Citation Nr: 21000121 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 14-04 905 DATE: January 4, 2021 REMANDED Entitlement to service connection for Gullian-Barre Syndrome is remanded. REASONS FOR REMAND The Veteran’s periods of service, and duty status, must be clarified on remand. Entitlement to service connection for Gullian-Barre Syndrome is remanded. In May 2019, the Board remanded the appeal for additional evidentiary development. While the Board regrets the delay, a remand is required before the Board may make a determination on the merits of the claim on appeal. The Veteran is seeking entitlement to service connection for GBS, as related to his active service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). First, the Veteran must establish a current disability. Pursuant to the May 2019 remand, the Veteran was afforded a VA examination. The information set forth in the January 2020 VA examination does not clearly establish that the Veteran suffers from a current disability of GBS for the reasons that follow. In January 2020 the Nurse Practitioner examiner checked the box on the form under the diagnosis Section 4 central nervous condition - Gullain Barre Syndrome, ICD code G 61, date of diagnosis January 8, 2020. However, it is not entirely clear that the Veteran has a current diagnosis as required for service connection. The Veteran’s records during active duty indicate that he suffered a non-service connected chronic subtalar inflammation of the right foot. The January 2020 medical examiner did not address the possible impact of this chronic subtalar inflammation of the right foot diagnosis, or any other conditions, upon the Veteran’s current symptoms and diagnoses. In the medical history section of the January 2020 report, the examiner gives the Veteran’s self-reported history of the illness and includes the statement that the Veteran reports he is no longer being followed for this condition (GBS) and not taking any medication. Further, the examiner reports that the Veteran complains of not being able to move his toes, loss of feeling in the feet, muscle spasms and weakness, abnormal gait, poor balance and pain with walking. Under section 4B “Gait”, the examiner notes that the Veteran’s gait is not normal. The form contains a prompt to the examiner as follows; “If gait is abnormal and the Veteran has more than one medical condition contributing to the abnormal gait, identify the conditions and describe each condition’s contribution to the abnormal gait.” In addition, some of the Veteran’s strength ratings reflected in section 4C measured less than normal, section 4D deep tendon reflexes are decreased, and some muscle weakness is noted at 4F. The examiner did not include any discussion of the potential impacts of the Veteran’s non-service connected chronic subtalar inflammation of the right foot, or any other medical conditions, on the Veteran’s current conditions and symptoms, although the Form contains prompts for this information, as seen at 4B, 4G, and elsewhere on the Form. At section 11D, the examiner notes that in September 1999, an electromyography was conducted and there was evidence to suggest GBS, but no testing is mentioned for the intervening twenty years up to the current time. In June 2011, private medical records were associated with the file. These documents contain an examination dated January 2006 entitled “Medical Clearance and Classification”. The form is signed by the examining physician with the finding: “Fit for all physical and manual duties.” The document appears to be a medical evaluation for purposes of work, with the employer listed in Fredericksburg Virginia. The Questionnaire includes the question “Are you being treated for any condition now?” and the Veteran’s response is “no”. At question 5: “Have you ever been hospitalized?” Veteran’s response is “yes”. “Gilliam Barre Syndrome, 1986, CA.” At question 9: “Are you taking any medication regularly?” Veteran’s response “no”. At question 13: “Have you ever received or applied for a pension or compensation for any permanent disabilities?” Veteran’s response: “Yes. SSI for Gilliam Barre Syndrome (no longer receive).” At question 16: “Do you consider yourself to be in good health?” Veteran’s response: “yes”. The “Entry Medical Examination Form” is dated December 2005 and reflects that the Veteran is applying for a position as “FAV Mechanic” assigned to the Middle East. Again, the examining physician indicates that in 2006 the Veteran was medically fit for assignment to the Middle East performing the job functions required for an FAV Mechanic, and that the Veteran formerly received Social Security Disability for his GBS but it was discontinued. The Veteran’s current symptoms may be impacted by factors that are not service connected, and the January 2020 medical opinion, along with other information in the Veteran’s claim file, does not clearly identify a current disability of GBS. Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). An adequate medical opinion with regard to etiology should consist of a thorough review of the claims file and discussion of the relevant evidence (including the disability in question), a consideration of the lay contentions of the Veteran, and clear conclusions with a supporting rationale. Barr, 21 Vet. App. at 311; Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) Second, in order for the Veteran to establish service connection, the dates of his service must be clear. The date of the Veteran’s onset of illness was March 1986 when he complained of radiating pain in his lower extremities and was diagnosed with GBS. See March 1986 private treatment record. The date of diagnosis is significant, specifically the date of diagnosis as it may relate to the Veteran’s dates of service. The dates of service are necessary to make determinations with regard to any diagnosis within the one-year presumptive period following active duty. In its previous remand, the Board requested that the Veteran’s periods of service, and duty status, must be clarified on remand. The Board renews that request, reminding the Veteran that this information is necessary in order for him to establish service connection. Moreover, the Board notes the Veteran has consistently stated that he was on active duty in March 1986. However, the military personnel records associated with the Veteran’s claim file indicate he was on inactive guard duty. The Veteran was provided with a May 2018 notification letter requesting that he submit any documentation to include buddy statements or letters written during this period, to support his contention that he was on active duty in March 1986. On remand the Veteran should be afforded another opportunity to submit the information and is advised that the failure to do so could negatively affect his claim for service connection of his GBS. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991), holding that “the duty to assist is not always a one-way street. If a Veteran wishes help, he/she cannot passively wait for it in those circumstances where he/she may or should have information that is essential in obtaining the putative evidence.” The Veteran has outstanding Social Security Disability records that must be obtained and considered. The Veteran mentions this in his letter to the Congressperson dated August 2012. The Senator’s office mailed the Veteran’s letter to the RO in August 2012. The Veteran mentions the Social Security Disability again in private medical records associated with the claims file June 2011, which were available to the RO in the claims file. The reference is contained in documents dated January 2006 entitled “Medical Clearance and Classification”, at question 13. The Board finds that additional development is required before further adjudication may proceed on the Veteran’s claims for entitlement to service connection. See Murincsak v. Derwinski, 2 Vet. App. 363 (1992) (holding that VA failed its duty to assist the Veteran in developing facts pertinent to his claim where it did not acquire an SSA decision or other records that it had notice of). Moreover, the Board finds that the Veteran’s application for SSA benefits, and any evidence submitted in support, are relevant to the instant appeal as the Veteran specifically reported he formerly received SSA benefits due to symptoms the Veteran attributes to his GBS, and that the benefits were then discontinued. The matters are REMANDED for the following action: 1. The RO should send a letter and request that the Veteran supply any information or evidence to include buddy statements or letters written during the period, to support his contention that he was on active duty in March 1986. 2. The RO should obtain any records from the Social Security Administration, to include any award and discontinuance of disability benefits and any underlying records used in reaching the determinations. All efforts to obtain the SSA records should be fully documented, and a negative response must be provided if records are not available. 3. The RO should schedule the Veteran with a VA examiner in the appropriate specialty after the RO notifies the Veteran to supply support for his contention that he was on active duty in March 1986, and after the RO obtains records from the Social Security Administration. 4. The VA examiner should identify the nature and etiology of all the Veteran’s current symptoms to determine whether or not the Veteran has a current diagnosis of GBS. Identify whether the Veteran suffers from one or more current diagnoses that may impact any GBS diagnosis. The examination should include any diagnostic testing or evaluation deemed necessary for the claimed disability. If the examiner finds a current diagnosis of GBS, address any inconsistent information in the Veteran’s claim file regarding GBS such as the referenced Veteran’s self-report that he is not currently treated and the referenced January 2006 employment physical finding no health problems. If the examiner finds a current diagnosis of GBS, address whether the current GBS is related to any injury or diagnosis incurred during active duty, and comment on the March 1986 Kaiser Permanente record with diagnosis of GBS relating to the Veteran falling at a job where he was a cook. The examiner should respond to the following: Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed GBS: (a) Began during active service; or (b) Manifested within one year after discharge from service; or (c) Was noted during service with continuity of the same symptomatology since service. The claims file, including any Social Security Disability records or treatment records obtained following this remand, as well as a copy of this remand, must be reviewed. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is   the case, and identify what additional evidence (if any) would allow for a more definitive opinion. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.M. Schneider 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.