Citation Nr: 21068226
Decision Date: 11/09/21	Archive Date: 11/09/21

DOCKET NO. 16-61 744
DATE: November 9, 2021

REMANDED

Entitlement to service connection for multiple sclerosis is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the U.S. Army from March 1994 to May 2003.

In October 2020, the Board of Veterans' Appeals (Board) remanded the matter on appeal for additional evidentiary development. Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that she is afforded every possible consideration. 

The Board finds that the November 2020 VA medical opinion that was proffered in response to its remand directives is inadequate for adjudicative purposes. The examiner concluded that it was less likely than not that the Veteran's multiple sclerosis began during her active duty service. She reasoned that the Veteran was diagnosed with this disability more than 11 years post service and that her in-service symptoms of chest/sternum pain, fatigue, lightheadedness, dizziness, vaginal bleeding, urinary problems, muscle spasms, back and neck pain, and tingling of the hands and feet all had etiology and medical explanations that were different from multiple sclerosis. The examiner also noted that she had considered the Veteran's assertions of continuity of symptomatology in formulating her opinion. The Board finds that this opinion is inadequate as it is conclusory; the examiner does not describe the alternate etiologies of the Veteran's in-service symptomatology in sufficient detail. Further, the examiner does not explain how her consideration of the Veteran's assertions of continuity of symptomatology led to a negative conclusion. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (finding that an opinion that does not provide a rationale or that is conclusory is inadequate). On remand an addendum opinion must be obtained.    

The matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's multiple sclerosis is at least as likely as not related to her active duty service, to include her documented in-service symptomatology, including chest/sternum pain, fatigue, lightheadedness, dizziness, vaginal bleeding, urinary problems, muscle spasms, back and neck pain, and tingling of the hands and feet. If the examiner finds that any or all of these symptoms have alternate etiology, he or she is asked to detail that alternate etiology or medical explanation. 

The examiner is also asked to specifically address the Veteran's assertions of continuity of symptomatology since service. 

A full discussion of the facts (particularly the evidence in the service treatment records and the Veteran's lay statements and testimony) and the medical principles involved would be of considerable assistance to the Board.   

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. Bush

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.