Citation Nr: 21071751 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 14-23 129 DATE: December 1, 2021 REMANDED Entitlement to an increased rating for residuals of multiple sclerosis, to include left foot drop, dizziness, voiding dysfunction, mild swallowing difficulties, and photophobia is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1998 to August 2001. The Veteran testified at a Board of Veterans' Appeals (Board) hearing in July 2017 before the undersigned Veteran's Law Judge. A transcript is of record. This mater returns to the Board following the issuance of a January 2018 Board remand which directed the Regional Office (RO) to undertake additional development. 1. Entitlement to an increased rating for residuals of multiple sclerosis, to include left foot drop, dizziness, voiding dysfunction, mild swallowing difficulties, and photophobia is remanded. The Veteran is seeking a higher rating for his service-connected multiple sclerosis (MS), to include left foot drop, dizziness, voiding dysfunction, mild swallowing difficulties, and photophobia. He testified that his symptoms had worsened, and the Board instructed the RO to obtain examinations to determine the current severity of his MS and residual symptoms. The Veteran has previously reported that his symptoms, specifically his left foot drop, flare up several times resulting in increased severity during the course of a year. The Veteran has stated that during these times, which he noted as active phases of MS, he experiences a loss of sensation in parts of his body, motor difficulties, the inability to open his hands, and increased foot dropping. While the Veteran was afforded VA examinations in March 2019, May 2020, August 2020, May 2021, and June 2021, at none of these examinations were the Veteran's reports of flare-ups discussed. Thus, in an effort to obtain a proper disability picture of the Veteran's MS, to include during active phases, the Board will remand the Veteran's claim for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain all outstanding VA medical records and associate them with the virtual claims file. 2. Obtain from an appropriate clinician, an opinion which discusses the severity of the Veteran's MS and any of the Veteran's MS related symptoms during an active phase of the disability. The examiner should opine about any functional loss resulting from the Veteran's MS and MS related residuals during an active phase. The complete claims folder must be made available to and be reviewed by any examiner. If an examination is deemed necessary by the examiner, one should be scheduled. The examiner should consider the Veteran's lay statements about his symptoms during an active phase of MS in their opinion. All tests deemed necessary should be conducted and the results reported in detail. In the event of an examination, full range of motion testing must be performed in both active and passive motion, in weightbearing and non-weightbearing with range of motion measurements of the opposite undamaged joint. The examiner should address in detail the additional functional impairment and range of motion loss due to factors such as pain, weakened movement, excess fatigability, incoordination, and flare-ups for each disability. The examiner should estimate any additional loss of motion to the best of their ability. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, they should clearly explain why that is so. If it is not possible to provide a specific measurement without speculation, the examiner should state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). All opinions should be accompanied by adequate reasons and bases. If the examiner cannot provide the requested opinion without resorting to mere speculation, they should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that they have exhausted the limits of current medical knowledge in providing an answer to that particular question(s).s B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor