HEPATITIS C

Summary

The veteran, who served in the U.S. Army from July 1983 to May 1989, appeals the denial of service connection for hepatitis C, type II diabetes mellitus (DM2), and a residual disability of the right-hand ring finger. These claims were previously remanded for additional development, including VA examinations. However, the veteran failed to attend the scheduled April 2024 examinations without good cause, and the Board proceeded to decide the claims based on the existing evidence of record. The Board noted the veteran's assertion of past difficulties with VA vendors and rescheduling, but found no good cause was submitted for missing the appointments. The factual background indicates no complaints or diagnoses of DM2 or hepatitis C during service, and the separation examination showed no abnormalities related to the right-hand ring finger. While medical treatment records after service showed a DM2 diagnosis and hepatitis C positive status, there was no evidence of onset within a year of discharge. A chiropractor's opinion linking DM2 and hepatitis C to service was found inadequate due to factual inaccuracies regarding the onset of these conditions. The Board concluded that the evidence of record persuasively weighs against service connection for all three conditions, as there are no adequate medical opinions establishing a causal relationship to service. The Board also noted the veteran's history of missing appointments, making further examinations seem futile. Consequently, the Board denied service connection for hepatitis C, type II diabetes mellitus, and the residual disability of the right-hand ring finger, finding the weight of the competent and credible evidence against the veteran's claims.

Rationale

No evidence of onset during service; No adequate medical opinion linking to service; Chiropractor opinion found inadequate due to factual inaccuracies

Full Decision Text

Citation Nr: 26004513
Decision Date: 04/14/26	Archive Date: 04/14/26

DOCKET NO. 17-42 337
DATE: April 14, 2026

ORDER

Service connection for hepatitis C is denied.

Service connection for type II diabetes mellitus (DM2) is denied.

Service connection for residual disability of the right-hand ring finger is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that hepatitis C began during active service or is otherwise related to an in-service injury or disease.

2. The evidence of record persuasively weighs against finding that type II diabetes mellitus (DM2) began during active service or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that residual disability of the right-hand ring finger began during active service or is otherwise related to an in-service injury or disease.

CONCLUSIONS OF LAW

1. The criteria for service connection for hepatitis C have not been met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

2. The criteria for service connection for type II diabetes mellitus have not been met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

3. The criteria for service connection for residual disability of the right-hand ring finger have not been met.  38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Army from July 1983 to May 1989. 

These issues were previously before the Board.  In May 2023, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development.  Specifically, the Board directed the AOJ to schedule VA examinations for the Veteran's right hand ring finger disability claim, type II diabetes mellitus claim (DM2), and hepatitis C claim.

The AOJ scheduled examinations in April 2024, but the Veteran did not show.  Thus, the Board finds that the RO substantially complied with the remand directives and no further action is necessary in this regard.  Stegall v. West, 11 Vet. App. 268 (1998).

Following evidentiary development, the VA Appeals Management Center (AMC) continued the previous denials in a supplemental statement of the case (SSOC) issued in May 2024.  

In July 2024, the Veteran's representative submitted an informal hearing presentation but did not offer good cause for missing the VA examinations in May 2024, other than to say that they "also note that [the Veteran] has had past difficulties with VA vendors when attempting to reschedule" his examinations.  The Board finds that no good cause was submitted for missing the VA examinations scheduled and will decide on the claims based on the evidence of record.  38 C.F.R. § 3.655(b).

Service Connection

Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304.  Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b).  Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary.  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  Id.; see also Gilbert v. Derwinski, 
 injury and the present disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b).  Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary.  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).  "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran."  Gilbert, 1 Vet. App. at 54.

Factual Background

Service treatment records show that in a June 1983 medical examination, the Veteran did not have any abnormalities.  In January 1988, the Veteran reported symptoms of nausea, vomiting, dizziness and diarrhea and was diagnosed with viral syndrome.  There are no complaints about treatments for, or diagnoses of DM2 or hepatitis C during service.  In an April 1989 medical examination, the Veteran did not have any abnormality relating to his right-hand ring finger, and there were no diagnoses of DM2 or hepatitis C.  In the corresponding report of medical history, there also was no diagnosis of DM2 or hepatitis C, and only the right-hand little finger was noted alongside fracture of his right wrist.  

In August 1989, the Veteran submitted claims for his dislocated rotator cuff, right knee, left knee, left ankle, spine, right wrist, right little finger, and headaches.  He did not submit claims for right ring finger, DM2, or hepatitis C.

