Citation Nr: 21029865 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 16-40 968 DATE: May 17, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marine Corps from January 1968 to October 1969 and is in receipt of the Combat Action badge and a Purple Heart for his service in the Republic of Vietnam. Entitlement to service connection for hepatitis C is remanded. The Veteran's service records contain repeated notations that he suffers from hepatitis C, to include positive antibody tests. The Board also notes that the Veteran has been service-connected for a left shoulder disability due to a gunshot wound. Tellingly, treatment records surrounding the gunshot wound show the Veteran required surgeries to include repairing his left axillary artery. Moreover, the Veteran maintains that he received blood transfusions as part of those surgeries and that said transfusions are the cause of his current hepatitis C. At the same time, the Veteran has reported other positive hepatitis C risk factors, to include in-service intravenous drug usage (i.e. possibly willful misconduct under 38 C.F.R. § 3.301(a)). Given the above history, the Board finds that the criteria has been met to obtain a needed medical opinion as to whether the Veteran's current hepatitis C is due to his in-service treatment for the gunshot wound to his service connected left shoulder disability or another risk factor to include in-service intravenous drug usage. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 84-86 (2006). Next, the Board notes that the Veteran claims that the left shoulder surgeries and blood transfusion occurred while he received in-patient treatment at the United States Naval Hospital, St. Albans, in July 1969. However, a complete copy of these records has not been associated with the record on appeal. Therefore, the Board finds that a remand is also required to do so. See 38 U.S.C. § 5103A(b). While the appeal is in remand status any other outstanding VA and private treatment records should also be obtained and associated with the record on appeal. See 38 U.S.C. § 5103A(b). The appeal is REMANDED for the following actions: 1. Attempt to obtain the Veteran's in-patient treatment records from his reported left shoulder surgeries and blood transfusions to include for the United States Naval Hospital, St. Albans in July 1969. The Board notes that service hospitalization records are sometimes stored separately from other service medical records and a specific request should be made for such separately stored records. Because these are Federal records, efforts to obtain them should be ended only if it is concluded that the records sought do not exist or that further efforts to obtain them would be futile. If the records cannot be located or no such records exist, a Memorandum of Unavailability documenting all of VA's actions to obtain the records should be prepared and associated with the claims file and the Veteran should be notified in writing that the records cannot be found. 2. Obtain and associate with the claims file any outstanding VA treatment records. 3. After obtaining all needed authorizations from the Veteran, associate with the claims file any outstanding private treatment records. 4. Schedule the Veteran for a VA examination for his hepatitis C. A copy of the Veteran's entire claims file should be provided to the examiner . Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. After a consideration of the evidence of record (both lay and medical) and the results of the examination, the examiner is asked to address the following: (a.) Provide an opinion as to whether the Veteran has a current diagnosis of hepatitis C. (b.) Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that his hepatitis C is casually or etiologically related to active duty service, to include the left shoulder surgeries due to a gunshot wound and the claimed blood transfusions, as opposed to any other risk factor to include his reported in-service intravenous drug use. (c.) Provide an opinion as to whether hepatitis C manifested in the first post-service year. In providing answers to the above questions, the examiner should specifically consider and address: (1) the positive antibody test circa October 2008 and September 2009 but also negative qualitative test circa September 2009; (2) the Veteran's statements that he received blood transfusions as part of surgical treatment in July 1969; and (3) the Veteran's report to a treating provider in November 2014 to using intravenous drugs "almost daily" for approximately one year during his tour in the Republic of Vietnam. In providing answers to the above questions, the examiner is also advised that the term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. In answering the questions please articulate the reasoning underpinning your conclusions. That is, (1) identify what facts and information--whether found in the record or outside the record--support your opinion, and (2) explain how that evidence justifies your opinion. If the examiner cannot respond to any inquiry without resort to speculation he or she should so state and must further explain why it is not feasible to provide a medical opinion, indicating whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or in the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 5. After undertaking the above development, issue the Veteran a supplemental statement of the case that includes notice of all evidence added to the record since the issuance of the statement of the case as well as notice of all potentially applicable laws and regulations including those governing willful misconduct at 38 C.F.R. § 3.301(a). NEIL T. WERNER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Woehlke 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.