Citation Nr: 21067146 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 15-15 418 DATE: November 3, 2021 REMANDED Service connection for multiple system atrophy (MSA) is remanded. Service connection for autonomic neuropathy is remanded. Service connection for special monthly compensation (SMC) on the basis of aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1975 to December 1982. In May 2017, the Veteran testified before the undersigned Veterans' Law Judge. A copy of the transcript is associated with the record. The Board notes that the Veteran's claims for service connection for an acquired psychiatric disorder and a cervical spine disability were granted in March and December 2020 rating decisions, respectively. As such, these issues are no longer on appeal before the Board. MSA Autonomic Neuropathy The Board remanded these matters in February 2019. Unfortunately, there was not substantial compliance with the Board's prior remand instructions. As such, remanded is required to follow the Board's prior remand instructions in clarifying the Veteran's diagnoses and to render a complete opinion on the etiology of his diagnosed disorders. Aid and Attendance The claim of entitlement to aid and attendance is inextricably intertwined with the remand of the claims for service connection. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination with a neurologist (M.D.) to determine the nature and etiology of his multiple system atrophy and autonomic neuropathy. The entire claims file and a copy of this REMAND must be made available to the examiner prior to the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The examination should include any diagnostic testing or evaluation deemed necessary by the examiner. The examiner is asked to: (a) Define the term "Parkinson's-plus" diseases. (b) Explain whether ALS, MSA, the general term "Parkinson-plus diseases" and Parkinson's disease are substantially the same diseases. If they are not, please explain the difference between them. (c) Explain whether autonomic neuropathy and peripheral neuropathy are substantially the same disease. If they are not, please explain the difference between them. (d) Diagnose whether the Veteran has or ever had a diagnosis of ALS, MSA, and/or Parkinson's disease. If the Veteran had a diagnosis of Parkinson's disease but no longer does, establish when his diagnosis began and when it changed. (e) Diagnose whether the Veteran has a diagnosis of autonomic neuropathy and/or peripheral neuropathy. If the Veteran had a diagnosis of peripheral neuropathy but no longer does, establish when his diagnosis began and when it changed. (f) For any diagnosed MSA, ALS, Parkinson's-plus, or Parkinson's disease, determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's condition had its clinical onset during active service or is related to any in-service disease, event, or injury, and/or manifested within one year of service separation. (g) For any diagnosed MSA, ALS, Parkinson's-plus, or Parkinson's disease, determine whether it is at least as likely as not (50 percent or greater probability) that Veteran's condition was caused or aggravated by his service connected TBI or PTSD. (h) For any diagnosed autonomic neuropathy and/or peripheral neuropathy, determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's condition had its clinical onset during active service or is related to any in-service disease, event, or injury, and/or manifested within one year of service separation. (i) For any diagnosed autonomic neuropathy and/or peripheral neuropathy, determine whether it is at least as likely as not (50 percent or greater probability) that Veteran's condition was caused or aggravated by his service connected TBI, service connected PTSD, Parkinson's or Parkinson's-plus disease. 2. Thereafter, after the Agency of Original Jurisdiction has confirmed that all above remand directives have been completed, readjudicate the claims, including the Veteran's claim for Aid and Attendance. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish, 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.