Citation Nr: 21012963 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 15-31 702 DATE: March 8, 2021 REMANDED Service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from March 1976 to March 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2018, a hearing was held before the undersigned. A transcript of the hearing is of record. In July 2019, the Board remanded the Veteran’s appeal to the RO for further evidentiary development. Service connection for hepatitis C In its July 2019 remand, the Board directed that an examination be obtained to assess the etiology of the Veteran’s hepatitis C and requested that the examiner consider the Veteran’s statements at the December 2018 hearing that although he engaged in IV drug use for a short period of time after service, he never shared needles. On January 2020 VA examination, the Veteran reported his belief that he was contaminated by an air gun vaccination. The Veteran said that he used IV drugs after 1986-1987 but never shared needles, and that he has not used IV drugs in 18 years. The Veteran also said that he smoked cocaine and used methamphetamines, and that he was first diagnosed with hepatitis C at a clinic in Seattle in 1991 or 1992. The VA examiner opined that it was less likely than not that the Veteran’s hepatitis C was caused by or onset during service because the Veteran was not diagnosed with hepatitis C (or hepatitis non-A non-B as it was known at the time) in service. She stated it was likely that the drug use was the cause of his hepatitis C infection because his VA treatment records indicated that he was living on the streets for 8 years with a drug addiction history. She indicated that medical literature states that most persons infected with hepatitis C acquired it by intravenous drug use, and because many such persons initially deny such drug use. This literature indicated that “it is not surprising that injection drug use with shared needles or other paraphernalia has been the most common identifiable source of acute [hepatitis C] infection.” The examiner said that other risk factors include intranasal drug use, presumably due to blood on shared straws. The Veteran wrote to VA in October 2020, stating that he never shared needles when he was using IV drugs because he wanted to avoid HIV. The Board finds the January 2020 opinion to be inadequate. Although the examiner considered the Veteran’s statements regarding not sharing needles, the opinion cited to medical literature that seems to be predicated on a risk factor of sharing needles. It is unclear from the discussion provided whether intravenous drug use in general is a risk factor or if it is just intravenous drug use with shared needles. The Board finds the Veteran’s statements that he did not share needles to be both competent and credible. Therefore, to the extent the opinion is based on a finding that the Veteran shared needles during his IV drug use, the Board finds the opinion to be based on an inaccurate factual premise. Thus, remand is required to obtain an addendum opinion.   The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records from January 2020 to the present. 2. Obtain an addendum opinion regarding the etiology of the Veteran’s hepatitis C. The clinician must opine whether it is at least as likely as not that hepatitis C is related to an in-service injury, event, or disease, including inoculations via air gun. In providing an opinion on this question, the clinician is asked to consider the Veteran’s statements to be both competent and credible that although he engaged in IV drug use for a short period after service, he did not share needles. As such, in discussing the Veteran’s IV drug use, the examiner is asked to clearly address whether IV drug use without sharing of needles is a risk factor for hepatitis C. The examiner should also address the Veteran’s reported history of smoking cocaine and using methamphetamines. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not   be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.