Citation Nr: 21026652 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 15-42 580A DATE: May 3, 2021 ORDER Service connection for hepatitis C is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's hepatitis C is causally related to his service. CONCLUSION OF LAW The criteria for service connection for hepatitis C have not been met. 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 November 1975 to September 1976. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the Board at a January 2019 hearing via videoconference. A transcript of that hearing is of record. The Veterans Law Judge who held that hearing has since left the Board. The Veteran was asked if he wanted another hearing in a March 2021 letter. The Veteran did not reply. This matter was remanded by the Board in April 2020 and most recently in June 2020 for further evidentiary development. The Board finds that there has been substantial compliance with those remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to insure compliance with the terms of the remand); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board's remand directives is required under Stegall). Service connection for hepatitis C Legal Criteria Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994).The Board must assess the credibility and weight of all of the evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. Factual Background & Analysis The Veteran contends service connection is warranted for hepatitis C because of air gun immunization injections he received during active service. See e.g., May 2015 NOD and January 2019 Hearing Transcript. December 2006 Kaiser Permanente treatment records reflect treatment for chronic hepatitis C. On October 2020 VA examination the Veteran was noted to have a history of intravenous drug use. The examiner opined that it is less likely than not that the Veteran's hepatitis C is causally related to his service. The examiner explained that this opinion was based on the Veteran's medical history, emphasizing that the earliest documented date of a hepatitis C diagnosis is 2006 (40 years after service). Moreover, the examiner note that the Veteran conveyed that he began using drugs intravenously in 2011 but was unsure of the exact year this started. The examiner explained that of all the Veteran's risk factors the air gun injections posed the least amount of risk for contracting hepatitis C. Rather, the examiner concluded based on their medical expertise that the Veteran's intravenous drug use is the Veteran's biggest risk factor for contracting hepatitis C. The Board has carefully reviewed the lay and medical evidence of record and finds that the most probative medical evidence is weighted against finding that the Veteran's hepatitis C is causally related to his service. In that regard, the October 2020 VA medical opinion communicated that it is less likely than not that the Veteran's hepatitis C was incurred in or is causally related to air gun injections during service. This examiner instead found that the Veteran's history of intravenous drug use is the likeliest cause of his hepatitis C diagnosis, basing this opinion on their medical expertise and a review of the medical evidence. The Board acknowledges the Veteran's lay contention that his hepatitis C is causally related to receiving air gun injections during service. As a lay person, the Veteran does not have the training or expertise to render a competent nexus opinion regarding the etiology of his hepatitis C which is more probative than the VA examiner's opinion on this issue as this is a medical determination that is complex and requires specific medical training and expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Further, there is otherwise no opinion or treatment record authored by a VA or private medical professional which supports the Veteran's contention that his hepatitis C is causally related to air gun injections during service. Consequently, the Board finds that the Veteran's contention regarding the etiology of his hepatitis C is outweighed by the competent etiology opinion of the VA examiner. See Id.; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). In sum, the Board finds that the weight of the competent and probative evidence is against a finding of service connection for hepatitis C. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kyle McKone 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.