Citation Nr: 21001892 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 12-34 253 DATE: January 12, 2021 REMANDED Entitlement to service connection for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1968 to February 1969 with additional Reserve service through April 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision. The Veteran’s claim for service connection was remanded by the Board in May 2020 and October 2017 for further development. Unfortunately, the claim requires yet another remand. Entitlement to service connection for multiple sclerosis is remanded. Pursuant to the Board’s May 2020 remand, the Veteran was provided with a medical opinion addressing the etiology of his multiple sclerosis. In response, the Veteran’s claims file contains a June 2020 medical opinion. For the reasons discussed below, the Board finds that the medical opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The June 2020 medical opinion states that the Veteran’s service treatment records and post-service treatment records do not show more than 50 percent probability that his multiple sclerosis had its onset during service, or manifested within seven years of separation from active service. The medical opinion further concludes that the Veteran’s multiple sclerosis is less likely than not related to any in service inoculations. In support, the medical opinion states that although there is a report of swollen painful joints noted on the Veteran’s separation examination in 1970, swollen painful joints is not a common presentation of multiple sclerosis as it is a demyelinating nerve condition and does not typically manifest as joint pain. The Veteran’s lay statements were considered, however, the report of a diagnosis of optic neuritis in 1976 is solely based on the subjective report of the Veteran and there is no objective evidence indicating he was seen and treated for optic neuritis in 1976. Furthermore, an ophthalmologic examination in 2008 did not show any findings of neuropathy of the optic nerve. The Veteran was also noted to have other underlying medical conditions of the eyes which were unrelated to multiple sclerosis. The medical opinion further provides that a review of the current medical literature does not show any established relationship or causality between in service inoculations and the development of multiple sclerosis years later. Based on this, the medical evidence does not link the Veteran’s multiple sclerosis to his active service, manifesting within seven years after service, or relation to any in service inoculations. The Board finds that the medical opinion is inadequate because the examiner’s rationale relied on an improper evidentiary standard. See Barr, 21 Vet. App. at 312. In particular, the examiner stated that evidence does not show more than 50 percent probability that his multiple sclerosis had its onset during service, or manifested within seven years of separation from active service, instead of whether it is at least as likely as not that his multiple sclerosis is related to his active service under the above theories of service connection. Further, the medical opinion is based, in part, upon an absence of contemporaneous documentation of an optic neuritis diagnosis in 1976 as it appears the Veteran’s lay statements concerning the subject were discounted solely because there was no objective evidence indicating he was seen and treated for optic neuritis at that time. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006) (holding that the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible); Cf. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that a VA opinion was inadequate where the examiner did not comment on the Veteran’s report of in-service injury and relied on lack of evidence in service medical records to provide a negative opinion); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, the Board finds that a new medical opinion is necessary to fully address the etiology of the Veteran’s multiple sclerosis. The matter is REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician regarding the etiology of the Veteran’s multiple sclerosis. The clinician must review the Veteran’s claims file. The clinician must opine: (a.) Whether it is it at least as likely as not (50 percent probability or greater) that the Veteran’s multiple sclerosis is related to an in-service injury, event, or disease, including in-service vaccinations. (b.) Whether it is it at least as likely as not (50 percent probability or greater) that the Veteran’s multiple sclerosis manifested during his active service from September 1968 to February 1969, or within seven years of his separation from service. • In providing this opinion, the examiner should specifically address any reported symptoms during the applicable time period, including the Veteran’s March 1970 Report of Medical History that showed he reported swollen or painful joints, arthritis or rheumatism, and recurrent back pain, as well as his reported diagnosis of optic neuritis lasting for about two months in 1976. If the clinician determines that the Veteran’s reported swollen or painful joints, arthritis or rheumatism, and recurrent back pain in March 1970 were not manifestations of multiple sclerosis, or that his multiple sclerosis is not related to any aspect of active service, the examiner should discuss what other factor(s) caused the above symptoms or caused his multiple sclerosis.  A complete rationale must be provided for all opinions and conclusions reached.  P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, Associate Counsel 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.