12-16 037, 12-16 037

Veteran served on active duty from Oct 1965 to Sep 1969 and appealed a February 27, 2010 VA rating decision denying service connection for hepatitis C.
Veteran alleges hepatitis C contracted from in-service blood transfusion during an appendix surgery in Lisbon (1968), tattoos received in service, and induction vaccinations where needles were not changed.
Service treatment records are incomplete (no separation exam); records from the British Hospital in Lisbon were not obtained, but service personnel records and a 1969 benefits application referencing the surgery are of record.
Medical records and a January 2015 VA exam confirm a current diagnosis of hepatitis C; the Veteran has past opioid use beginning after surgery and a history of fibrosis/liver damage.
Two April 2011 private physician letters opined a possible service link (blood transfusion), while the January 2015 VA examiner found causation speculative; the Board found the evidence in relative equipoise and resolved doubt in the Veteran’s favor.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether hepatitis C is service connected	Hepatitis C was likely contracted from an in-service blood transfusion, tattoos, or unsterile induction vaccinations	VA examiner: linking hepatitis C to those in-service events would be mere speculation	Granted: service connection for hepatitis C (reasonable doubt resolved for Veteran)

Shedden v. Principi, 381 F.3d 1163 (Fed. Cir.) (elements required for direct service connection)
Scott v. McDonald, 789 F.3d 1375 (Fed. Cir.) (duty to assist/claims processing principles)
Stegall v. West, 11 Vet. App. 268 (Vet. App.) (requirement to comply with Board remand directives)
Owens v. Brown, 7 Vet. App. 429 (Vet. App.) (Board may favor one competent medical opinion over another with adequate reasons)
Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App.) (reasonable doubt rule in veterans benefits cases)
Bryant v. Shinseki, 23 Vet. App. 488 (Vet. App.) (procedural duty to assist/notice considerations)