Citation Nr: 21016055 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 17-63 507 DATE: March 19, 2021 REMANDED Entitlement to service connection for hepatitis, to include hepatitis B and hepatitis C, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1970 to April 1972. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, a Board hearing was held before the undersigned. A transcript of the hearing is of record. This matter was previously before the Board in February 2020 when it was remanded for further development.   Entitlement to service connection for hepatitis, to include hepatitis B and hepatitis C, is remanded. Although the additional delay is regrettable, the Board finds another remand is required as there has not been substantial compliance with the February 2020 Board remand. A remand by the Board confers on the Veteran, as a matter of law, a right to substantial compliance with remand instructions, and imposes upon VA a concomitant duty to ensure substantial compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). If the Board proceeds with final disposition of an appeal, and the Agency of Original Jurisdiction has not substantially complied with the remand orders, the Board itself errs in failing to ensure substantial compliance. Id. In the February 2020 Board remand, the Board directed the RO to obtain an examination and opinion as to whether the Veteran’s hepatitis (to include any residuals) was related to his active service, including his in-service treatment for hepatitis or using someone else’s razor and nicking himself with that razor during service. In providing the requested opinions, the examiner was also asked to explain whether the Veteran’s service treatment records indicated which type of hepatitis he was treated for during service and to address the Veteran’s lay statement that he was informed his hepatitis B could turn into hepatitis C. In the May 2020 opinion, the examiner opined that it was less likely than not that the Veteran’s hepatitis C was related to his service. The examiner stated that the Veteran was diagnosed with infectious hepatitis (hepatitis A) in service and explained that hepatitis A is a self-limiting acute viral infection and does not cause other forms of hepatitis. The examiner indicated the onset of hepatitis B was unknown but was contracted after the Veteran’s service and there was no additional documentation to support the Veteran had hepatitis B in service. The examiner explained that there was no supporting evidence that hepatitis B causes hepatitis C and that hepatitis A, B, and C are separate diagnoses and not related. Although this opinion adequately addressed which type of hepatitis he was treated for in service and the matter of whether his hepatitis B could have caused his hepatitis C, the examiner failed to provide an opinion as to whether the Veteran’s hepatitis could have been caused by using someone else’s razor and nicking himself with the razor during service. Thus, the Board finds remand is required to ensure substantial compliance with the above prior remand directives. Stegall, 11 Vet. App. 271. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records for the period from June 2020 to the present. 2. Obtain an addendum opinion regarding the etiology of the Veteran’s hepatitis C. If the reviewing clinician determines an examination is necessary to obtain the requested opinion, then such should be scheduled. The reviewing clinician is asked to provide an opinion addressing the following: Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s hepatitis, including hepatitis C and any residuals of hepatitis, was caused by or is otherwise related to the use of someone else’s razor and nicking himself with that razor during service (as reported on the September 2017 VA examination)? 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 S. Jiggetts 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.