Citation Nr: 21009126 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 15-27 436 DATE: February 19, 2021 ORDER Entitlement to service connection for hepatitis C is denied. FINDING OF FACT The Veteran’s hepatitis C condition did not have its onset during active service, nor is it otherwise related to service. CONCLUSION OF LAW The criteria for service connection for hepatitis C have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1970 to December 1972. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). In July 2015, the Veteran requested a hearing before a Veterans Law Judge at his local VA office, but in October 2018, he withdrew his hearing request. In March 2019 and August 2020, the Board remanded the case for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for hepatitis C is denied. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service” the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran is seeking service connection for hepatitis C. He asserts that due to the use of air gun injections during his induction, he got hepatitis C in service. He also states that he believes that he was given a blood transfusion due to surgery for a broken jaw while in service and that during his recovery, and while at hospital, he was given the job to sterilize used dental tools, and that on occasion, he would get stuck by a tool. The Veteran’s service treatment records do not reveal treatment for hepatitis or any manifestations of hepatitis. A clinical record, dated in September 1972, does not reflect that the Veteran underwent a blood transfusion during his oral surgery. VA treatment records show that the Veteran has a diagnosis of hepatitis C. An August 2001 VA medical note shows that the Veteran was diagnosed with hepatitis in 1990. In a December 2004 VA medical note, it shows that the Veteran believed that he had undergone a blood transfusion as a child when he was found to be anemic. A July 2015 VA medical note shows that he underwent treatment for his condition. The Veteran was afforded a VA examination in May 2015. Transfusions of blood or blood products before 1992, intravenous drug use or intranasal cocaine use and high risk of sexual activity were noted. The Veteran was diagnosed with hepatitis C. The VA examiner noted a review of the Veteran’s claims file. The VA examiner opined that the Veteran’s condition was not caused by or a result of air gun vaccinations in service, blood transfusion during surgery for mandible fracture in service, or finger sticks cleaning dental equipment in service. The VA examiner included medical literature, to include articles entitled Screening for Chronic Hepatitis C Virus Infection, and Epidemiology and Transmission of Hepatitis C Virus Infection, and a Department of VA article entitled Relationship Between Immunization with Jet Injectors and Hepatitis C Infection as it Relates to Service Connection in her rationale. The VA examiner stated that the Veteran’s hemimandibular fracture did not result in blood loss and that the fracture was treated with a closed reduction, and not an open procedure, as noted in the report. The wound was noted to be clean, and that no transfusion would have been required. The VA examiner also noted that the claimed finger sticks, while cleaning dental equipment, could not be confirmed; while possible to obtain hepatitis through an accidental, occupational needlestick, it was certainly not the most common method. The VA examiner also stated that while it was biologically possible that hepatitis C could be spread by air gun vaccines, it had never been confirmed in medical literature. The VA examiner stated that when considering the likely cause for the Veteran’s hepatitis, one must view all risk factors and the documented strength of association. The Veteran had numerous risk factors that were well known to place him at an increased risk of developing hepatitis C, as the records indicated he had had a blood transfusion in childhood, which occurred decades before blood products were screened for hepatitis. He used intravenous and intranasal drugs, had used alcohol heavily in the past, and had multiple sexual partners. IV drug use and blood transfusions conferred the biggest risk of infection. The VA examiner stated that the Veteran’s hepatitis C was most likely caused by or a result of IV drug use and/or blood transfusion in childhood. In a December 2019 VA medical addendum, the VA examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The VA examiner noted that while it is biologically possible that hepatitis C could be spread by air gun vaccinations, it had never been confirmed in medical literature. The VA examiner noted that just because something was “possible”, it did not mean it was probable, and it did not mean that there was a 50 percent or greater chance it occurred. The VA examiner stated that the Veteran did not have a blood transfusion during his jaw surgery. The fracture was treated with a closed reduction. The VA examiner also stated that for the finger sticks while cleaning dental equipment, that while it was possible to obtain hepatitis through an accidental, occupational needlestick, it was certainly not the most common nor the most probable method. The VA examiner again noted that because something was “possible”, it did not mean that it was probable, and it did not mean that there was a 50 percent or greater chance it occurred. Medical records were requested from the Social Security Administration (SSA), but in an August 2018 correspondence, SSA indicated that no medical records were found for the Veteran. After a review of the record, the Board finds that the preponderance of the evidence is against the claim of service connection for hepatitis C. The evidentiary record does not contain evidence that the Veteran’s currently diagnosed hepatitis C disorder either manifested in service or for years following service. There is no medical opinion linking the Veteran’s hepatitis C to service. In this regard, the Board finds the negative opinions of the VA examiner, to include the May 2015 and December 2019 opinions, to be most probative. The VA opinions were provided based upon comprehensive review of the claims file and examination of the Veteran, and provided an adequate rationale that considered the Veteran’s in-service treatment, post-service treatment, and the Veteran’s self-reported history. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Further, there is no competent and probative opinion to the contrary. The Veteran is certainly competent, even as a layman, to report symptoms of which he has personal knowledge. Layno v. Brown, 6 Vet. App. 465, 469 (1994). As a layperson, however, he is not competent to establish a medical diagnosis or to establish a medical etiology merely by his own assertions, since this requires medical expertise. See 38 C.F.R. § 3.159(a)(1). Additionally, medical training and credentials are required to provide diagnoses that can be considered competent evidence. The Board recognizes the Veteran’s competence to report on the observable symptoms and deems his lay statements credible. In this case, however, greater evidentiary weight is placed on the noted examination opinions, as the VA examiner possessed the training and expertise necessary to determine the nature and etiology of the claimed condition. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). In light of the foregoing, the Board finds that the preponderance of the evidence is against the claim. As such, the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Service connection for hepatitis C is denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A-L Evans, 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.