Citation Nr: 21030041 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 13-10 035 DATE: May 17, 2021 REMANDED Service connection for residuals of surgical removal of a spinal cord tumor, to include incomplete paraplegia of the lower extremities (claimed as confinement in a wheelchair due to surgical removal of an intramedullary spinal cord tumor) is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active duty service from September 1985 to April 1989. The Veteran also served in the Army Reserves from April 1989 to October 2004. The instant case is on appeal from a Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The instant case has been before the Board of Veterans' Appeals (Board) previously. In July 2019, the Board denied the claim for service connection. The Veteran filed a motion for reconsideration in September 2019, which was denied in November 2019. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court) and a September 2020 Joint Motion for Remand (JMR) vacated the Board decision for further proceedings consistent with the JMR. After a review of the record, the Board finds that additional development in the form of an addendum VA medical opinion is needed to comply with the terms of the JMR. In December 2020, the Veteran asked to have the case remanded to the Agency of Original Jurisdiction for initial review of newly-submitted evidence, then in May 2021 provided a private medical opinion (opinion dated July 2019). The representative mentioned waiving the additional time to submit evidence after submission of their brief, but did not acknowledge or address the Veteran's clear request for AOJ review. Given that the AOJ will be responsible for reviewing the claim after the additional medical evidence is obtained, any due process issues will be satisfied by AOJ review. Service Connection for Residuals of Surgical Removal of a Spinal Cord Tumor, to Include Incomplete Paraplegia of the Lower Extremities The JMR identified two areas that required additional medical development. The July 2019 Board decision stated that scoliosis and lordosis preexist service as they are considered developmental defects. The JMR agreed the reasons and bases in support of this statement to be inadequate in two ways. First, although the March 2017 VA examiner noted that the scoliosis diagnosis was "developmental," the VA examiner also identified that the condition was "acquired" when asked whether the scoliosis was "congenital or acquired." The JMR suggested that additional information was needed to resolve this potential discrepancy. Second, the Board should demonstrate that the medical evidence supports its finding that lordosis is developmental. The JMR instructed the Board to address these concerns and to consider whether service connection for these conditions was warranted. The JMR also agreed that there were inadequate reasons and bases in support of the determination to favor the March 2017 VA examiner's opinion over the 2013 private opinion by Dr. C.N.B. The JMR stated that the March 2017 VA examiner did not adequately address Dr. C.N.B.'s contention as far as how the syringomyelia developed from inadequately treated syphilis. The March 2017 VA examiner opined that it was "unlikely that the patient would have chronic sequelae of syphilis" because the Veteran "received timely treatment of two weeks of penicillin that is very effective in curing syphilis"; however, the March 2017 VA examiner did not address the theory beyond those statements. Specifically, the March 2017 VA examiner needed to address the fact that a June 1993 VA medical examination stated that the Veteran's service-connected iritis "might possibly be due to inadequately treated syphilis." The VA examiner also needed to address Dr. C.N.B.'s explanation that the Veteran received two spinal taps in 1988 due to worries of central nervous system infection from syphilis; statement that this was likely sub-optimal antibiotic treatment manifest by persistent recurrent iritis per the 1993 eye examination; and statement that the Veteran received a spinal cord operation 14 years after service and the "latent period for Tabes dorsalis-neurosyphilis-tertiary syphilis is 5 [to] 20 years," which causes lesions in the thoracic spinal cord consistent with the Veteran's clinical presentation. The Board was instructed to address the adequacy of the March 2017 VA opinion insofar as the examiner did not address any of the supporting rationale provided by the private physician or the June 1993 medical evidence. The Board was also instructed to address the medical treatise that was appended to the 2013 private opinion. The Veteran has supplied a second private opinion by Dr. K.D.M. that theorizes that the syringomyelia is due to the scoliosis and that argues that the Veteran has had chronic and continuous symptomatology of back pain. Although the Veteran has previously contended that the scoliosis did not exist during service, see September 2019 Motion for Reconsideration, the service treatment records reflect a February 1988 radiological consultation for chest pain that revealed mild dorsal scoliosis. The Board finds that this theory will need additional development as it is also related to the questions related to scoliosis, as described above. The matter is REMANDED for the following action: 1. Request addendum opinions from a VA examiner. The VA examiner is to provide the following opinions with a rationale for each: (a.) Is the etiology of the scoliosis "developmental" or "acquired"? (b.) Is the lordosis a congenital defect that preexisted service? (c.) What is the etiology of the syringomyelia? Was there inadequate treatment for syphilis during service? If so, is the syringomyelia caused by inadequately treated syphilis during service? In providing this opinion, please consider all evidence of record, to include the lay statements given by the Veteran and by people who know the Veteran's condition. Please also specifically address the following: -The specific rationale in the 2013 opinion that was given by Dr. C.N.B., which includes that syringomyelia developed from inadequately treated syphilis, which turned into neurosyphilis. This is to include the fact that the Veteran received two spinal taps in 1988 due to worries of central nervous system infection from syphilis; that this was likely sub-optimal antibiotic treatment manifest by persistent recurrent iritis per the 1993 eye examination; and that the Veteran received a spinal cord operation 14 years after service and the "latent period for Tabes dorsalis-neurosyphilis-tertiary syphilis is 5 [to] 20 years," which causes lesions in the thoracic spinal cord consistent with the Veteran's clinical presentation. -The June 1993 VA medical examination statement that the Veteran's service-connected iritis "might possibly be due to inadequately treated syphilis." -The medical article from Medline Plus on syphilitic myelopathy, uploaded September 18, 2015. -The alternate theory suggested by Dr. K.D.M. in May 2021 (dated in July 2019) that theorizes that the syringomyelia is due to the scoliosis. 2. Readjudicate the claim. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Smith, 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.