Citation Nr: 21022731 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 17-04 878 DATE: April 19, 2021 REMANDED Entitlement to service connection for multiple sclerosis (MS), to include as due to mononucleosis, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1975 to December 1978. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In February 2021 the Veteran testified at a hearing before the undersigned Veterans Law Judge. 1. Entitlement to service connection for MS, to include as due to mononucleosis. A remand is required for additional development. In a November 2016 report of general information, the Veteran claimed that a search for her Service Treatment Records (STRs) be performed utilizing her maiden name as she had gotten married while in service. A February 2017 deferred rating noted that all STRs under the Veteran’s maiden and married names had been completed and associated with the file in January 2014. These records included the Veteran’s entrance examination and some lab results but were largely devoid of medical treatment records. The file included mostly personnel records. In the February 2021 hearing, the Veteran’s representative challenged the VA’s satisfaction of its duty to assist (DTA) in the first instance in obtaining complete STRs in conjunction with this claim. The Veteran has identified additional records such as a vaccination list and medical records from when she was provided with a month of leave due to mononucleosis. There is still no formal finding that complete STRs were not available because they do not exist; therefore, another attempt should be made to obtain his complete STRs. The Board also finds that after any of the Veteran’s outstanding records are associated with the file, a VA opinion must also be obtained. VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). According to a November 2013 medical treatment record and several VA treatment records, the Veteran is diagnosed with MS. The Veteran has claimed that this disability was the result of mononucleosis that she contracted in service or due to a swine flu vaccine that she received while on active duty. The Veteran claimed that the mononucleosis may have caused damage to her frontal lobe which contributed to the MS, or that as a side effect of the swine flu vaccine, she developed MS. The Veteran has continuously and consistently asserted this premise. The Board notes that while the Veteran’s lay statements may not be competent to be dispositive of the claim, those statements are sufficient to overcome the low threshold necessary to trigger the VA’s duty to provide an examination for the claimed conditions. McLendon, supra. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination is required. The matters are REMANDED for the following action: 1. Contact the Veteran and afford her the opportunity to identify by name, address, and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from the appropriate sources. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and her representative. 2. Contact the appropriate VA Medical Centers and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Required notice and opportunity to respond should be provided to the Veteran and his or her representative. 3. Make an original attempt to obtain the Veteran’s complete Service Treatment Records (STRs) in connection with the service connection claim currently on appeal. This should include all separation examinations and vaccination records, to the extent they exist. Document all requests for information as well as all responses in the claims file. 4. Provide the Veteran with an appropriate examination to determine the etiology of her diagnosed MS. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the MS had onset in, or is otherwise related to, active service, to include as a result of mononucleosis or as a side effect of a swine flu vaccine injection. The examiner must address the following: 1) the Veteran’s lay statements regarding the alleged etiology of her MS in the February 2021 hearing and 2) the submitted medical literature entitled, “The Linking Pathogen in Neuro-Systemic Disease: Chronic Fatigue, Alzheimer’s, Parkinson’s, and Multiple Sclerosis.” H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board AK 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.