Citation Nr: 21022415 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 16-09 264 DATE: April 15, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1974 to December 1974. This appeal is before the Board of Veterans’ Appeals (Board) on appeal of a May 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran appeared at a hearing before the undersigned Veterans Law Judge in April 2021. The Veteran argues that he “was forced to receive injections from an automatic air injection gun” during his military service and believes he “contracted Hepatitis C due to improper use of the pedolite air injection gun for inoculations in boot camp.” He recalls the equipment was not properly sanitized and was “quite filthy with blood when it was used on” him. See July 2014 VA Form 21-4138, Statement in Support of Claim. It was stated during his hearing that he did not have any other risk factors for hepatitis C. In this regard, it is noted that a June 1997 treatment report from the Portland VA Medical Center (VAMC), notes the Veteran’s risk factors included “IVDA” in the past and alcohol (none for about 10 years.) Initially, it is noted that review of the record suggests that the medical evidence available for review is incomplete. Specifically, the record reflects the Veteran was diagnosed with hepatitis C by liver biopsy in February 1997 (when he was found unqualified for Naval Reserve service.) He sought treatment at the Portland VAMC in March 1997, when he reported a history of treatment by an outside (private) primary care physician and gastroenterologist, identified as J. Lobitz, M.D. Review of the record shows the private treatment records have not been obtained and are not available for review. In addition, although the May 2015 rating decision notes an electronic review of treatment records from Portland VAMC dated from July 1997 to May 2000 was completed, the records in the claims file available for review show a gap between March 1997 and 2014; thereby, suggesting the records from the Portland VAMC may be incomplete. The Veteran testified that he was receiving Social Security Administration disability benefits for hepatitis C. On remand, complete updated VA and private treatment records and medical records developed by SSA should be obtained. The Board notes that the Veteran testified that he had aches in his liver and joints around 1981 that were misdiagnosed as rheumatoid arthritis but these records are unobtainable. It is also noted that the Board cannot make a fully-informed decision on the issue of entitlement to service connection for hepatitis C because no VA examiner has opined as to the nature and etiology of the Veteran’s hepatitis C, to include whether it is related to risk factors associated with service, to specifically include air gun injections. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to secure for the record copies of complete updated clinical records (any not already of record) of all VA and/or private treatment the Veteran has received for hepatitis C, to specifically include: a) The outside (private) primary care physician and gastroenterologist (J. Lobitz, M.D), who treated the Veteran in 1996/1997, prior to the start of his treatment at the Portland VAMC. b) Complete VA records, including from the Portland VAMC from 1997 to the present. 2. Please associate relevant SSA records with the virtual file, that is, those records that relate to hepatitis C and have a reasonable possibility of helping to substantiate the claim. 3. After the development in paragraphs 1 and 2 has been completed to the extent possible, please obtain a medical opinion from an appropriate clinician regarding: Whether the Veteran’s hepatitis C is at least as likely as not related to being injected with an air gun during service or is otherwise related to service. In this regard, the examiner is asked to assume that that transmission of the virus via air gun is biologically plausible. The opinion provider is asked to consider and discuss as necessary the Veteran’s report that he had no other risk factors, and the June 1997 Portland VAMC treatment report which notes the Veteran’s risk factors included “IVDA” in the past and alcohol (none for about 10 years.) The examiner must provide a complete rationale for the proffered opinion. If an opinion cannot be provided without resort to speculation, the examiner should   provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K Hughes 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.