Citation Nr: 21015581 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 16-06 520 DATE: March 17, 2021 REMANDED Entitlement to service connection for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1998 to August 1999. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The matter was remanded in September 2018 and May 2020 for additional development. The case has been returned to the Board for appellate consideration. Entitlement to service connection for multiple sclerosis is remanded. While the Board regrets the additional delay, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of entitlement to service connection for multiple sclerosis. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998) The Veteran contends that her current diagnosis of multiple sclerosis had its onset in service. She contends that she experienced manifestations of multiple sclerosis while in service and within the seven-year presumptive period. By way of history, the Veteran was denied entitlement to service connection for multiple sclerosis in an August 2013 rating decision. The next month, the Veteran filed a notice of disagreement (NOD) and a statement of the case (SOC) was issued in January 2016. A September 2018 Board decision remanded the Veteran’s claim for a VA examination to address the Veteran’s claims of a symptom onset in 2000. The Board specifically requested the VA examination be conducted by a specialist in neurology. In accordance with the Board remand, the Veteran was afforded a VA examination in June 2019, conducted by a family nurse practitioner. A May 2020 Board decision remanded the Veteran’s claim again for another VA examination, to be performed by the requested specialist. In accordance with the May 2020 Board remand, the Veteran was afforded a VA examination in July 2020 with a Doctor of General Medicine. An etiology opinion was provided by a Doctor of Internal Medicine in August 2020. The VA examiner opined that the Veteran’s multiple sclerosis is less likely than not incurred in or caused by her service. In support of this opinion, the VA examiner reasoned that the Veteran was diagnosed with multiple sclerosis in 2008 following a spell of numbness in her right arm and resulting MRI that was positive for multiple sclerosis. After reviewing the evidence of record, the Board finds that the July 2020 VA examination and August 2020 etiology opinion are inadequate, and remand is warranted for an addendum opinion. The Board’s September 2018 and May 2020 remands specifically directed that the Veteran’s file should be reviewed by a specialist in neurology to determine the nature and etiology of her multiple sclerosis. There is no indication whether the July 2020 and August 2020 VA examiners specialized in neurology, as was directed by the Board in its remand instructions. Therefore, the Board finds that an additional remand is needed to obtain the requested specialist. The matters are REMANDED for the following action: 1. The Veteran’s claims file should be reviewed by a specialist in neurology to determine the nature and etiology of her multiple sclerosis. The examiner is asked to furnish an opinion with respect to the following questions: (a.) Whether multiple sclerosis is at least as likely as not (50 percent or greater probability) related to the Veteran’s military service. Why or why not? (b.) Did multiple sclerosis manifest within seven years of the Veteran’s separation from service in August 1999? Why or why not? Specifically discuss the significance of neurological symptoms noted in 2000 and any continuity of symptomatology. In making these necessary determinations, the examiner must remain mindful of the Veteran’s lay statements of having purportedly experienced continuous symptoms since service. All findings, along with the complete rationale for all opinions expressed, should be set forth in the examination report. If the examiner finds a physical examination of the Veteran is necessary in order to make these findings, such an examination should be provided. 2. Then, readjudicate the claim. If action remains averse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Slaughter, 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.