Citation Nr: 21009584 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 17-14 133 DATE: February 22, 2021 REMANDED Service connection for hepatitis C is remanded. Service connection for liver cancer as secondary to hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to June 1979. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2020, the Veteran testified before the undersigned Veterans Law Judge at a virtual hearing. A transcript is of record. 1. Service connection for hepatitis C is remanded. 2. Service connection for liver cancer as secondary to hepatitis C is remanded. The Veteran asserts his hepatitis C is related to jet gun immunization received in service. He also asserts that his liver cancer is secondary to his hepatitis C. The Board remanded the appeal in July 2020 for further development. Unfortunately, another remand is necessary. In compliance with the Board’s July 2020 remand directives, VA addendum opinions were obtained in August 2020. An examiner opined that it is less likely than not that hepatitis C was incurred in or due to the Veteran’s in-service jet gun immunization. The examiner reasoned that the lack of a causal relationship is consistent with the Veteran’s medical records as no medical records for any association were found. The examiner further stated that the Veteran does not have a longitudinal relationship between his military service and his hepatitis C. The examiner provided a list of risk factors for hepatitis C infection, one of which included persons born between 1945 and 1965. She opined that while the Veteran did receive jet gun vaccination in service, he was also born between 1945 and 1965, and hepatitis C was not even discovered until 1989, long after his military service. An addendum opinion is necessary because the rationale for the August 2020 opinions is conclusory at best and does not provide a sufficient explanation as to why the VA examiner has arrived at this conclusion. Accordingly, on remand, an addendum opinion should be obtained. Finally, because a decision on the remanded issue of service connection for hepatitis C could significantly impact a decision on service connection for liver cancer, the issues are inextricably intertwined. Service connection for liver cancer must be remanded at this time. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician, and if possible from a clinician who has not previously provided an opinion, regarding whether the Veteran’s hepatitis C is at least as likely as not related to an in-service injury, event, or disease, including any in-service jet-gun immunizations he may have received. In formation of the opinion and rationale, the examiner must review the June 2004 VBA Fast Letter that states that transmission of the virus via air gun is ‘biologically plausible;’ the June 2020 private opinion by R.S.; and the June 2020 statement by the Veteran’s VA hepatologist. A discussion of the medical principles involved (as applied to the lay and medical evidence and facts used in the opinion) would be helpful. If the examiner links the Veteran’s hepatitis C to a cause other than air gun injectors, then the examiner must include a full discussion of all potential modes of transmission applicable to the Veteran and a detailed rationale as to why the examiner believes the air gun injector was not the source for the hepatitis infection. If the requested opinion cannot be provided without resorting to speculation, an explanation as to why this is so is required. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, 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.