Citation Nr: 21012676 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 16-60 476 DATE: March 4, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 percent for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1970 to March 1972 and from October 1978 to October 1982. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2018, the Board remanded the case for further development. 1. Entitlement to an initial disability rating in excess of 10 percent for hepatitis C is remanded. The Veteran seeks a higher initial rating for his service-connected hepatitis C. The Board’s previous remand noted that the appeal period before the Board is from March 7, 2003 to the present, and that the Veteran’s representative contends that he has experienced symptoms associated with his hepatitis C at various times during the appeals period, including shortness of breath, weakness, fatigue, loss of appetite, anemia, lack of motivation, and memory changes. The Board requested a retrospective medical opinion addressing the severity of the hepatitis C since the March 2003 effective date of service connection. Specifically, the Board stated that the examiner should identify the nature and severity of any manifestations of hepatitis C since March 7, 2003 and, if at all possible, indicate (a) whether at any point during that period the service-connected hepatitis increased in severity; (b) the approximate date(s) of any such change(s); and (c) the severity of the disability on each date. Specifically, the examiner should report the nature, severity, and frequency of all signs and symptoms associated with the Veteran’s hepatitis, to include but not limited to: any fatigue, malaise, weight loss, anorexia, malnutrition, nausea, vomiting, arthralgia, hepatomegaly, right upper quadrant pain. The examiner is advised that the Veteran is competent to report his symptoms and history, and such statements by the Veteran must be acknowledged and considered in formulating any opinions concerning the severity of his hepatitis. There is a statement dated July 2018 from the Veteran’s attorney which may provide useful information about some of the Veteran’s symptoms throughout the appeal period in question. The RO obtained an opinion in November 2020 and an addendum opinion dated December 2020. The examiner stated that the record did not show that the Veteran had treatment for hepatitis C between 2003 and 2012. The Board finds that this opinion is inadequate for ratings purposes as it does not address VA treatment records that show relevant or potentially relevant symptoms during the 2003 to 2012 period, including an August 5, 2010 treatment record that notes “hepatitis C exacerbation” and other treatment records showing symptoms such as fluctuations in weight, complaints of depressed mood, and appetite changes. There are multiple VBMS entries (i.e. marked CAPRI or ‘Medical Treatment Record -Government Facility’ received July 14, 2003; February 12, 2012; February 29, 2012; May 17, 2013 and more) which contain notated treatment records as well as the Veteran’s representative’s statements dated in July 2018 and February 2021 that detail some of the Veteran’s symptoms throughout the appeal period in question. A remand by the Board confers on a veteran, as a matter of law, a right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The matter is REMANDED for the following action: Return the file to the November 2020 VA examiner for an addendum opinion. If that examiner is not available, an opinion must be obtained from an appropriate medical professional to identify the nature and severity of any manifestations of hepatitis C since March 7, 2003 and, if at all possible, indicate (a) whether at any point during that period the service-connected hepatitis increased in severity; (b) the approximate date(s) of any such change(s); and (c) the severity of the disability on each date. Specifically, the examiner should report the nature, severity, and frequency of all signs and symptoms associated with the Veteran’s hepatitis during the appeals period, to include but not limited to: any fatigue, malaise, weight loss, anorexia, malnutrition, nausea, vomiting, arthralgia, hepatomegaly, right upper quadrant pain. The examiner is advised that the Veteran is competent to report his symptoms and history, and such statements by the Veteran must be acknowledged and considered in formulating any opinions concerning the severity of his hepatitis. In this regard, the examiner is directed to the numerous VBMS entries (marked CAPRI or ‘Medical Treatment Record -Government Facility’ entries received July 14, 2003; February 12, 2012; February 29, 2012; May 17, 2013 and more), as well as the Veteran’s representative’s statements dated in July 2018 and February 2021 that detail some of the Veteran’s symptoms throughout the appeal period in question. A complete rationale for the requested opinions should be provided. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Mazzucchelli, 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.