Citation Nr: 21021990 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-48 914 DATE: April 14, 2021 REMANDED Entitlement to service connection for infectious hepatitis (claimed as hepatitis C with fatigue) is remanded. Entitlement to service connection for peripheral neuropathy of the left lower extremity (LLE), to include as secondary to infectious hepatitis, is remanded. Entitlement to an extraschedular total disability rating based on individual unemployability (TDIU) prior to December 5, 2012, is remanded. REASONS FOR REMAND The Veteran had qualifying service from January 1973 to October 1977 and November 1978 to August 1986. In January 2020, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. In a March 2020 Decision, the Board: (a) granted entitlement to a TDIU effective December 5, 2012; (b) remanded entitlement to service connection for infectious hepatitis; (c) remanded entitlement to service connection for peripheral neuropathy of the LLE; and (d) remanded entitlement to an extraschedular TDIU prior to December 5, 2012. Unfortunately, based on the reasons discussed below, the Board finds that the agency of original jurisdiction (AOJ) did not substantially comply with the Board’s March 2020 directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for infectious hepatitis The March 2020 Board Decision, in pertinent part, directed the AOJ to obtain an etiological opinion regarding whether the Veteran’s hepatitis C was etiologically related to service, including whether it was contracted: (a) via air gun injections of vaccinations during basic training (see October 2013 VA Form 21-4142); and/or (b) via occupational exposures to scalpels, needle sticks, blood, bodily fluids, etc. while working as a medic and nurse during service (see January 2020 hearing transcript). McLendon v. Nicholson, 20 Vet. App. 79 (2006). The AOJ obtained pertinent etiological opinions in March 2020 and November 2020; however, neither examiner discussed the contention that the Veteran contracted hepatitis C via air gun injections of vaccinations during basic training (see October 2013 VA Form 21-4142). Stegall, supra; Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The March 2020 examiner’s analysis addressed the probability of occupational exposures, but failed to address the contention of exposure via air gun injections of vaccinations. Barr, supra. The November 2020 examiner’s analysis merely stated that the Veteran’s occupational exposures are not substantiated because he has no documented diagnosis of hepatitis C in his service records; not only did this examiner fail to address the contention of exposure via air gun injections of vaccinations, but she also failed to address the probability of contracting hepatitis C via occupational exposures. Barr, supra. Notably, the Board concedes that the Veteran likely had occupational exposures in service because such exposures are consistent with the circumstances of the Veteran’s service as a practical nurse. See DD Form 214 (the Veteran worked as a practical nurse during his service period from November 1978 to August 1986). As such, the Board must remand for the AOJ to obtain an addendum etiological opinion that adequately addresses all of the Veteran’s contentions. 2. Entitlement to service connection for peripheral neuropathy of the LLE The Veteran has contended that his peripheral neuropathy of the LLE is secondary to his infectious hepatitis (see May 2010 Letter by Dr. CTT, September 2014 Letter by MRK, and January 2020 hearing transcript). Thus, this issue is inextricably intertwined with the infectious hepatitis issue and must be remanded concurrently. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other); Gurley v. Peake, 528 F.3d 1322 (Fed. Cir. 2008) (remand of inextricably intertwined claims was warranted for reasons of judicial economy even in absence of administrative error). 3. Entitlement to an extraschedular TDIU prior to December 5, 2012 The Veteran has contended that his disabilities have affected full-time employment since March 2006 and/or since 2010. See April 2013 VA Form 21-8940; April 2015 VA Form 21-8940. The Veteran has already been granted schedular TDIU since December 5, 2012, the effective date of service connection for his only service-connected disability currently (posttraumatic stress disorder). See June 2020 Codesheet. However, entitlement to a TDIU prior to December 5, 2012, may be warranted if the other claims remanded herein are granted. 38 C.F.R. §§ 3.340, 3.341, 4.16 (2018). Thus, this issue is inextricably intertwined with the other remanded issues herein and must be remanded concurrently. Harris, supra; Gurley, supra. The matters are REMANDED for the following action: 1. Obtain an addendum etiological opinion regarding whether the Veteran’s hepatitis C was etiologically related to service, including whether it was contracted: (a) via air gun injections of vaccinations during basic training (see October 2013 VA Form 21-4142); and/or (b) via occupational exposures to scalpels, needle sticks, blood, bodily fluids, etc. while working as a medic and nurse during service (see January 2020 hearing transcript). The examiner is advised that: (a) the March 2020 VA opinion is inadequate because the examiner failed to address the contention of exposure via air gun injections of vaccinations; (b) the November 2020 VA opinion is inadequate because the examiner not only failed to address the contention of exposure via air gun injections of vaccinations, but also failed to address the probability of contracting hepatitis C via occupational exposures; and (c) the Board concedes that the Veteran likely had occupational exposures in service because such exposures are consistent with the circumstances of the Veteran’s service as a practical nurse. 2. Readjudicate the appeal. The AOJ is advised that: (a) the peripheral neuropathy of the LLE issue is inextricably intertwined with the infectious hepatitis issue; and (b) the TDIU issue is inextricably intertwined with the other two remanded issues herein. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Daus, 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.