Citation Nr: 21028907
Decision Date: 05/12/21	Archive Date: 05/12/21

DOCKET NO. 12-06 692
DATE: May 12, 2021

REMANDED

Entitlement to service connection for multiple sclerosis (MS) is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1965 to March 1967.  He died in July 2020, and the appellant is his surviving spouse.  She was substituted for the Veteran as the claimant in this matter.  This case comes to the Board of Veterans' Appeals (Board) on appeal from an April 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).  In April 2014, a Travel Board hearing was held before the undersigned.  In September 2014, the Board remanded the case to the RO for additional development.  In November 2016, the Board determined that new and material evidence has been received to reopen the claim of service connection for MS, and (on de novo review) remanded the case for additional development.  In November 2018 and October 2020, the Board again remanded the case to the RO for additional development.  

Entitlement to service connection for MS

Unfortunately, there has not been substantial compliance with the Board's previous remand directives, and another remand is required.  Stegall v. West, 11 Vet. App. 268, 271 (1998).  The October 2020 remand directives requested among other things an opinion on the more likely etiology for the Veteran's MS (if it was not incurred in service), but such was not included in the January 2021 medical opinion that was received.  Further, while the consulting provider furnished a general explanation for the risk factors and known causes for the development of MS generally, the physician omitted any explanation as to how they applied to the Veteran specifically, as requested.  Therefore, the Board seeks to ensure that the record contains an adequate opinion.  

The matter is REMANDED for the following action:

Obtain an addendum medical advisory opinion from the January 2021 VA consulting physician (or another neurologist, if that physician is unavailable or unable to provide the opinion sought).  The consulting provider is asked to respond to the following:  

(a).  Is the Veteran's MS at least as likely as not (a 50 percent or greater probability) related to his period of service from March 1965 to March 1967, to include his presumed exposure to herbicide agents in Vietnam? 

(b).  If it was not incurred in service, what is considered to be the more likely etiology for the Veteran's MS?  

The opinions must be accompanied by rationale, with citation to supporting factual data and existing pertinent medical and scientific literature, if/where possible, including explanations for the risk factors and known causes for the development of MS generally and in regard to the Veteran specifically.  The rationale should specifically include an explanation of the observation that MS is "an autoimmune disorder" (whether that is a factor weighing against exposure to Agent Orange being a risk factor for its development). 

If the examiner determines that the opinion sought cannot be given without resort to speculation, (to satisfy legal requirements) the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the requisite knowledge or training).  

 

 

George R. Senyk

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Debbie Breitbeil, 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.