Citation Nr: A21020360 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 200820-105013 DATE: December 21, 2021 ORDER Service connection for primary lateral sclerosis (PLS) is granted. FINDING OF FACT The Veteran's PLS is a variant of amyotrophic lateral sclerosis (ALS). CONCLUSION OF LAW The criteria for service connection for PLS, as a variant of ALS, are met. 38 U.S.C. §§ 1110, 5107); 38 C.F.R. §§ 3.102, 3.303, 3.318. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active service from July 1966 to April 1970. The rating decision on appeal was issued in June 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the Veteran elected the Hearing option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant or his or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Veteran testified in a virtual hearing before the undersigned Veterans Law Judge in September 2021 and a transcript of the hearing has been associated with the claims file. Entitlement to service connection for PLS Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran contends that service connection is warranted for PLS. Specifically, he and his representative contend that presumptive service connection is warranted for PLS as a variant of ALS. Under 38 C.F.R. § 3.318, the development of ALS manifested at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease if the veteran had active, continuous service of 90 days or more. The Veteran has satisfied the active service requirements per his DD Form 214 for presumptive service connection for ALS. See 38 C.F.R. § 3.318(b)(3). The record reflects that the Veteran was diagnosed with PLS, in the October 2019. In a private treatment letter from October 2019,the Veteran's treating physician indicated that the Veteran was followed for severe and progressive weakness, spasticity, slurred speech, and respiratory insufficiency. The physician reported that the Veteran was diagnosed with an upper motor neuron disease noted as PLS. It was noted that PLS and ALS shared many of the same features and there was a debate as to whether they were two separate conditions or simply two points on a continuum. The physician noted that while the Veteran did not exhibit manifestation of lower motor neuron disease, the progression of the upper motor neuron condition was a concern. A December 2019 VA ALS disability benefits questionnaire (DBQ) shows that the examiner noted that the Veteran had been diagnosed with ALS, and noted that PLS pertained to ALS. The VA examiner identified muscle weakness, swallowing difficulties, and bowel impairments attributable to ALS. Upper and lower extremity neurological symptoms were assessed. At the Board hearing the Veteran and his representative also cited and submitted several articles, including from Johns Hopkins Medicine that PLS is a variant of, and the rarest form of, ALS. After reviewing the evidence of record, the Board finds that the evidence is in approximate balance as to whether the Veteran's PLS is a variant of, or form of, ALS. Here, the VA examination report identified that the Veteran had ALS in the form of PLS. Additionally, the medical literature indicated the PLS was a rare form of ALS. In such circumstances, the regulations dictate that reasonable doubt is to be resolved in the Veteran's favor on this material issue. 38 U.S.C. § 5107(b). (Continued on the next page) Accordingly, as the benefit-of-the-doubt rule is for application, the Board finds that the competent medical evidence of record shows that it is at least as likely as not that the Veteran's PLS is a variant of ALS, and warrants presumptive service connection under 38 C.F.R. § 3.318. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dworkin, 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.