Citation Nr: 21008610 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 13-30 532 DATE: February 17, 2021 ORDER Entitlement to service connection for hepatitis B is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran’s hepatitis B is etiologically related to service. CONCLUSION OF LAW The criteria for service connection for hepatitis B are 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 served on active duty from January 1964 to January 1967. He died in October 2016. At this juncture, the Board would be remiss if it did not recognize the Veteran’s outstanding service. The Veteran’s service to his country is greatly appreciated. The Veteran’s surviving spouse has been substituted into this appeal. The appellant’s current claim is on appeal from a rating decision dated February 2011. In February 2020, the Board granted entitlement to service connection for coronary artery bypass graft times 2, ischemic heart disease, diabetes mellitus, type II, with erectile dysfunction, peripheral neuropathy of the left lower extremity, and left ulnar neuropathy. In a July 2020 VA rating decision, the Regional Office (RO) granted entitlement to service connection for Hepatitis C. As this action represents a complete grant of the benefit sought, that matter is no longer on appeal. These claims were previously remanded by the Board in an October 2020 decision. The remand directives ordered the following actions: (1) obtain an addendum opinion from the February 2020 VA examiner on whether the Veteran’s hepatitis B clearly and unmistakably existed prior to the Veteran’s entrance into Active Duty and, if not, whether it was at least as likely as not (a 50 percent or greater probability) that the Veteran’s hepatitis B was related to service. The Board finds that the RO has substantially complied with the October 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for hepatitis B During his lifetime, the Veteran contended that his hepatitis B was the result of his naval service in Vietnam. Alternatively, the Veteran contended that his hepatitis B was the result of vaccinations when he enlisted in the military as he denied ever receiving blood transfusions prior to his diagnosis, he was not an injection drug user, and he did not have tattoos. The Board concludes that the evidence is at least in equipoise as to whether the Veteran had a current disability of hepatitis B that was the result of a possible in-service exposure to contaminated needles. 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). The Board notes that in a July 2020 VA rating decision, the Veteran was granted service connection for hepatitis C. This decision was based on the opinion of a February 2020 VA examiner who opined that it was at least as likely as not (50 percent or greater probability) that the Veteran’s hepatitis C was incurred in or caused by the Veteran’s possible exposure to contaminated needles. The same February 2020 VA examiner opined that it was less likely than not that the Veteran’s hepatitis B was due to military service because he had a history of jaundice and illness at age 17, which the examiner thought was likely a manifestation of hepatitis B. In its October 2020 remand, the Board determined this was not the correct legal standard regarding whether the Veteran’s hepatitis B pre-existed military service, and, as such, was entitled to no probative value. A November 2020 VA examiner provided an addendum opinion that it was less likely than not that the Veteran’s hepatitis B clearly and unmistakably existed prior to the Veteran’s entrance into active duty, and thus, the hepatitis B did NOT clearly and unmistakably exist prior to active duty (emphasis in original). As rationale, the November 2020 VA examiner noted that there were many other possible causes of the Veteran’s jaundice noted prior to service and it would be mere speculation to determine that it was a manifestation of hepatitis B. The examiner further noted that the Veteran did have evidence of hepatitis B in 1971 private treatment records and again in 2001. The VA examiner indicated it would be mere speculation to determine the source of his hepatitis B. The Board notes that the VA has determined that risk factors for Hepatitis B include contact with blood borne products, exposure to blood contaminated needles, using intravenous drugs, getting tattoos, and engaging in unprotected sex with an individual who has hepatitis B. As discussed above, the Veteran did not have any of the risk factors for hepatitis B except possible exposure to contaminated needles while in service. Because the Veteran has already been granted service connection for hepatitis C due to potential exposure to contaminated needles; hepatitis B and hepatitis C can both be transmitted through contaminated needles; and there is no clear and unmistakable evidence that the Veteran’s hepatitis B pre-existed service; then the weight of the evidence is at least in equipoise as to whether the Veteran’s hepatitis B is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for hepatitis B is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Taylor, 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.