Citation Nr: 21014979 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 14-30 211 DATE: March 16, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for dizziness, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for a back disability, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for a right knee disability, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for chronic fatigue, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for chronic abdominal pain, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for joint pain, to include as secondary to hepatitis C, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to hepatitis C, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1969 to April 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). A May 2018 Board decision, in part, denied the Veteran’s claims of service connection for hepatitis C and claims of secondary service connection for dizziness, a back disability, a right knee disability, chronic fatigue, chronic abdominal pain, joint pain and an acquired psychiatric disorder all secondary to hepatitis C. In addition, the May 2018 Board decision denied an increased rating claim for the Veteran’s service-connected hemorrhoids. The Veteran appealed the May 2018 Board decision to the extent it denied the service connection claims to the United States Court of Appeals for Veterans Claims (Court). By a December 2019 Memorandum Decision, the Court vacated that part of the May 2018 Board decision which denied service connection for hepatitis C, dizziness, a back disability, a right knee disability, chronic fatigue, chronic abdominal pain, joint pain and an acquired psychiatric disorder and remanded the claims back to the Board for compliance with the Court’s decision. 1. Entitlement to service connection for hepatitis C is remanded. As noted above, the Court determined that the Board provided an inadequate explanation in its May 2018 decision as to why it relied on an April 2012 VA examination to deny service connection for hepatitis C. The Court noted that the April 2012 opinion shows that the examiner based his negative nexus opinion on his belief that there is no evidence that in-service inoculations cause hepatitis C. However, the Court stated it is unclear why the Board relied on this examination, given that VA has conceded that in-service air gun inoculations are a “biologically plausible” source for hepatitis C. The Court determined that the Board further erred by relying on a May 2013 VA examination, and the examiner failed to explain why it was more likely that the Veteran’s drug use caused his hepatitis C, outside of his conclusory statements to that effect. In light of the Court’s findings, remand is required to obtain a new VA examination as to the etiology of the Veteran’s hepatitis C which provides a reasoned medical explanation connecting the ultimate opinion with the facts surrounding the Veteran’s condition and with VA’s stated position that in-service air gun inoculations are a “biologically plausible” source for hepatitis C. 2. Entitlement to service connection for dizziness, to include as secondary to hepatitis C is remanded. 3. Entitlement to service connection for a back disability, to include as secondary to hepatitis C is remanded. 4. Entitlement to service connection for a right knee disability, to include as secondary to hepatitis C is remanded. 5. Entitlement to service connection for chronic fatigue, to include as secondary to hepatitis C is remanded. 6. Entitlement to service connection for chronic abdominal pain, to include as secondary to hepatitis C is remanded. 7. Entitlement to service connection for joint pain, to include as secondary to hepatitis C is remanded. 8. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to hepatitis C is remanded. The Court further determined that the claims for secondary service connection must also be remanded. In this regard, as the claim for service connection for hepatitis C is being remanded, the claims for the above conditions as secondary to hepatitis C must also be remanded as they are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Updated treatment records should also be obtained upon remand. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the Agency of Original Jurisdiction (AOJ) should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After records development is completed, schedule the Veteran for a VA hepatitis C examination to determine the nature of his hepatitis C and to obtain an opinion as to whether such is related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that hepatitis C arose during service or is otherwise related to service, to include conceded exposure to air gun inoculations therein. Please explain why or why not, to include addressing the Veteran’s contentions and the medical evidence of record. The examiner is advised that VA has conceded that in-service air gun inoculations are a “biologically plausible” source for hepatitis C. If the Veteran’s hepatitis C is determined to be unrelated to service, to include air gun inoculations therein, the examiner should identify the etiology considered more likely and explain why that is so. All opinions must include a detailed rationale. 3. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the AOJ must readjudicate the issues on appeal. If any benefit sought remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHELLE P. KATZ Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Medina, 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.