Citation Nr: 22040906 Decision Date: 07/18/22 Archive Date: 07/18/22 DOCKET NO. 17-43 387 DATE: July 18, 2022 REMANDED Entitlement to service connection for human immunodeficiency virus (HIV) is remanded. REASONS FOR REMAND The Veteran served on active-duty July 1977 to June 1984. This case is before the Board of Veterans' Appeals (Board) on appeal from March 2016 and October 2016 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. In March 2018, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of his testimony is associated with the claims file. The Board previously remanded this claim in March 2019, December 2019, and March 2021. 1. Entitlement to service connection for human immunodeficiency virus (HIV) is remanded. The Veteran and his representative assert that the Veteran is entitled to service connection for HIV because he claims it originated during his active-duty service. Although the Board regrets the additional delay, yet another remand is necessary to ensure that the Veteran is afforded every possible consideration. In the July 2019 VA examination, the examiner concluded that the Veteran's HIV was less likely than not caused by his reported rape during service. The examiner noted that most of "all HIV positive people will progress to AIDS (acquired immunodeficiency syndrome) with in an 8 to 10-year time span" if the HIV is not treated. As the Veteran separated from service in June 1984, was diagnosed with HIV in 1991, and did not begin treatment for HIV until 1998, the examiner believed that the 8 to 10-year timeline meant that the Veteran more likely than not acquired HIV after his active-duty service. However, in December 2019, the Board took judicial notice of publications from the United States Department of Health and Human Services, which asserted that HIV has a clinical latency period of 10 to 15 years of untreated HIV before entering the final stage of AIDS. The Board remanded this claim to obtain another VA examination and opinion regarding the etiology of the Veteran's HIV, as the 10 to 15-year time span would date back to the Veteran's active-duty service. The Board remanded this claim in March 2021 to afford the Veteran a new VA examination and to obtain another etiological opinion. Pursuant to the March 20201 Board remand, the RO scheduled the Veteran for another VA examination; however, in June 2021 the Veteran asserted that he did not wish to attend any further VA examinations. Based on this assertion, the VA examination was cancelled, and the claim was returned to the Board. In a recent brief, the Veteran's representative suggested that the Board use an addendum opinion based on a review of the record versus an in-person examination. The Board therefore finds that an addendum opinion is still needed to address the etiological cause of the Veteran's HIV and addresses the publications from the United States Department of Health and Human Services, which asserted that HIV has a clinical latency period of 10 to 15 years of untreated HIV before entering the final stage of AIDS. The matter is REMANDED for the following action: Obtain an opinion from a VA physician with the appropriate expertise necessary to determine the likely etiology of the Veteran's HIV. The claims file, a copy of the March 2018 Board hearing transcript, and a copy of this remand must be made available to the VA physician and the physician shall indicate in the examination report that the claims file was reviewed. After reviewing the claims file, the examiner should render an opinion as to whether it is at least as likely as not (approximately 50 percent probability or greater) that the Veteran contracted HIV in service, to include as a result of engaging in sexual acts during active-duty service. In rendering this opinion, the examiner is specifically asked to discuss the estimated period of time between exposure to the virus and becoming HIV positive and how this corresponds to the Veteran's claims of exposure and becoming HIV positive. The examiner's discussion must reflect consideration of the Veteran's entire documented medical history and assertions and all lay evidence. The examiner should also address the HIV period of clinical latency of 10 to 15 years noted by the United States Department of Health and Human Services. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner must provide a thorough rationale for each opinion given. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, 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.