BVA9403696 DOCKET NO. 92-08 990 ) DATE ) ) ) THE ISSUE Entitlement to service connection for hepatitis. ATTORNEY FOR THE BOARD Christine E. Puffer, Associate Counsel INTRODUCTION The veteran had active military service from March 1968 to March 1970. This appeal comes before the Board of Veterans' Appeals (Board) from a February 1992 rating determination of the Department of Veterans Affairs (VA) Cleveland, Ohio, Regional Office (RO). The appeal was remanded by Board decision of April 1993 for further development. This development has been accomplished and the case is now ready for appellate review. CONTENTION OF APPELLANT ON APPEAL The veteran essentially contends that he received a blood transfusion while in service which resulted in his being infected with hepatitis C. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against service connection for hepatitis. FINDINGS OF FACT 1. All evidence necessary for an equitable adjudication of the instant claim has been obtained by the RO. 2. The veteran did not receive a blood transfusion while in service and hepatitis is not otherwise related to service. CONCLUSION OF LAW Hepatitis was not incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, we find that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); see Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). That is, we find that he has presented a claim which is not implausible when his contentions and the evidence of record are viewed in the light most favorable to the claim. We are also satisfied that all relevant facts have been properly and sufficiently developed. The veteran has contended that he received a blood transfusion after sustaining fragment wounds to his abdomen, left leg and left foot in Vietnam. He stated that he remembered having needles put in his arm after being wounded. The veteran informed a VA examiner in August 1993 that he bled significantly while in the field and believed he had been transfused in the field, maintaining that he had received multiple transfusions. He submitted a letter from Robert B. Kirkpatrick, M.D., which stated that a liver biopsy revealed the veteran had cirrhosis and chronic active hepatitis which was felt to be due to hepatitis C. Further evaluation ruled out other causes for the cirrhosis as no history of contributing factors, such as alcohol use, had been revealed. The physician concluded that since chronic hepatitis C is often transmitted by blood transfusion, it was probable that the veteran contracted the hepatitis after receiving many transfusions due to the wounds he had received in Vietnam. In order to establish service connection, there must be both evidence of a disease or injury incurred or aggravated in service, and a present disability which is attributable to such disease or injury. 38 U.S.C.A. § 1131 (West 1991); Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). Review of service medical records indicates that the veteran's abdominal injury occurred in October 1968, at which time he also sustained injuries to his left leg and left foot. Contemporary treatment records reveal on the day of the injury he was treated at the 45th Surgical Hospital where his wounds were debrided and the veteran underwent a laparotomy. A Narrative Summary reflecting an admission date in October 1968 shows that no abnormal blood count was reported and no blood was given the veteran in the course of his treatment. No abdominal injury or injury to the viscera was found and there was no nerve or artery involvement. He did well post-operatively and was evacuated via the 12th Evacuation Hospital to the United States Army Hospital, Camp Zama, Japan, from whence he was later returned to active duty. Records from Camp Zama corroborate the above-noted prior treatment, adding that the veteran received physical therapy during this hospitalization and was discharged in November 1968. The Board notes that the veteran had received an earlier fragment wound to his right buttock in September 1968 for which he received debridement. No intravenous fluids were administered and there is no evidence of any transfusion of blood products in the treatment of this injury. Service medical records contain no evidence of any diagnosis of, or treatment for, any form of hepatitis. The Board notes the conditional tone of Dr. Kirkpatrick's December 1991 letter, offered by the veteran in support of his contentions. The physician states that other causes for cirrhosis, including alcohol use, had not been evidenced. This statement is clearly contradicted by the history given in an Ohio State University Hospital record evidencing treatment received by the veteran from Dr. Kirkpatrick during hospitalization in August and September 1991, wherein a "long history of alcohol abuse, approximately one fifth per day times 20 years" was noted. The history of extensive past alcohol abuse is repeated in other treatment records from this facility and from a VA hospitalization in October l976. While the veteran presently disputes the amount of alcohol consumed, medical records in 1976 evidence treatment for alcohol addiction and statements in other treatment records support a conclusion of an extensive history of alcohol abuse. In his letter, Dr. Kirkpatrick also states that, since hepatitis C is often transmitted by blood transfusions, it was "probable" that the veteran contracted it after the receipt of "many blood transfusions" in Vietnam. As noted, there is no evidence to confirm that a single blood transfusion took place while the veteran was in service. In finding the conditions on which the physician predicated his opinion to be without foundation or objective support, his conclusion that the veteran probably contracted hepatitis C after blood transfusions in Vietnam is clearly based on inaccurate information. While proof of service-connection may be allowed through lay evidence (see 38 C.F.R. § 3.303 (1993); Cartright v. Derwinski, 2 Vet.App. 24, 25-26 (1991)), the lay witness may be incapable of offering evidence which requires specialized medical knowledge, especially when the relevant issue does not lie within the range of common experience or knowledge. See Espiritu v. Derwinski, 2 Vet.App. 492 (1992). While we do not doubt that persons who initially treated the veteran may well have used an intravenous needle, that in itself is insufficient evidence of the receipt of any blood products. There is no evidence that the veteran had suffered significant blood loss in the course of the noted injury, or any other condition which would necessitate a blood transfusion. Medical records from all three facilities from which he received treatment for his abdominal injury also fail to corroborate the veteran's claim that he received a blood transfusion the night of his injury. We find the veteran is not competent to provide testimony as to whether he received one or more blood transfusions solely on the basis that he was injured and had an intravenous needle placed in his arm. Given our finding that no credible evidence has been presented that the veteran received any blood transfusions in service, or that he contracted hepatitis at that time, we find the evidence is not in equipoise and that service connection cannot be granted for hepatitis. 38 C.F.R. § 3.102 (1993); See Rabideau at 143. ORDER Service connection for hepatitis is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * WARREN W. RICE, JR. (MEMBER TEMPORARILY ABSENT) CHARLES E. HOGEBOOM *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.