In an August 1989 VA examination, the Veteran reported that he had hurt his right hand in 1988 and that he had some ulnar deviation of the fifth finger of the right hand since.  There was no mention of his ring finger by the Veteran nor the examiner.

Medical treatment records from September 1989, after discharge from active duty, show that the Veteran was involved in a motor vehicle accident.  In May 1996, the Veteran complained of right-hand numbness that affected his fourth digit.  There is no record of diagnoses of hepatitis C or DM2 within a year of discharge from active duty. 

In an August 2004 VA examination, the Veteran reported that he injured his right hand in 1985.  Imaging showed a healed fracture of the distal end of the right fifth metacarpal, or the little finger.  There was no evidence of any arthritic process of the fingers of the hand.

VA Medical Center treatment records from May 2006 show that the Veteran was diagnosed with DM2 but has not taken insulin as an outpatient.  He was also "hep C AB positive" and a follow up was scheduled.  Treatment records from January 2007 show that the Veteran has hepatitis C.

In a March 2010 VA examination and in a January 2014 VA examination, the Veteran only reported symptoms of the little finger and not the ring finger.

In March 2023, a chiropractor opined that the Veteran's DM2 had its onset during his active service and therefore directly and causally related to his military condition.  Regarding hepatitis C, the chiropractor stated that the onset was during active service and therefore at least as likely as not related to the Veteran's service.  The chiropractor, however, did not opine on the etiology of the Veteran's right-hand ring finger disability, only noting hypoesthesia of the finger.  As the chiropractor relied upon factual inaccuracy, namely there being onset in service for hepatitis C and DM2 when there is no evidence of onset, the opinion is inadequate.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

In May 2023, the Board remanded the claims as discussed above and directed the AOJ to schedule VA examinations.  The Veteran did not show for examinations and did not offer good cause.  The Board notes that the Veteran does not contend that he did not receive notifications for these exams, instead he asserts that he has submitted a private medical opinion that links his issues on appeal with his active-duty service.  He further asserts that he has had past difficulties with VA vendors when attempting to reschedule his compensation and pension (C&P) exams.  There is no evidence he attempted to reschedule these appointments.  

1. Service connection for
odriguez v. Peake, 22 Vet. App. 295 (2008).

In May 2023, the Board remanded the claims as discussed above and directed the AOJ to schedule VA examinations.  The Veteran did not show for examinations and did not offer good cause.  The Board notes that the Veteran does not contend that he did not receive notifications for these exams, instead he asserts that he has submitted a private medical opinion that links his issues on appeal with his active-duty service.  He further asserts that he has had past difficulties with VA vendors when attempting to reschedule his compensation and pension (C&P) exams.  There is no evidence he attempted to reschedule these appointments.  

1. Service connection for hepatitis C

2. Service connection for type II diabetes mellitus (DM2)

3. Service connection for residual disability of the right-hand ring finger

As discussed above, the evidence of record shows that the Veteran has diagnoses of hepatitis C, DM2, and residual disability of the right-hand ring finger.  The Board in May 2023 directed the AOJ to schedule medical examinations but the Veteran did not show for the April 2024 VA examinations without offering good cause.  Thus, the claims must be decided based on the evidence of record.  38 C.F.R. § 3.655.  

However, there are no adequate medical opinions of record that show a causal relationship between the Veteran's disabilities and his service.  Lacking medical opinions supporting casual relationship between service and his disabilities, the claims must be denied as the criteria for service connection have not been met.  The Board also finds that scheduling further VA examinations would be futile as the Veteran has a history of missing a VA examination in July 2023, as well as missing several examinations in February 2026 for claims not currently before the Board. 

To the extent the Veteran asserts that a relationship exists between his disabilities and his service, the Board finds that such assertions do not provide persuasive evidence in support of the claim.  The matters of the medical etiologies of the disabilities here at issue are within the province of trained medical professionals.  Jones v. Brown, 7 Vet. App. 134, 137-38 (1994).  Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the etiology of the Veteran's disabilities are complex medical matters that fall outside the realm of common knowledge of a lay person.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  

Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54.  The weight of the competent and credible evidence is against the Veteran's claim, and as such entitlement to service connection for hepatitis C, type II diabetes mellitus, and residual disability of the right-hand ring finger are denied.

 

 

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	H. Yun

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.