Citation Nr: 21030696 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 15-23 133 DATE: May 19, 2021 REMANDED Entitlement to service connection for multiple sclerosis is remanded. Entitlement to service connection for dizziness, to include as secondary to multiple sclerosis, is remanded. Entitlement to service connection for fatigue, to include as secondary to multiple sclerosis, is remanded. Entitlement to service connection for a bilateral knee disability, to include as secondary to multiple sclerosis, is remanded. Entitlement to service connection for a bilateral leg disability, to include as secondary to multiple sclerosis, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1977 to July 1992 with additional service in the Army Reserve from July 1993 to December 1995. The current appeal was previously before the Board in August 2018. The claims were remanded for additional development to determine whether the Veteran had service within the Southwest Asia theater of operations and for nexus opinions. Although the Board regrets the additional delay, upon review of the claims file, the Board believes that additional development on the claims on appeal is warranted. Service Connection for Multiple Sclerosis The claim for service connection for multiple sclerosis was previously remanded for opinions on whether the disability was incurred in active duty, to include due to environmental exposures or vaccinations, and whether the disability manifested within seven years of separation. In December 2019, VA obtained the requested opinions, but the opinions are either inconsistent with the evidence of record or lack a supporting rationale. As such, the Board finds that new opinions are needed. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Since the August 2018 Board remand, additional service records have been added to the claims file that show that the Veteran did not serve in the Southwest Asia theater of operations but instead served in Egypt. See February 2021 Military Personnel Records, p. 1. Because service in Egypt is not qualifying service for presumptive exposure to environmental hazards, there is no need for additional development on the question of whether the Veteran's disability is related to environmental exposures. Finally, the service personnel records in the claims file do not indicate when the Veteran had periods of active duty or active duty for training (ADUTRA) during his Army Reserve service. These dates are necessary to determine whether the Veteran's multiple sclerosis manifested during service. Accordingly, the Agency of Original Jurisdiction (AOJ) should take appropriate steps to verify the dates of active duty and ACDUTRA during the Veteran's Army Reserve service. Service Connection for Dizziness The Veteran underwent a VA examination in November 2019 for his dizziness. See November 2019 VA Examination, pp. 1-11. The examiner indicated that there was no diagnosis of an ear or peripheral vestibular condition. However, the Veteran's non-VA treatment records indicate that his dizziness is a symptom of his multiple sclerosis. See May 2011 Private Treatment Records, p. 9. As noted in the August 2018 Board remand, the Veteran's claim for service connection for dizziness is intertwined with his multiple sclerosis claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Because the claim for service connection for multiple sclerosis is being remanded, the claim for dizziness must also be remanded. Service Connection for Fatigue The AOJ obtained an examination and opinion related to the Veteran's fatigue. See December 2019 VA Examination, pp. 1-2; December 2019 VA Examination, pp. 1-2; December 2019 VA Examination, pp. 1-10. The examination report is internally inconsistent in that it states that the Veteran has chronic fatigue syndrome and then also states that there is no official diagnosis of chronic fatigue syndrome. Moreover, the negative nexus opinions do not include a supporting rationale. Accordingly, the Board finds that a new opinion is needed. See Barr, 21 Vet. App. 303. Service Connection for a Bilateral Knee Disability The AOJ obtained an examination and opinion related to the Veteran's right and left knee disabilities. See December 2019 VA Examination, p. 2; December 2019 VA Examination, p. 2; December 2019 VA Examination, pp. 1-25. The examiner's opinion notes that the Veteran could not recall any damage, injury or accident that caused his disabilities, but the examination report reflects the Veteran's reports of falls, jumping, and 12-mile rucks with a 75-pound medic bag. Because the examiner's opinion does not consider the Veteran's reports of these in-service knee injuries, a new opinion is needed. See Barr 21 Vet. App. 303; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The new opinion should also address the Veteran's contention that his knee injuries are secondary to his multiple sclerosis. Service Connection for a Bilateral Leg Disability The December 2019 VA examiner indicated that there was no evidence of a chronic bilateral leg condition and that the Veteran's symptoms were subjective. See December 2019 VA Examination, p. 2. The only examination report of record is for the knee and lower leg, but it is unclear from the evidence whether the Veteran's complaints of bilateral leg pain are neurological, skeletal, or muscular in nature. On remand, the AOJ should obtain a new examination and opinion that addresses the nature and etiology of the Veteran's bilateral leg pain, to include whether such symptoms are secondary to his multiple sclerosis. The matters are REMANDED for the following action: 1. Conduct additional development to identify and verify the Veteran's periods of active duty and ACDUTRA between July 1993 and December 1995. Any outstanding service records associated with the Veteran's Army Reserve service should be associated with the claims file. 2. Obtain a VA opinion that addresses the etiology of the Veteran's multiple sclerosis. If deemed necessary by the examiner designated to provide an opinion, schedule the Veteran for an examination. