HEPATITIS

A. J. SPECTOR · 2026 · Case ID: A26038279

GRANTED

Summary

The Veteran, a Veteran who served from June 1976 to April 1978, appeals the denial of service connection for Hepatitis C with cirrhosis. The Veteran contends that his Hepatitis C was contracted during service through inoculations administered with a "jet air gun." The Veteran testified that he has no typical risk factors for Hepatitis C and that his doctor noted over thirty years of liver scarring, consistent with contracting the disease during service. The Veteran's service treatment records indicate inoculations in June 1976, but no Hepatitis C symptoms were noted in service. A May 2019 VA examination provided a negative nexus opinion, stating inoculations were not a risk factor and mischaracterizing a VBA Fast Letter regarding the biological plausibility of transmission via air gun. The Board found this VA examination inadequate. A July 2025 private medical opinion provided a detailed positive nexus, explaining the biological plausibility of Hepatitis C transmission via multi-use jet injectors due to blood residue and imperfect cleaning. The clinician noted the Veteran's lack of other risk factors (no blood products, tattoos, dialysis, needle-stick exposures) and that his progression from presumed infection in 1976 to cirrhosis in 2013 fit the typical 20-30 year window for untreated Hepatitis C. The private opinion concluded it was at least as likely as not that the Veteran's Hepatitis C and subsequent cirrhosis were proximately due to service. The Board found this private opinion more probative than the inadequate VA exam. Finding the evidence in approximate balance, the Board resolved doubt in the Veteran's favor and granted service connection for Hepatitis C with cirrhosis.

Rationale

Private medical opinion found Hepatitis C transmission via jet air gun biologically plausible.; Private opinion noted Veteran's lack of other risk factors and trajectory consistent with infection during service.; VA examination was inadequate, mischaracterizing VBA Fast Letter and failing to address Veteran's contentions.; Evidence found in approximate balance; doubt resolved in Veteran's favor.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210601-163246

Full Decision Text

Citation Nr: A26038279
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 210601-163246
DATE: April 23, 2026

ORDER

Entitlement to service connection for Hepatitis C with cirrhosis is granted.

FINDING OF FACT

The Veteran's Hepatitis C with cirrhosis is related to inoculations during service.

CONCLUSION OF LAW

The criteria for service connection for Hepatitis C with cirrhosis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1976 to April 1978.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 11, 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ). The rating decision found that new and relevant evidence had been received.

The Veteran elected the Board's hearing docket in his June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). The Veteran appeared at a Board hearing on May 6, 2025; a transcript is of record.

Therefore, the Board may only consider the evidence of record at the time of the June 2020 supplemental claim rating decision, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302. If evidence was submitted either (1) during the period after the AOJ issued the June 2020 rating decision and prior to the May 2025 Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to service connection for Hepatitis C with cirrhosis

The Veteran believes that his Hepatitis C with cirrhosis was caused by inoculations he received with a "jet air gun" during service.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The Veteran testified in his May 2025 hearing that during basic training he received inoculations with an air gun. He believes that he contracted Hepatitis C from these inoculations because he does not have any of the typical risk factors for Hepatitis C. He also testified that when he was diagnosed with Hepatitis C in 2012, the doctor told him that his liver had over thirty years of scarring, which would have been consistent with the timeline of the disease being contracted during service.

The Veteran's service treatment records (STRs) indicate that was administered several vaccines, including a flu vaccine, in June 1976. There was no indication of Hepatitis C symptoms in the STRs.

A May 2019 VA examination diagnosed the Veteran with Hepatitis C and noted that the Veteran had signs or symptoms attributable to cirrhosis. The examiner provided a negative nexus opinion with the rationale that there is no evidence that inoculations during service is a risk factor in the development of Hepatitis C. The examiner cited VBA Fast letter 04-13, and noted that the Veteran's Hepatitis C was diagnosed in 2013, more than 30 years after discharge from service, before concluding that the preponderance of currently established medical and scientific data does not support the claim that in-service air gun inoculations play a material/causal role in the Veteran getting infected with Hepatitis C. The examiner fundamentally mischaracterized VBA Fast letter 04-13, which concluded that "[d]espite the lack of any scientific evidence to document transmission of HCV with airgun injectors, it is biologically plausible." The letter goes on to state that the report upon which the determination of service connection is made includes a full discussion of all modes of transmission, and a rationale as to why the examiner believes the air gun was the source of the veteran's Hepatitis C. The May 2019 VA examiner did not discuss whether the Veteran has any other risk factors or the Veteran's contention that air gun inoculations caused his Hepatitis C as biologically plausible. Therefore, the examination is not adequate and has minimal probative value.

A July 2025 private medical opinion provided a detailed positive nexus opinion. The clinician explained that jet injector guns, or air guns, sped mass immunizations, but their multi-use fluid pathways often retained microscopic blood residues, and imperfect cleaning allowed splash-back contamination, making bloodborne virus transmission absolutely biologically plausible. The clinician found that the absence of any other risk factors (the Veteran never received blood products, tattoos, dialysis, or needle-stick exposures during or after service) makes jet gun inoculation the only credible source of current infection and subsequent cirrhosis. The private clinician discussed the Veteran's medical history, including the diagnosis of Hepatitis C in 2013, and stated that histologic studies show that untreated HCV progresses to cirrhosis in 20-30 percent of patients over 20-30 years, with a median interval to cirrhosis of about 30 years. The clinician explained that the Veteran's trajectory - from presumed infection in 1976 to cirrhosis in 2013 - fits precisely within that window, with no competing exposures (alcohol intake two drinks or fewer per week until 2012, no intravenous drug use, no transfusions, no tattoos, and long-term monogamy since 1983). The clinician wrote that the Veteran's imaging, scans, lab patterns, and clinical events all fit a decades-long process of scarring that his first hepatologist described as looking like 30 years of liver damage. The clinician explained that there is a very low chance that the Veteran would have progressed to cirrhosis prior to 2033 if he had just been infected in 2013. The clinician concluded that it is at least as likely as not that the Veteran's HCV is proximately due to or the result of service during which time he was vaccinated with multi-use jet injectors. The clinician also opined that it is at least as likely as not that the Veteran's cirrhosis diagnosed in October 2013 is secondary to Hepatitis C virus infections, with the rationale that discusses the progression of untreated HCV 1a and explains that the Veteran's 37-year interval from presumed inoculation in 1976 to cirrhosis in 2013 precisely accords with this natural history.

The Board finds that this private opinion contains at least as much probative value as the inadequate VA examination because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinion discusses the Veteran's medical history, noting his lack of other risk factors and explaining how the Veteran's specific illness is consistent with Hepatitis C contracted during service.

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Upon review of the record, the Board finds the evidence to be at least in approximate balance as to whether the Veteran's Hepatitis C with cirrhosis is related to service or another claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for Hepatitis C with cirrhosis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 782 (Fed. Cir.
, noting his lack of other risk factors and explaining how the Veteran's specific illness is consistent with Hepatitis C contracted during service.

(Continued on the next page)

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Budd, 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.

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