Citation Nr: 18155708 Decision Date: 12/06/18 Archive Date: 12/04/18 DOCKET NO. 16-54 305 DATE: December 6, 2018 REMANDED Entitlement to service connection for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1989 to May 1992. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Service connection for multiple sclerosis The Veteran contends that he has multiple sclerosis that is related to his service, to include his service in Southwest Asia when he was exposed to nerve agents. The Board observes that the Veteran’s service treatment records are absent complaints of or treatment related to multiple sclerosis or symptoms associated therewith. However, the Board notes that the Veteran’s personnel records document his service in Southwest Asia and that his military occupational specialty was a medic. The Veteran was provided a VA examination for his multiple sclerosis in September 2014. After examination of the Veteran and consideration of his medical history, the VA examiner diagnosed the Veteran with multiple sclerosis and concluded that this disability is not caused by or a result of the Veteran’s service. The VA examiner’s rationale for their conclusion was based on their finding that the Veteran was not initially treated for symptoms associated with multiple sclerosis until 2003 as well as the absence of symptoms associated with multiple sclerosis in the service treatment records. Pertinently, the Board observes that following the September 2014 VA examination, the Veteran reported in his October 2016 substantive appeal that his symptoms associated with multiple sclerosis began in 1995. He specifically reported inability to walk due to numbness and weakness in the right leg, inability to use right arm and hand, neuropathy and nerve pain over the entire body, mental fog and decreased cognition, acute exhaustion and fatigue, difficulty speaking, loss of vision in right eye, loss of balance, memory loss, gastrointestinal disturbances, sleep disturbances, joint pain, and headaches. He also submitted a statement dated July 2015 from P.F., LMSW who has treated him for PTSD. Notably, P.F., LMSW indicated that the Veteran delayed treatment for the multiple sclerosis due to the Veteran’s PTSD in that the Veteran had trust issues with receiving medical treatment. The Board notes that these statements were not considered in the September 2014 VA opinion. As these statements therefore indicate an earlier onset of the Veteran’s multiple sclerosis, the Board finds that an addendum opinion should be obtained on remand as to the etiology of the Veteran’s multiple sclerosis. The matter is REMANDED for the following action: 1. Contact P.F., LMSW and request copies of all records concerning the Veteran, to include date of first treatment and first evidence documenting symptoms of MS. 2. After the above, forward the claims file to a medical professional with the appropriate level of expertise for an opinion as to the etiology of the Veteran’s multiple sclerosis. The examiner is requested to review all pertinent records associated with the claims folder, including the Veteran’s service treatment records, post-service medical records, and lay statements. Based on the review of the Veteran’s claims file, the examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s multiple sclerosis is related to service, to include his report of exposure to nerve agents during his service in Southwest Asia. In rendering the requested opinion, the examiner should address the Veteran’s statements that he had symptoms associated with multiple sclerosis since 1995 and that he delayed seeking treatment for these symptoms due to trust issues associated with his PTSD. The symptoms reported by the Veteran that have existed since 1995 consisted of inability to walk due to numbness and weakness in the right leg, inability to use right arm and hand, neuropathy and nerve pain over the entire body, mental fog and decreased cognition, acute exhaustion and fatigue, difficulty speaking, loss of vision in right eye, loss of balance, memory loss, gastrointestinal disturbances, sleep disturbances, joint pain, and headaches. (The Board makes no opinion regarding the credibility of such statements.) 3. Review the claims file to ensure that all the foregoing requested development is completed, and arrange for any additional development indicated. Then readjudicate the   claim on appeal. If the benefits sought remain denied, issue an appropriate supplemental statement of the case and provide the Veteran and his representative with the requisite period of time to respond. H. N. SCHWARTZ Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Arif Syed, Counsel