Citation Nr: 18158706 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 16-08 417 DATE: December 18, 2018 REMANDED Entitlement to service connection for multiple sclerosis due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Navy from June 1965 to February 1971. The Veteran served in the Republic of Vietnam where he earned a Bronze Star, among other commendation medals. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for multiple sclerosis due to herbicide exposure The Veteran contends that he contracted mononucleosis prior to entering the service in 1965 and attending doctors and scientific studies indicate that mononucleosis often leads to multiple sclerosis. The Veteran believes that the previously contracted mononucleosis combined with exposure to Agent Orange in Vietnam caused his multiple sclerosis. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. VA’s duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to decide on the claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); Duenas v. Principi, 18 Vet. App. 512 (2004); Robinette v. Brown, 8 Vet. App. 69 (1995); McLendon v. Nicholson, 20 Vet. App. 79 (2006). For the below noted reasons, the Board finds that a VA examination is necessary to determine the nature and etiology of the Veteran’s multiple sclerosis and whether any pre-existing conditions and/or exposure to Agent Orange caused or aggravated the Veteran’s current diagnosis of multiple sclerosis. Private medical records provided by the Veteran show that he was diagnosed with multiple sclerosis in 1994. The Veteran’s military personnel records confirm that he served in the Republic of Vietnam where it is likely that he was exposed to herbicides including Agent Orange. However, the Veteran has not been afforded a VA examination to determine the nature and etiology of his multiple sclerosis and whether it is related to herbicide exposure. Additionally, in a September 2013 Statement in Support of Claim, the Veteran contends that his current diagnosis of multiple sclerosis may be related to the mononucleosis he contracted before entering the service and exposure to herbicides may have aggravated this condition. The Veteran’s service treatment records show that in January 1961 he was examined for the Naval Reserve Officer Training Corps. The examiner notated that the Veteran contracted a case of aseptic meningitis in the summer of 1959; however, they were no residual effects. Also, an August 1965 clinical record note indicates that mononucleosis was documented and treated conservatively. The Veteran’s entrance and separation exams are silent as to multiple sclerosis, meningitis, and mononucleosis. Therefore, on remand, an opinion should be obtained to address the Veteran’s contentions that his multiple sclerosis may be caused by or aggravated by exposure to Agent Orange while serving in Vietnam. The matter is REMANDED for the following actions: 1. Schedule the Veteran for an examination to determine the current nature and etiology of the Veteran’s currently diagnosed multiple sclerosis. The claims file should be made available to review. Following a review of the record and examination of the Veteran, the examiner is asked to furnish an opinion with respect to the following: (A) The examiner should opine as to whether there is a causal connection between meningitis and/or mononucleosis and a subsequent diagnosis of multiple sclerosis. (B) The examiner should then opine as to whether there is clear and unmistakable evidence that multiple sclerosis or conditions related to multiple sclerosis existed prior to service. (C) If the examiner determines that multiple sclerosis or conditions related to multiple sclerosis existed prior to service, the examiner must address whether there is clear and unmistakable (undebatable, obvious, or manifest) evidence that the disability was not aggravated by such service. Note: Aggravation means that the disability was permanently worsened beyond the natural progression of the disease; temporary or intermittent flare-ups of a pre-existing injury during service are insufficient to constitute aggravation in service, unless the underlying condition itself, as contrasted with mere symptoms, has worsened. In addressing the above, the physician must consider and discuss all relevant medical and other objective evidence, including the Veteran’s lay assertions. (D) If the examiner determines there is clear and unmistakable evidence that multiple sclerosis existed prior to service and there is clear and unmistakable evidence that the multiple sclerosis was not aggravated by such service, the examiner must opine as to whether it is at least likely as not (i.e., a 50 percent or greater probability) that a multiple sclerosis was incurred in or is otherwise related to his military experience, specifically exposure to herbicides. In addressing the above, the physician must consider and discuss all relevant medical and other objective evidence, as well as all lay assertions. A complete rationale must be provided for each opinion offered.   2. Readjudicate the appeal. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hartford, Associate Counsel