Citation Nr: 21032783 Decision Date: 05/28/21 Archive Date: 05/27/21 DOCKET NO. 10-40 876A DATE: May 28, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for non-Hodgkin's lymphoma, as secondary to hepatitis C is remanded. Entitlement to service connection for diabetes mellitus, type II, as secondary to hepatitis C is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1972 to February 1975. This case has a long procedural history. The appeal was most recently before the Board in October 2020 when it was remanded for additional development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for hepatitis C is remanded. The October 2020 VA addendum opinion obtained on remand is inadequate. The examiner prefaced the opinion with the statement "[n]o idea how/when hepatitis C was contracted." The opinion the examiner attempted to offer is internally inconsistent with regard to specific test results. The examiner said it would be mere speculation to say the Veteran's elevated blood tests results were due to hepatitis C, yet opined that the Veteran's hepatitis C was less likely than not incurred in or related to service. The examiner did not discuss what information would be necessary for him to provide a definitive opinion. Additionally, the October 2020 VA examiner noted that the SGPT lab test was non-specific, i.e. not a diagnostic test for hepatitis C, however the August 2016 VA examiner specifically noted that the SGPT test was much more specific for liver damage. Accordingly, on remand the VA examiner should discuss the significance of the SGPT test for hepatitic C in the new opinion obtained on remand. Entitlement to service connection for non-Hodgkin's lymphoma, as secondary to hepatitis C is remanded. Entitlement to service connection for diabetes mellitus, type II, as secondary to hepatitis C is remanded. Finally, because a decision on the remanded issue of entitlement to service connection for hepatitis C could significantly impact a decision on the issues of entitlement to service connection for non-Hodgkin's lymphoma and diabetes mellitus, the issues are inextricably intertwined. A remand of those claims are required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate provider, preferably a hepatologist, to determine the nature and likely etiology of the Veteran's diagnosed hepatitis C. Copies of all pertinent records, including this remand, must be made available to the examiner for review. Based on the review of the record (and examination if needed), the examiner should answer the following: Is it at least as likely as not that the Veteran's hepatitis C was incurred in or is otherwise related to service? Why or why not? The examiner must consider and discuss the following: (i) the 1974 (in service) elevated SGPT test results; (ii) the elevated liver enzyme findings recorded after the post-service 1976 motor vehicle accident, and; (iii) the Veteran's assertion that he was exposed to hepatitis C by another soldier in his company who was a drug user, possibly by using a razor or accidently poking him with a syringe while shooting up. In rendering an opinion, the examiner should discuss the significance of SGPT testing with regards to hepatitic C, and consider and discuss as necessary the notation by the August 2016 VA examiner that the SGPT test was more speculative than the SGOT and LDH tests for liver damage and the notation by October 2020 VA examiner that SGPT testing was non-specific for hepatitic C. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided or cannot provide an opinion 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. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue service connection for non-Hodgkin's lymphoma and diabetes mellitus type II as secondary to hepatitis C. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Eric Struening 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.