Citation Nr: 21015319 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-12 336 DATE: March 17, 2021 ORDER Entitlement to service connection for hepatitis C is denied. FINDING OF FACT The preponderance of the evidence is against finding that hepatitis C began during active service, or is otherwise related to an in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for hepatitis C have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1985 to November 1992. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in July 2020. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran currently has a diagnosis of hepatitis C for service-connection purposes, which the record reflects was most recently noted by VA examiners in July 2014 and again in January 2017. He has asserted, including during his hearing before the undersigned, that his hepatitis C was shown in positive in-service test results of hepatitis B core antibodies (anti-HBc) and hepatitis B surface antibodies (anti-HBs) in early 1990 with subsequent treatment for nausea and malaise in November 1990. The Veteran has also claimed to have been in several physical altercations in service where he incurred lacerations and abrasions. The Board notes that the presence of anti-HBc indicates previous or ongoing infection with hepatitis B, and the presence of anti HBs is generally interpreted as indicating recovery and immunity from, or recent vaccination against, hepatitis B. https://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf. Hepatitis B and hepatitis C viruses are distinct from one another. It is also noted that that hepatitis C is not a chronic disease listed in 38 C.F.R. § 3.309(a). Consequently, the provisions of 38 C.F.R. § 3.303(b) providing for service connection based upon chronicity in service or a continuity of symptomatology since service are not for application in the present case. Thus, in order for service connection to be warranted, the competent, credible and probative evidence of record must establish that the Veteran’s hepatitis C is the result of an injury, disability or event incurred in service pursuant to the provisions in § 3.303(a). Other than the above-noted positive hepatitis B results, the Veteran’s service treatment records (STRs) show no complaints, diagnosis, or treatment related to hepatitis C. Post-service, VA medical records note the Veteran reporting that hepatitis C was first diagnosed during service in 1988. As noted, however, his STRs only note hepatitis B. Further, the medical record contains nothing further until he established VA care in April 2007, where he was referred to the hepatitis C clinic. The Veteran first presented for a VA examination in August 2014, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner noted the Veteran’s statements that he “might have been exposed” to hepatitis B or hepatitis C when stationed in Korea, including from involvement in physical altercations where he claims to have incurred several lacerations and abrasions. The Veteran’s in-service findings of hepatitis B antibodies were also noted. The examiner opined that the Veteran’s hepatitis C was less likely than not incurred in or caused by the claimed in-service injury, event, or illness, essentially explaining that there was no diagnosis of hepatitic C during service, to include during an evaluation after he suffered from lacerations and abrasions from a physical altercation. As the examiner did not address the Veteran’s hepatitis B findings in service or his subsequent treatment for nausea and malaise, an additional examination was provided the following May 2015. The examiner noted that the Veteran was seen in service by an infectious disease specialist and studies were done that indicated his hepatitis B surface antigen was negative, but his HBc (core antibody) and HBSab (surface antibody) were positive, reflecting a positive result to a prior hepatitis B vaccination. Later in late 1990 during a prolonged viral episode, while the pervious hepatitis studies were noted, it was felt that the symptoms were due to an unidentified virus. The examiner also noted that, according to the Veteran’s medical records, he had a long history of substance abuse, including cocaine and methamphetamine, both of which are risk factors for hepatitis C. As such, the examiner opined that it was less likely than not that the Veteran’s hepatitis C was related to service. If there had been active infection lasting chronically into the fall of 1990, the examiner explained, this would have been detected by positive studies to the surface antigen which is the viral particle tested for to determine on-going infection. While the Veteran currently has chronic hepatitis C, there is history of significant high risk behavior with drug abuse post-discharge, which makes it more likely than not that any current issues are related to that behavior and not to issues during service. The Board finds the above opinions, as a whole, to be highly probative as they were made by medical professionals with consideration of the specific facts in this case and after examination of the Veteran. There is also no medical opinion or competent and credible evidence in significant conflict with the VA medical opinions, including evidence to support the claim that he was diagnosed with hepatitis C in service, only the separate and distinct condition of hepatitis B which is no longer present. For the above reasons, the Board finds the preponderance of the evidence is against the claim, and service connection must be denied. The Board has considered the Veteran’s statements, to include his assertions that his hepatitis C is related to service. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms of hepatitis C that are observable to a layperson, i.e., nausea, fatigue, and malaise; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not, however, competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable in this case. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Scarduzio, 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.