Citation Nr: 21015136 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 16-00 241 DATE: March 16, 2021 REMANDED Entitlement to service connection for hepatitis C, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from May 1979 to June 1986. In November 2018, the Board of Veterans’ Appeals (Board) remanded the issue of entitlement to service connection for hepatitis C for further development. Specifically, the Board instructed the regional office (RO) to schedule the Veteran for a VA examination pertaining to her claim. Entitlement to service connection for hepatitis C. The Board finds that a new examination and etiological opinion is necessary to decide the Veteran’s claim. The Veteran contends that her hepatitis C is secondary to her service-connected PTSD. She reports that the military sexual trauma she experienced during service caused her to use intravenous drugs. The Veteran underwent a VA examination in July 2020, in which the examiner opined that the Veteran’s hepatitis C was less likely than not aggravated, made permanently worse beyond the natural progression of the disease, by her service-connected PTSD. However, the July 2020 examiner used the incorrect definition for her aggravation opinion for secondary service connection. Per a recent decision from the United States Court of Appeals for Veterans Claims (Court), permanent worsening need not be shown. Any incremental increase in disability and any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence constitutes aggravation. Ward-Neal v. Wilkie, 31 Vet. App. 233 (2019). As such, remand for a new examination is warranted to adequately address the nature and etiology of the Veteran’s claimed hepatitis C. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran’s hepatitis C. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: (a.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s hepatitis C had its onset in or is related to service, to include her documented in-service drug use. (b.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s hepatitis C was caused or aggravated by the Veteran’s PTSD, including any drug use undertaken to self-treat the same. An opinion as to both causation and aggravation is requested. The examiner must specifically discuss the Veteran’s lay statement that she began to use intravenous drugs after she experienced military sexual trauma. (c.) If the examiner finds that the Veteran’s hepatitis C was aggravated by her service-connected PTSD, then he/she should specify the baseline level of disability of the hepatitis C prior to aggravation due to the service-connected PTSD.  Note that aggravation means any incremental increase in disability in the hepatitis C (i.e., any additional impairment of earning capacity) resulting from the service-connected PTSD.  If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. LLOYD CRAMP Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Cramp 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.