Citation Nr: 22017107 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 16-46 364 DATE: March 24, 2022 REMANDED Entitlement to service connection for Guillain Barre syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) is remanded. REASONS FOR REMAND The Veteran had active naval service from December 1967 to November 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal of a July 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This case was previously before the Board in April 2020 and January 2021, at which times the issue on appeal was remanded for additional development. This case has been returned to the Board for further appellate action. Service Connection GBS/CIDP The Board regrets additional delay but finds that another remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim. In the January 2021 Board remand, the Board instructed a VA examiner to provide an opinion of whether the Veteran's GBS and CIDP were etiologically related to his service. At that time, the Board specifically requested that the VA examiner address the Veteran's June 2014 description of his symptoms and treatment since service. Additionally, the Board requested that the VA examiner address medical literature that was added to the record. In the October 2021 VA medical opinion, a VA examiner opined that the Veteran's GBS and CIDP were not caused by his service. The VA examiner noted that the Veteran was not seen by a medical doctor, nor did he receive a diagnosis, during his service. Additionally, the VA examiner noted the 30-year difference between the Veteran's 1967 flu vaccine and 1997 diagnosis for GBS. Further, the VA examiner found that it was impossible to prove that the Veteran had an infection in boot camp and subsequently developed GBS since no tests were done in boot camp. The Board finds that the October 2021 VA medical opinion is inadequate for adjudication purposes. In that regard, the VA examiner did not adequately address the Veteran's lay statements pertaining to the onset and continuity of his symptoms. Additionally, the VA examiner failed to address the relevant medical literature of record, to include the medical excerpt from December 2019. Further, the VA examiner partially relied on the absence of evidence, in-particular the missing in-service testing and diagnosis, to support their conclusion. Based on the foregoing, the Board finds that the development conducted does not adequately comply with the January 2021 Board remand directives. The Board notes that compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). Thus, the Board finds that an addendum opinion should be obtained. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. Then, forward the Veteran's claims file to a neurologist with sufficient expertise, who has not previously provided an opinion in this appeal, for an addendum opinion regarding the nature and etiology of the Veteran's GBS and CIDP. The claims file must be reviewed by the examiner, and that review must be noted in the report. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present GBS and CIDP had its onset during the Veteran's active service, or is otherwise etiologically related to such service, to specifically include the Veteran's reported adverse reaction to a flu vaccine received during such service. In forming the opinion, the VA examiner must specifically address the following: (a.) The medical excerpt submitted by the Veteran in December 2019. Specifically, the examiner must address the typical early symptoms listed in the excerpt in relation to the evidence of record, to include the Veteran's lay statements of the symptoms he experienced during service. (b.) The medical literature noted in the August 2020 VA medical opinion. Specifically, the examiner must address the documented increased risk of GBS with the swine influenza vaccine in relation to the Veteran's assertion that his symptoms of GBS began after his in-service flu vaccine. (c.) The medical literature submitted by the Veteran in December 2021. In particular, the examiner must address the information pertaining to the difficulties in diagnosing CIDP in relation to the delay in time between the Veteran's initial in-service infection and his post-service diagnosis. A complete and detailed rationale must be provided for all opinions expressed. Another examination of the Veteran should only be provided if deemed necessary by the examiner provided the requested medical opinions. 2. Confirm that the VA examination report and all opinions provided comport with this remand, and undertake any other development found to be warranted. 3. Then, readjudicate the appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for a response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, 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.