. After a long discussion of the patient's history, the physician opined that the Veteran may have potentially contracted hepatitis C from the air jet inoculations that he was exposed to in 1967. Also, in favor of the Veteran’s claim is an October 2020 private medical opinion by a Board-Certified Internist and Geriatrician. The physician opined the Veteran likely contracted Hepatitis C while in the service between 1967 and 1969, and was infected for three decades, from service until his diagnosis in the late 1990s (10/09/2020 Medical Treatment Record - Non-Government Facility, pg. 7). The physician, in presenting his opinion, considered the Veteran’s medical and social history and explained the Veteran’s risk factors. The opinion was based on four potential risk factors for hepatitis C in this case, to include jet injection devices used for immunizations, dental work received during the military, sharing razors while on active duty, and administering CPR (10/09/2020 Medical Treatment Record - Non-Government Facility, pg. 4). The Veteran has competently and credibly explained that he was diagnosed with Hepatitis C in the late 1990s but was not aware of air jet guns being a possible cause of Hepatitis C until 2015. He has stated he did not have an organ transplant prior to 1992 and did not have a transfusion of blood or blood products prior to 1992. He denies hemodialysis, accidental exposure to blood by health workers, intravenous drug use, intranasal cocaine use. The Veteran denies having tattoos or piercings or having used the toothbrush or shaving equipment of another person. He has also denied high risk sexual activity. The Veteran also provided that prior to his diagnosis he had frequent illnesses, such as colds. (7/08/2015 VA 21-4138 Statement In Support of Claim and 8/24/2020 VA 21-4138 Statement In Support of Claim). (Continued on the next page)   Upon review of the record, the Board finds that the probative evidence is at least in equipoise, supporting the Veteran's contention that he was exposed to and contracted hepatitis C during service. Resolving doubt in favor of the Veteran, the Board finds that the criteria for service connection for hepatitis C have been met. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. A. Myers 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.