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's multiple sclerosis was caused by, aggravated by, or is otherwise etiologically related to his active duty service? In providing this opinion, the examiner must consider whether any of the vaccinations that the Veteran received during his service may have caused his multiple sclerosis. (b) Is it at least as likely as not that the Veteran's multiple sclerosis onset within seven years of the Veteran's separation from service? In providing this opinion, the examiner must consider the Veteran's reports that he experienced fatigue, leg pains and dizziness during his Army Reserve service and that the symptoms increased over the years. See May 2011 Private Treatment Records, p. 26; July 2012 Statement in Support of Claim, p. 1; April 2013 Buddy Statement, p. 1. The examiner is advised that the Veteran is competent to report his history and symptoms, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. 3. Obtain a VA opinion that addresses the nature and etiology of the Veteran's fatigue. If deemed necessary by the examiner designated to provide an opinion, schedule the Veteran for an examination. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a) Identify all diagnoses that pertain to the Veteran's fatigue. (b) For any diagnosis identified above, is it at least as likely as not (a 50 percent probability or greater) that the Veteran's disability was caused by, aggravated by, or is otherwise etiologically related to his active duty service? In providing this opinion, the examiner must consider the Veteran's reports of experiencing fatigue during his Army Reserve service. See July 2012 Correspondence, p. 2; March 2019 Buddy Statement, p. 1. (c) Is it at least as likely as not that the Veteran's fatigue is etiologically related to his multiple sclerosis? The examiner is advised that the Veteran is competent to report his history and symptoms, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. 4. Obtain a VA opinion that addresses the etiology of the Veteran's right and left knee disabilities. If deemed necessary by the examiner designated to provide an opinion, schedule the Veteran for an examination. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's right and left knee disabilities were incurred in, aggravated by, or are otherwise etiologically related to his active duty service? In providing this opinion, the examiner must consider the Veteran's reports of having many bad falls in service as well as jumping and falling on knees and monthly 12-mile rucks with a 75-pound medic bag. The examiner must also consider the March 1979 injury to the left knee. See May 2013 STR, p. 19. (b) Is it at least as likely as not that the Veteran's right and left knee disabilities are caused or aggravated by his multiple sclerosis? In providing this opinion, the examiner must consider any impact to the Veteran's knees that is caused by an abnormal gait due to his multiple sclerosis. See December 2019 VA Examination, p. 6. The examiner is advised that the Veteran is competent to report his history and symptoms, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. 5. Schedule the Veteran for an examination to ascertain the nature and etiology of his bilateral leg disability. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this REMAND, should be made available to the examiner designated to provide an opinion, and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a) Identify all diagnoses that pertain to the Veteran's bilateral leg disability. In providing this information, the examiner should note whether the Veteran's complaints of pain are neurological, skeletal, or muscular in nature. (b) For any diagnosis identified above, is it at least as likely as not (a 50 percent probability or greater) that the Veteran's disability was incurred in, aggravated by, or is otherwise etiologically related to his active duty service? In providing this opinion, the examiner must consider the Veteran's reports of experiencing leg pains during his Army Reserve service and the documented leg cramps on his May 1992 separation examination. See July 2012 Statement in Support of Claim, p. 1; April 2013 Buddy Statement, p. 1; May 2013 STR, pp. 85-86. (c) Is it at least as likely as not that the Veteran's bilateral leg disability is caused or aggravated by his multiple sclerosis? In providing this opinion, the examiner must consider any impact to the Veteran's knees that is caused by an abnormal gait due to his multiple sclerosis. See December 2019 VA Examination, p. 6. The examiner is advised that the Veteran is competent to report his history and symptoms, and such reports must be considered. If the examiner rejects the Veteran's reports, the examiner must provide a reason for doing so. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W.V. Walker, 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.