HEPATITIS

MICHAEL A. PAPPAS · 2026 · Case ID: 26005020

GRANTED

Summary

The Veteran, a veteran who served from July 1970 to March 1972, including service in the Republic of Vietnam, appeals the denial of service connection for hepatitis C. The Veteran claims hepatitis C was contracted due to intravenous drug use, which he asserts was caused by his service-connected PTSD. The Board reviewed multiple VA medical opinions, some of which were deemed inadequate or of diminished probative value, while others provided unfavorable nexus opinions regarding the direct link between mass inoculations and hepatitis C. However, the Board found that the unfavorable opinions did contain facts supporting a link between the Veteran's drug use and hepatitis C. Crucially, a June 2011 private medical opinion from a licensed psychologist established that the Veteran's heroin addiction, which began after his return from Vietnam, was at least as likely as not caused by his service-connected, combat-related PTSD. The Board found this opinion adequate and probative, noting that the Veteran's combat experiences were corroborated. Considering the totality of the evidence, the Board found the evidence in approximate balance, concluding that the Veteran's PTSD led to his IV drug use, which in turn caused hepatitis C. Therefore, service connection for hepatitis C on a secondary basis was granted.

Rationale

Veteran diagnosed with hepatitis C.; Service connection for PTSD established.; Private opinion linked drug use to PTSD.; Drug use linked to hepatitis C.; Benefit of the doubt applied due to approximate balance of evidence.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-43 615

Full Decision Text

Citation Nr: 26005020
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 15-43 615
DATE: April 29, 2026

ISSUE

Entitlement to service connection for hepatitis C.

ORDER

Entitlement to service connection for hepatitis C is granted, subject to the laws and regulations governing the payment of monetary benefits.

FINDINGS OF FACT

1. The Veteran's hepatitis C was caused by intravenous drug use related to his service-connected posttraumatic stress disorder (PTSD).

CONCLUSIONS OF LAW

1. The criteria for service connection for hepatitis C as secondary to service-connected disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.301, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1970 to March 1972, with confirmed service in the Republic of Vietnam. He received a Bronze Star Medal, among other awards and decorations.

In the November 2015 substantive appeal (VA Form 9), the Veteran and his attorney requested a hearing before a Veterans Law Judge. A hearing was initially scheduled for August 27, 2018, but the Veteran's attorney sought to reschedule this hearing. Another hearing was scheduled for November 20, 2018.

The Veteran did not report for this hearing, did not provide a statement of good cause for failing to report, and did not ask for the hearing to be rescheduled. The Veteran's request for a personal hearing was therefore deemed withdrawn.

This appeal was first before the Board in January 2019, at which time it was

remanded as inextricably intertwined with a claim regarding the timeliness of the

December 31, 2010, Notice of Disagreement (NOD). The appeal was then

remanded again in July 2021, as the Board found that the Agency of Original

Jurisdiction (AOJ) had not substantially complied with the January 2019 remand directives by failing to provide the Veteran with a Supplemental Statement of the

Case (SSOC).

After an SSOC was issued in August 2022, the appeal returned to the Board. In February 2023, the Board reopened and remanded the claim for entitlement to service connection for hepatitis C. The Board directed the AOJ to obtain a new VA medical examination regarding the etiology of the Veteran's hepatitis C. In November 2023, the Veteran's attorney submitted a new request for a hearing in this appeal. A hearing was scheduled for March 4, 2024. On February 16, 2024, the Veteran's attorney requested to postpone this hearing, and on March 1, 2024, the request to postpone was granted. A new hearing was then scheduled for August 26, 2024, but on August 21, 2024, the Veteran's attorney withdrew the hearing request.

In December 2024, the Board remanded the claim for entitlement to service connection for hepatitis C to (1) obtain information regarding the qualifications of the August 2012 and March 2023 Department of Veterans Affairs (VA) examiners and (2) obtain an addendum VA medical opinion regarding the etiology of the Veteran's hepatitis C, to include the Veteran's assertion that he was exposed to unsterilized mass inoculations that caused him to contract hepatitis C during service. Review of the record shows that the qualifications of the August 2012 and March 2023 VA examiners have been added to the claims file. New VA medical opinions were also obtained in January 2025, March 2025, and July 2025.

In February 2026, the matter was remanded for an additional examination due to the Veteran's participation in a toxic exposure risk activity (TERA). See 38 U.S.C. § 1168(a). In a March 2026 Supplemental Statement of the Case (SSOC), the Veteran's service connection claim for hepatis C remained denied. The matter has returned to the Board for adjudication.

The Board notes that the Veteran has been afforded additional TERA medical opinions. Therefore, the Board finds there has been substantial compliance with its February 2026 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008).

Entitlement to service connection for hepatitis C.

The Veteran asserts that he has hepatitis C due to intravenous drug use caused by his service-connected PTSD.

VA grants service
Supplemental Statement of the Case (SSOC), the Veteran's service connection claim for hepatis C remained denied. The matter has returned to the Board for adjudication.

Entitlement to service connection for hepatitis C.

The Veteran asserts that he has hepatitis C due to intravenous drug use caused by his service-connected PTSD.

VA grants service connection for disabilities resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "Direct" service connection requires: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus (a causal link) between the current disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Disorders diagnosed after discharge may still be service connected if the evidence establishes that the disorder was incurred in service. 38 C.F.R. § 3.303(d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994).

A veteran may establish service connection on a "secondary" basis for a non- service-connected disability that was caused by a service-connected disability. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Generally, service connection on a direct basis is not permitted for diseases or injuries that result from a person's own willful misconduct, including abuse of alcohol or drugs. 38 U.S.C. § 105; 38 C.F.R. §§ 3.1(m), 3.301(c)(3)(d). However, an alcohol or drug abuse disability arising as a direct result of a psychiatric condition, such as PTSD, may be service connected. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001).

