Citation Nr: 21004708 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 19-27 275 DATE: January 27, 2021 ORDER Service connection for multiple sclerosis is denied. FINDING OF FACT The preponderance of the evidence is against finding that multiple sclerosis began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for multiple sclerosis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1961 to September 1964. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal in December 2019. There has been substantial compliance with remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800 (c). Service connection for multiple sclerosis is denied. The Veteran contends his multiple sclerosis is related to his active duty service. Alternatively, the Veteran contends his multiple sclerosis is secondary to his service-connected conditions. For the reasons that follow, the Board finds entitlement to service connection is not warranted. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 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, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). Additionally, secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected condition. 38 C.F.R. § 3.310. The Veteran has a current diagnosis of multiple sclerosis as evidenced by his February 2020 VA examination. Multiple sclerosis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Similarly, the Veteran’s disability did not onset during service and is not otherwise related to an in-service injury, event, or disease. The Veteran’s service treatment records are silent for complaints of, treatment for, and/or a diagnosis of multiple sclerosis. The Veteran’s May 1961 enlistment and June 1964 separation reports of medical examination reflect normal clinical evaluations, including of the neurologic system. He endorsed only a history of mumps on his May 1961 enlistment and June 1964 separation reports of medical history. VA and private treatment records show the Veteran was not diagnosed with multiple sclerosis until 2006, decades after his separation from service and decades outside of the applicable presumptive period. An October 2000 private ear, nose, and throat treatment record notes the Veteran reported a history of being off balance for about two months with prior symptoms in the past. An April 2005 private treatment record notes some episodes of right foot weakness. A September 2006 Social Security Administration record notes a primary diagnosis of multiple sclerosis. A May 2012 VA treatment record reflects the Veteran was diagnosed with multiple sclerosis six years ago with symptoms of leg weakness. In March 2017, the Veteran indicates that his neurologic problems consisting of leg numbness and right foot dragging started more than 20 years ago. While the Veteran is competent to report having experienced symptoms of leg numbness and foot dragging, he has not reported such symptoms since service or during the presumptive period. Additionally, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of multiple sclerosis as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, the Board gives more probative weight to the competent medical evidence. In this case, the record contains a March 2017 favorable opinion and February 2019, February 2020, and June 2020 unfavorable opinions. In March 2017, the Veteran’s neurologist opined that, given the history, the extensive white matter disease with ‘black holes’ on the magnetic resonance imaging (MRI) of the neuraxis, and as a multiple sclerosis specialist, the Veteran’s disease should be considered as service-connected. The Veteran underwent a VA examination in February 2019. During the examination, the Veteran reported diagnosis with multiple sclerosis in 2006. The examiner opined that the Veteran’s multiple sclerosis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted the Veteran was diagnosed with multiple sclerosis in 2006, which is long after the conclusion of his military service. The examiner also noted that there are records of agent orange exposure; however, as of now, there has not been a clear link established between agent orange exposure and subsequent development of multiple sclerosis. In compliance with the Board’s prior remand directives, an addendum opinion was obtained in February 2020. During the examination, the Veteran reported his symptoms started in 1985 with weakness in legs that was intermittent and progressively worsened until diagnosis in 2006. The examiner opined that the Veteran’s multiple sclerosis was not at least as likely as not aggravated beyond its natural progression by a service-connected condition. The examiner noted that there is no established natural progression as multiple sclerosis is different for each person. The examiner noted that the Veteran’s multiple sclerosis has not been aggravated by a service-connected condition as it is an autoimmune disorder. The February 2020 examiner also opined that the Veteran’s multiple sclerosis is less likely than not proximately due to or the result of his service-connected conditions as multiple sclerosis is an autoimmune condition and therefore is not related to any service-connected conditions. Next, the examiner opined that the Veteran’s multiple sclerosis was less likely than not incurred in or caused by service as he reports his symptoms as beginning in 1985 after service. The examiner further explained that the service treatment records as well as the separation examination report are silent for symptoms or complaints that would be consistent with multiple sclerosis. Finally, the examiner opined that, since the Veteran did not experience symptoms until 1985, his multiple sclerosis did not manifest at all within seven years after discharge from active duty. An addendum opinion was obtained in June 2020. In compliance with the Board’s prior remand directives, the examiner acknowledged the March 2017 report that he experienced neurological problems consisting of numbness in his legs and right foot dragging more than 20 years ago and the favorable opinion from the VA neurologist. The examiner again noted that there is no evidence of multiple sclerosis during service or within seven years of service. The examiner reiterated that the Veteran does not report symptoms until 1986—20 years after separation from service. The examiner further indicated that the favorable opinion does not change that he did not have symptoms during or within seven years of service and that there is nothing in the literature to support determining the length of time multiple sclerosis has existed based on a MRI. The examiner noted that the neurologist did not cite any supporting evidence to back up his opinion. He additionally indicated that there is no natural progression for multiple sclerosis and that the progression of multiple sclerosis is different for everyone. The Board finds the VA opinions and supporting rationale to be the most probative evidence of record. In reaching this conclusion, the Board notes that whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Here, the March 2017 positive opinion provided by the Veteran’s neurologist does not provide a clear rationale for the positive opinion and does not address the Veteran’s reports that his symptoms began in 1985 and/or 1986. In comparison, the VA opinions were provided by VA medical professionals who possess the necessary education, training, and expertise opine regarding causal nexus. Additionally, the opinions are shown to have been based on a review of the Veteran’s records, including the March 2017 positive opinion, and were accompanied by a sufficient explanation as to why the Veteran’s multiple sclerosis does not warranted presumptive service connection as a chronic condition. Thus, the Board places more probative weight on the VA medical opinions. The Veteran has also sought entitlement to service connection for multiple sclerosis as secondary to a service-connected condition. The Board concludes that, while the Veteran has a current disability, the preponderance of the evidence is against finding that the Veteran’s multiple sclerosis is proximately due to or the result of or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The February 2020 VA examiner opined that the Veteran’s multiple sclerosis is instead an autoimmune condition and not related to any service-connected condition. The opinion was provided by a VA medical professional who possesses the necessary education, training, and expertise to provide the requested opinions. Additionally, the opinion is also shown to have been based on a review of the Veteran’s record. While the Veteran believes his multiple sclerosis is proximately due to or the result of or aggravated beyond its natural progression by a service-connected disability, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, pathology, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Furthermore, there is no competing medical opinion of record. Consequently, the Board gives more probative weight to the February 2020 VA opinion. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the claim, the doctrine is not applicable. Accordingly, service connection for multiple sclerosis is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, 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.