Citation Nr: 21065526 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 19-35 899 DATE: October 26, 2021 ORDER Service connection for multiple sclerosis is granted. REMANDED Service connection for uveitis of the right eye is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, symptoms of the currently diagnosed multiple sclerosis manifested during a period of active service. CONCLUSION OF LAW The criteria for service connection for multiple sclerosis are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 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 in the U.S. Army from October 2004 to January 2006, to include service in the Persian Gulf. In October 2021, the Veteran testified before the undersigned Veterans Law Judge in support of his claims. SERVICE CONNECTION Service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Multiple sclerosis diagnosed within seven years of separation from service may be presumptively service connected as a chronic disability. 38 C.F.R. § 3.307 (a)(3). A diagnosis of multiple sclerosis after the seven-year presumptive period may warrant service connection where there was evidence of symptoms in-service or within seven years after service and a subsequent medical opinion attributes these symptoms to multiple sclerosis. Traut v. Brown, 6 Vet. App. 495, 500 (1994); see also 38 C.F.R. § 3.307 (c). A lay person is competent to report on the onset and reoccurrence of current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). The Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The record reveals that the Veteran was not diagnosed with multiple sclerosis until 2017, approximately eleven years after he separated from service. Despite the date of diagnosis, the Board finds that service connection for multiple sclerosis is warranted based upon evidence that this disease initially manifested in service by way of visual impairment in service. In this regard, the Veteran has submitted several statements in which he reports that he began seeing "spots in [the] right eye" while in service in approximately 2005; and seeing "floaters" in his eyes in approximately 2007. The Veteran's report of vision symptoms in service has also been documented by his medical providers, specifically his board-certified neurologist (Dr. R.R.S.). In September 2017, Dr. R.R.S. wrote in a progress note that the Veteran had a variety of vague visual symptoms which had been on-going for more than 10 years. He stated that recent medical examination findings suggested the Veteran had uveitis, a possible early manifestation of his multiple sclerosis. The Board initially finds for the record that the Veteran is competent to describe observable symptoms such as vision impairment because this requires only personal knowledge as it comes to him through his senses. Given the consistency of his statements, the Board also finds no reason to conclude that the Veteran is anything other than credible in his reports. Additional evidence supportive of the Veteran's multiple sclerosis claim includes an October 2020 letter from Dr. R.R.S. in which Dr. R.R.S. opined that it was at least as likely as not that the Veteran's first symptoms of multiple sclerosis dated back to 2005 while he was in service, given that is when the Veteran's first visual symptoms started. The Board has no reason to doubt the private neurologist's medical opinion. Moreover, the evidence does not contain a contrary medical opinion as to the etiology of the Veteran's multiple sclerosis. Therefore, while the Veteran was not diagnosed with multiple sclerosis until 2017, the more probative and persuasive evidence of record indicates that the Veteran's multiple sclerosis began manifesting in approximately 2005 in the form of visual impairment symptoms in service. This evidence is sufficient upon which to grant service connection because VA regulations do not require that the disease be diagnosed in service, but that it manifests in service. Given the in-service manifestations of the Veteran's illness, the appeal for service connection for multiple sclerosis is granted. REASONS FOR REMAND Evidence in the claims file includes several articles submitted by the Veteran addressing the relationship between multiple sclerosis and uveitis, in that uveitis has been found to be a potential precursor to the onset of multiple sclerosis. The October 2020 medical opinion from the Veteran's neurologist, referenced above, essentially states that visual symptoms in the Veteran's right eye that occurred in 2005 and 2007/2008 were at least as likely as not the first symptoms/manifestations of the Veteran's multiple sclerosis. In September 2017, Dr. R.R.S. wrote in a progress note that the Veteran had a variety of vague visual symptoms which had been on-going for more than 10 years. He stated that recent medical examination findings suggested the Veteran had uveitis, a possible early manifestation of his multiple sclerosis. However, Dr. R.R.S. did not state in his letter the likelihood that the Veteran's visual symptoms in service were the result of uveitis. Notably, a private medical opinion from the Veteran's optometrist confirms that the Veteran has a history of recurring vitritis/intermediate uveitis with flare-ups that were possibly contributed to by his multiple sclerosis. However, the optometrist stated that he could not "say for sure when the uveitis occurred." The Board observes that the Veteran was afforded a VA examination related to his vision in April 2017. However, the Veteran was diagnosed only with right eye vitreous degeneration, not uveitis, at that time. Additionally, the medical opinion related to that examination only narrowly addressed the question of whether the Veteran's right eye condition was incurred in or caused by his exposure to hazardous materials during service. The April 2017 VA examiner did not address the issue of a direct causal connection between the Veteran's post-service uveitis and his period of service other than to state that there was "no sufficient evidence to make a connection to service." Thus, although there is evidence to suggest that the Veteran's visual symptomatology in service was the result of uveitis, this evidence is unfortunately vague and conclusory without any support or rationale. As such, the Board finds that medical guidance would be helpful in evaluating the Veteran's uveitis claim; and remands the issue for further development. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination with an appropriately qualified medical professional in relation to his claim of entitlement to service connection for uveitis of the right eye. The examiner must review the claims file, with emphasis on the Veteran's statements, articles submitted by the Veteran discussing the development of uveitis as a potential precursor to the development of multiple sclerosis, the VA medical opinions of record, and the September 2017 neurology record cited above. In formulating his/her opinion, the examiner should be instructed not to consider the lack of service treatment records corroborating the Veteran's statements regarding having vision impairment in service. These statements should be presumed to be true. Thereafter, the examiner is asked to provide an opinion as to whether it is at least as likely as not that the visual symptomatology reported by the Veteran in service in 2005 was caused by or related to his post-service diagnosis of an eye disorder other than a refractive error. The examiner is also asked to provide an opinion as to whether any currently diagnosed eye disorder, other than a refractive error, was caused or aggravated by his multiple sclerosis. The examiner should provide a rationale to support the opinions. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Talpins 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.