Citation Nr: 0003144 Decision Date: 02/08/00 Archive Date: 02/15/00 DOCKET NO. 98-12 107 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Los Angeles, California THE ISSUE Entitlement to service connection for hepatitis C with cirrhosis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Marisa Kim, Associate Counsel INTRODUCTION The veteran had active military service from April 1967 to March 1969. This appeal is before the Board of Veterans' Appeals (Board) from a March 1998 rating decision from the Los Angeles, California, Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for hepatitis C with cirrhosis. FINDINGS OF FACT 1. The veteran has a current hepatitis C with cirrhosis disability. 2. There is no medical evidence of a nexus between the post- service hepatitis C with cirrhosis and an in-service event. CONCLUSION OF LAW The claim of entitlement to service connection for hepatitis C with cirrhosis is not well grounded. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The May 1967 examination report stated that the veteran's health was normal, and no defects or diagnoses were noted except for an identifying body mark on the left wrist. Service medical records shows that the veteran was injured in a motorcycle accident in March 1968 and admitted to the military hospital for emergency surgery. The veteran's October 1997 application alleged that he contracted hepatitis C from a blood transfusion during surgery. The Medical Evaluation Board granted the veteran a medical discharge from service in March 1969. The veteran was examined at the Southern California Medical Gastroenterology Group, Inc. in February 1995. The veteran reported that he was a recovering alcoholic and drug addict and that he had a positive hepatitis C antibody. He reported feeling well, without symptoms. The February 1995 liver biopsy showed evidence of chronic active hepatitis C with possible early cirrhosis. The assessment was chronic active hepatitis Type C. The March 1995 liver profile report stated that the veteran's specimen was positive for the hepatitis C virus. A private physician examined the veteran in December 1995. The veteran reported a diagnosis of hepatitis in the 1980s and that he had not used drugs since 1990. He reported that he probably had blood transfusions in 1968 when he was unconscious from an accident for 5 days but he was unsure of this. The impression was hepatitis C with cirrhosis. The December 1995 liver biopsy showed moderate chronic active hepatitis consistent with known positive hepatitis C antibody. The September 1996 liver biopsy showed chronic active hepatitis consistent with hepatitis C disease with probable development of early cirrhosis. The October 1996 liver biopsy showed cirrhosis present. The veteran provided sworn testimony at a regional office hearing in January 1999. The veteran was injured in a motorcycle accident while in service. He was unconscious for a number of days and underwent surgery to repair broken bones. The veteran contends that he received an infected blood transfusion during the surgery but that he does not have medical records to document the transfusion. Transcript (January 1999), page 2. The veteran could not pinpoint when he started feeling fatigue from hepatitis because he had abused alcohol and drugs. Transcript (January 1999), page 5. A VA doctor diagnosed non-A, non-B hepatitis, and 3 years later, a private doctor diagnosed hepatitis C. Transcript (January 1999), pages 6-7. The veteran submitted a National Institute of Health article, entitled "Management of Hepatitis C, March 24-26, 1997" into evidence. Transcript (January 1999), page 3. Even though many years had passed since service, the article convinced the veteran to pursue the claim for service connection. Transcript (January 1999), page 5. The March 1997 National Institute of Health article stated that chronic hepatitis C progresses, if at all, at a slow rate without symptoms or physical signs in the majority of patients during the first 2 decades after infection, and at least 20 percent of patients develop cirrhosis of the liver within 2 decades of the onset of infection. Criteria The Court has held that a well-grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The Court has held that a well-grounded claim requires competent evidence of current disability (a medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the in-service injury or disease and the current disability (medical evidence). See Epps v. Brown, 126 F.3d. 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be established where the evidence demonstrates that an injury or disease resulting in disability was contracted in the line of duty coincident with military service, or if pre-existing such service, was aggravated therein. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Cirrhosis may be presumed to have been incurred service if it is manifested to a degree of 10 percent within one year following the veteran's separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). Analysis The medical evidence shows that the veteran has current hepatitis C with cirrhosis disability. Examinations and liver biopsies in December 1995, September 1996, and October 1996 revealed that the veteran had chronic hepatitis consistent with hepatitis C disease and early cirrhosis. Nonetheless, the claim for service connection for hepatitis C with cirrhosis is not well grounded because there is no medical evidence of a diagnosis of or treatment for hepatitis, cirrhosis, or liver problems within a year after separation from service. Rather, the record shows the first diagnosis of hepatitis C and cirrhosis in 1995, over 25 years after the veteran separated from service. In addition, the claim for service connection for hepatitis C with cirrhosis is not well grounded because there is no medical evidence of a nexus between the current disability and an in-service event. The veteran's October 1997 application alleged that he was infected in service from a blood transfusion during the 1968 surgery. While the veteran, as a lay person is competent to provide evidence on the occurrence of observable symptoms during and following service, such a lay person is not competent to make a medical diagnosis or render a medical opinion which relates a medical disorder to a specific cause. Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992). Thus, the veteran is not competent to diagnosis the cause of his current disability because the evidence does not show that he is a trained medical professional. Service medical records do not show that the veteran received a blood transfusion during the 1968 surgery, and the veteran could not observe events while he was unconscious. Accordingly, the claim of entitlement to service connection for hepatitis C with cirrhosis is not well grounded. The foregoing discussion is sufficient to inform the veteran of the elements necessary to complete an application to reopen the claim. See Graves v. Brown, 8 Vet. App. 522 (1996); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). The VA cannot assist in any further development of the claim because the claim is not well grounded. 38 U.S.C.A. § 5107(a); Morton v. West, No. 96-1517 (U.S. Vet. App. July 14, 1999). ORDER The claim of entitlement to service connection for hepatitis C with cirrhosis is denied. V. L. Jordan Member, Board of Veterans' Appeals