Citation Nr: 19124705
Decision Date: 04/03/19	Archive Date: 04/02/19

DOCKET NO. 12-07 439
DATE:	April 3, 2019

REMANDED

Entitlement to service connection for Guillain-Barre syndrome, to include secondary to any service-connected disabilities is remanded.

REASONS FOR REMAND

The Veteran had active service from October 1969 to April 1971.  The Veteran died in November 2012 and his surviving spouse is substituted as appellant. The claim was most recently before the Board in February 2018 when it was remanded for further development. 

Entitlement to service connection for Guillain-Barre syndrome, to include secondary to any service-connected disabilities is remanded.

The Board cannot make a fully-informed decision on the claim because no VA examiner has opined whether surgery for  the Veteran’s service-connected left hip caused or aggravated his Guillain-Barre syndrome. A January 1996 consultation note in the treatment records indicates that the surgeon who performed the Veteran’s left hip surgery suggested that the surgery “triggered” his Guillain-Barre syndrome. 

The Veteran’s service-connected left hip disability is characterized as “left hip replacement resulting from Reiter’s syndrome.” The May 2018 addendum opinion provided in response to the most recent Board remand is inadequate because the examiner did not include any rationale and does not consider the right question.  Given the January 1996 medical statement, the central question is not whether the Guillian-Barre is caused by the service-connected Reiter’s syndrome, but whether the Guillian-Barre was caused or aggravated by the surgery for the service-connected left hip disability, which itself is the result of Reiter’s syndrome. Therefore, an addendum opinion must be obtained. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  

The matter is REMANDED for the following action:

1. Forward the Veteran’s complete file, to include a copy of this remand, to the May 2018 VA examiner (or other appropriate VA examiner if unavailable) to obtain a supplemental medical opinion as to whether the Veteran’s Guillain-Barre syndrome was caused or aggravated by the left hip replacement surgery or the service-connected Reiter’s syndrome.

Based on the review of the record, the examiner is to address the following questions:

(a) Is it at least as likely as not that the Guillain-Barre syndrome was caused or aggravated by the 1995 surgery for the service-connected left hip? 

The examiner should review, and discuss as necessary, the January 1996 treatment record (received in file on April 3, 1996) where the Veteran’s orthopedic surgeon stated that the Veteran’s left hip replacement surgery may have triggered his Guillain Barre syndrome.

(b) If the answer to (a) is no, is it at least as likely as not that Veteran’s Guillain Barre syndrome was caused or aggravated by his service-connected Reiter’s syndrome?

The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation.

The examiner must explain the rationale for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner determines that the questions cannot be resolved without resorting to speculation, then an explanation as to why this is so must be provided.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans’ Appeals

ATTORNEY FOR THE BOARD	M. G. Perkins, Associate Counsel