Citation Nr: 20022522 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 15-19 471 DATE: April 1, 2020 REMANDED Entitlement to service connection for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from March 1970 to November 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office. This matter previously came before the Board of Veterans’ Appeals (Board) and was remanded for a medical opinion in July 2018. While the issue of service connection for multiple sclerosis was previously remanded to afford the Veteran a VA examination and seek a medical opinion, the opinion obtained in May 2019 does not offer a response to various questions presented in the July 2018 remand. As such, there has not been substantial compliance with the previous remand directives. Therefore, another remand is warranted to comply with the previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In providing a medical opinion, the examiner was asked to address whether it is at least as likely as not that the Veteran’s multiple sclerosis began during active service, is related to an incident of service, including exposure to herbicide agents in the Republic of Vietnam, or began within seven years after discharge from active service . The May 2019 examiner provided a negative opinion based only on the perceived lack of correlation between multiple sclerosis and herbicide exposure. Additionally, the Board emphasized in the July 2018 remand that the examiner must address the February 2014 statement from the Veteran’s former wife indicating he was having foot drag symptoms during their marriage, as well as the Veteran’s self-reported history of a neck injury in the 1970’s. The May 2019 examiner failed to address this evidence in his response. Additionally, as highlighted by the Veteran’s representative, the Board remand directed that the requested opinions be provided by a Accordingly, this matter is again remanded for a proper medical opinion in compliance with the July 2018 remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a neurologist regarding the etiology of the Veteran’s diagnosed multiple sclerosis. The entire claims file, to include a copy of this Remand, must be made available to and reviewed by the examiner. Reexamination of the Veteran is not required, unless deemed necessary by the examiner providing the opinion. The examiner must provide opinions as to the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s multiple sclerosis began during his active service. (b) Whether the Veteran’s multiple sclerosis is related to an incident of service, including exposure to herbicide agents in the Republic of Vietnam, or began (i.e. symptoms were manifested to a compensable degree) within seven years after discharge from active service. The examiner’s attention is called to the statement of the Veteran’s former wife who indicated the Veteran had foot drop during their marriage which began in June 1973. Additionally, attention is directed to the Veteran’s self-reported history of a neck injury in the 1970’s. The examiner must consider and discuss these lay statements in providing the requested opinion. The examiner may not rely on the absence of multiple sclerosis under the herbicide agent presumption regulations for a negative opinion. The examiner must provide all findings, along with a rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. (Continued on next page) 2. The RO must ensure that the examination report complies with the directives of this remand, and if not, take appropriate measures to correct any deficiencies. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ferrando 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.