Discussion and Analysis

The record reflects the Veteran has been diagnosed with hepatitis C. Additionally, he has been awarded service connection for post-traumatic stress disorder (PTSD). See April 13, 2012, Rating Decision.

An August 2012 VA examination documents the Veteran's report of contracting hepatitis C due to drug use (heroine), intercourse with prostitutes and tattoos. The August 2012 examiner opined against a nexus to service reasoning that it would be mere speculation to conclude that the Veteran contracted hep C through IV drug use since the Veteran also reported high risk sexual behavior with prostitutes since leaving the military and that the Veteran could have contracted hepatis C from a tattoo. See August 2012 VA examination and medical opinion. The Board notes that the Veteran's counsel has asserted that the Veteran's did not have any tattoos at the time of the examination report.

The Board notes that in a July 2025 VA medical opinion, an examiner opined against a nexus between the Veteran's claimed mass inoculations and hep C reasoning that per Centers for Disease Control (CDC), "Hepatitis C (HCV) is primarily contracted through blood-to-blood contact, most commonly by sharing needles or other drug injection equipment, but also through other exposures to contaminated blood". The examiner noted that there are no records of Veteran's mass inoculation in 1970 besides his personal testimony. The examiner explained that the CDC notes, "Most people with hepatitis C do not have symptoms. In people who develop symptoms, the average period from exposure to symptom onset is 2-12 weeks (range: 2-26 weeks). Tests can detect viral RNA as early as 1-2 weeks after exposure to the virus". See July 2025, Medical Opinion.

The Board observes that while the examiner rendered an unfavorable nexus opinion with respect to mass inoculations, the examiner's medical reasoning supports the premise that the Veteran's hepatitis C is at least as likely as
but also through other exposures to contaminated blood". The examiner noted that there are no records of Veteran's mass inoculation in 1970 besides his personal testimony. The examiner explained that the CDC notes, "Most people with hepatitis C do not have symptoms. In people who develop symptoms, the average period from exposure to symptom onset is 2-12 weeks (range: 2-26 weeks). Tests can detect viral RNA as early as 1-2 weeks after exposure to the virus". See July 2025, Medical Opinion.

The Board observes that while the examiner rendered an unfavorable nexus opinion with respect to mass inoculations, the examiner's medical reasoning supports the premise that the Veteran's hepatitis C is at least as likely as not, related to the Veteran's IV drug use. The Board observes that the July 2025 examiner discusses the risks of contracting hepatitis through unsafe sexual practices but references the CDC when identifying the most common risk for contracting-via blood-to-blood contact by sharing needles or other drug injection equipment." See July 2025, Medical Opinion. Because the Veteran's drug use is a well-established risk factor for hepatitis C, the Board must grant benefit of the doubt that the Veteran's drug use was the source of his claimed disability.

The remaining question for resolution is whether the Veteran's drug use was as a result of his service-connected PTSD. Generally, service connection on a direct basis is not permitted for diseases or injuries that result from a person's own willful misconduct, including abuse of alcohol or drugs. 38 U.S.C. § 105; 38 C.F.R. §§ 3.1(m), 3.301(c)(3)(d). However, an alcohol or drug abuse disability arising as a direct result of a psychiatric condition, such as PTSD, may be service connected. Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001).

In a June 2011 medical opinion, a licensed psychologist stated that the Veteran's drug addiction, primarily heroin from 1972 to 1992, is at least as likely as not caused by his combat related PTSD. (The Board pauses to note that the Veteran's combat related experiences in Vietnam have been corroborated by the AOJ. See April 13, 2012, Rating Decision.)

The psychologist reasoned that Veteran began using heroin after arrival in Vietnam. The psychologist cites an April 1989 VA treatment record that documents the Veteran heroin abuse for 17 years since returning from Vietnam. The psychologist also cites a Neuropsychiatric examination in September 1976 that notes the Veteran has taken heroin ever since he was in Vietnam. The psychologist also noted, when treated for opioid dependence at the Lebanon Pa, VA, his physician (Dr. F.A.) cited PTSD as a significant treatment issue bearing on his narcotic withdrawal and rehabilitation. See June 20, 2011, medical opinion (B.J., Ph.D.). In sum, this June 2011 private opinion determined that the Veteran's history of IV drug use (heroin), is secondary to his primary service-connected PTSD. The Board notes that the AOJ, in part, relied on this June 2011 private opinion when establishing service connection for the Veteran's combat-related PTSD. The Board finds this June 2011 medical opinion adequate and probative.

The Board is cognizant that multiple medical opinions during the course of this appeal rendered unfavorable nexus opinions. The Board observes however that the medical opinions that directly addressed the Veteran's initial and primary theory of entitlement were deemed either inadequate or of diminished probative value for purposes of this adjudication (See February 2023, BVA remand; February 2026 BVA.) Notwithstanding, the Board finds that these same medical opinions, to a degree at least as likely as not, contained facts and reasoning to support a link between the Veteran's drug use and hepatitic C. See August 2012; July 2025 Medical Opinions. Moreover, the June 2011private medical opinion established a link between the Veteran's drug use and his service-connected, combat-related PTSD. See June 20, 2011, medical opinion (B.J., Ph.D.).

(Continued on next page.)

In view of the totality of evidence the Board finds the evidence is at least in approximate balance, that the Veteran's PTSD caused his intravenous drug use which, in turn, caused hepatitis C. Accordingly, service connection for hepatitis C on a secondary basis is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Little, Calvin

The Board's decision in this case is binding only with respect to the instant
PTSD. See June 20, 2011, medical opinion (B.J., Ph.D.).

(Continued on next page.)

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Little, Calvin

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.

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