Citation Nr: 21015313 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-33 034 DATE: March 17, 2021 ORDER Service connection for Guillain-Barre syndrome is granted. FINDING OF FACT The evidence is at least in equipoise as to whether the Veteran’s current Guillain-Barre syndrome was incurred in the line of duty during his active duty for training (ACDUTRA) service. CONCLUSION OF LAW The criteria for entitlement to service connection for Guillain-Barre syndrome are met. 38 U.S.C. §§ 101(24), 1110, 1131, 5107; 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1975 to January 1976, with additional service in the National Guard. This matter is on appeal from a March 2015 decision of a Department of Veterans Affairs (VA) Regional Office (RO).  In January 2021, a videoconference hearing was held before the undersigned. A transcript of the hearing is in the record. Guillain-Barre Syndrome The Veteran contends that he is entitled to service connection for Guillain-Barre syndrome. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Entitlement to direct service connection requires evidence of three elements: (1) the existence of 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, 1167 (Fed. Cir. 2004). Service connection may also 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). “Active military, naval, or air service” includes active duty; any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). The term “in line of duty” means “an injury or disease incurred or aggravated during a period of active military, naval, or air service unless such injury or disease was the result of the veteran’s own willful misconduct.” 38 C.F.R. § 3.1(m); see also 38 U.S.C. § 105(a); 38 C.F.R. § 3.301(a). Additionally, a service department finding that an injury occurred in the line of duty will be binding on VA unless it is patently inconsistent with the requirements of laws administered by VA. 38 C.F.R. § 3.1(m). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).  In this case, August 2015 private treatment records note a current diagnosis of Guillain-Barre syndrome. Thus, the first element of Shedden is satisfied. Further, military personnel records reflect that the Veteran served on ACDUTRA from April 10, 1978 to April 24, 1978. An April 1978 Line of Duty Determination reflects that the Veteran was performing his 15-day annual training when he complained of numbness in his face, hands, and feet with slurring of speech and requested permission to go to sick call. The illness was diagnosed as Guillain-Barre syndrome. A final finding was made that the disease was incurred in the line of duty. During the January 2021 hearing, the Veteran stated that in the spring of 1978, he became ill and “started getting all of the numbness and tingling, and it started spreading all over my body.” He stated that he reported to his sergeant that he had been dropping tools and could not hold objects. He stated that he had been experiencing numbness and tingling but did not know what caused it. He stated that he went to a hospital and had a spinal tap and was diagnosed with Guillain-Barre syndrome. In August 2018, the Veteran was provided with a VA examination in which the examiner opined that the in-service diagnosis was a misdiagnosis. He stated that the symptoms were not a progressive neuropathy from the feet upward with weakness progressing from the feet and legs. He stated that the symptoms were tingling and numbness all over the body with hand weakness. He cited the National Institute of Health (NIH) website, which states that Guillain-Barre syndrome (GBS) is a disorder in which the first symptoms include varying degrees of weakness or tingling sensations in the legs. He stated that this is not how the Veteran presented because he never expressed any leg weakness. He stated that he “would not try to convince this Veteran after 40 years that his diagnosis was incorrect, but [he] could not concur with the neurologist who made the diagnosis” of GBS and stated that he did not “know what this Veteran had 40 years ago.” In June 2020, VA received a letter from a private medical provider who responded to the August 2018 examiner and stated that although he “would agree with what the VA doctor told you about [the disease] most commonly starting in the feet and working its way up the body from there is true, there are many variant … in which this is not the case.” He stated that the “most well-known of these variants is the Miller-Fischer variant … that presents with numbness and weakness in the eyes, face, and mouth and loss of reflex.” He stated that “the fact that you did not have numbness and weakness starting in your feet and moving up your body from there does not preclude AIDP [acute disseminated inflammatory polyneuropathy/polyneuroradiculopatis]/GBS being the correct diagnosis in 1978.” He also stated that “the nature of this disease is that it is monophasic—it attacks you, you suffer a deficit, and then you recover as much as you are able to.” He stated that “many people who had [the disease] in the past look quite normal years afterwards, making it very difficult to believe that they had it … [and] their nerve conduction studies can even recover to normal, despite complaints of lingering numbness and tingling, although these usually do fade over time.” He opined that “it is very speculative at best to try and second-guess the diagnosis at that time, as there is inadequate evidence available from that time to do so and no way to generate new evidence that could contradict that diagnosis.” He stated that “in [his] professional opinion, I believe your most likely diagnosis in 1978 was AIDP/GBS.” He also stated that “there was not and currently is not a way to tell with any certainty if the GBS/AIDP you had was caused by the flu vaccine” administered in service. As this opinion reflects more thorough consideration of the nature of the Veteran’s disability, the Board assigns greater probative value to this opinion than to the August 2018 VA opinion. Based on the foregoing, and resolving any reasonable doubt in the Veteran’s favor, the Board finds that the evidence is at least in equipoise that the Veteran was disabled from Guillain-Barre syndrome that was incurred in the line of duty during   a period of ACDUTRA. As such, entitlement to service connection for Guillain-Barre syndrome is warranted, and the claim is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, Associate 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.