Citation Nr: 21041031 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-17 336 DATE: July 7, 2021 REMANDED Entitlement to service connection for hepatitis C is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 1973 to December 1974. This matter is before the Board of Veterans' Appeals (Board) on appeal of a March 2015 Department of Veterans Affairs (VA) rating decision. In August 2019 and March 2020, this matter was remanded for additional development. The March 2020 Board remand ordered development for a VA medical advisory opinion regarding the etiology for the Veteran's hepatitis C; the provider was to specifically address a February 2015 statement by the Veteran's VA physician. If an opinion could not be given without resort to mere speculation, the provider was to explain why that is so (whether due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training)?). In the April 2020 VA advisory opinion received in response, the provider opined it was less likely than not that the Veteran's hepatitis C is related to service. He opined (without more detailed explanation) that in many cases the cause of hepatitis C remains unknown, as here with this Veteran. He did not adequately explain why if the Veteran had contract hepatitis C in service, it would be unlikely he would remain asymptomatic (not developing a complication from hepatitis) for 30+ years. While the provider acknowledged the existence of the statement by the Veteran's personal physician, he did not address (express agreement or disagreement with) the opinions therein themselves. The April 2020 VA opinion is not responsive to the Board's remand directives, and corrective action is necessary. See Stegall v. West, 22 Vet. App. 268 (1998). The matter is REMANDED for the following: Arrange for the Veteran's record to be forwarded to an appropriate (with some specific subject matter expertise) clinician for review and an advisory medical opinion regarding the likely etiology of his hepatitis C. [If an examination of the Veteran is deemed necessary for an opinion sought, such should be arranged).] The consulting provider should: (a.) Identify the likely etiology for the Veteran's hepatitis C. Specifically, is it at least as likely as not (a 50% or greater probability) that hepatitis C began in service, is due to an etiological (risk) factor therein, or is otherwise etiologically related to his service? (b.) If the hepatitis C is determined to be unrelated to service (and any risk factors therein), identify the etiology for the hepatitis C that is considered to be more likely (and explain why that is considered so). All opinions must include rationale. Comment on (express agreement or disagreement with) the February 2015 statement offered by the VA physician. If an opinion sought cannot be provided without resort to speculation, explain WHY that is so (e.g., whether the opinion sought is beyond what any medical practitioner might be able to provide, because there is inadequate information available, and if so identify what further information is needed, or because no medical professional could offer such opinion based on the evidence of record and the current state of medical knowledge). If the opinion is that the etiology for the Veteran's hepatitis C is unknown (cannot be determined), identify the primary known risk factors for development of hepatitis C, noting any shown in/with the Veteran during service and after service. Some discussion of what is known medically about the incubation period for hepatitis C before it becomes symptomatic following exposure to the risk factor implicated would also be helpful. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Naumovich, Associate 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.