Citation Nr: 22017735 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 16-53 796A DATE: March 26, 2022 REMANDED Entitlement to service connection for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served in the US Navy from April 1972 to April 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2016 rating decision issued by a Department of Veteran's Affairs (VA) Regional Office (RO) (hereinafter agency of original jurisdiction (AOJ)). In October 2021, the Veteran testified at a video hearing before the undersigned Veteran's Law Judge. A written transcript of that hearing is of record. Entitlement to service connection for multiple sclerosis is remanded. The Veteran asserts that his multiple sclerosis (MS) is related to his active military service. Specifically, the Veteran contends that while stationed on the USS Ramsey, he was exposed to asbestos and agent orange. Further, the Veteran stated that, as a boatswain's mate, he was required to repack asbestos around the ship's pipes, reapply asbestos filled paint, and handle barrels of agent orange. Additionally, the Veteran described an event, where, while loading food on to the ship, a 90-pound bag of potatoes was dropped on the Veteran knocking him unconscious. Additionally, the Veteran contends that he began having symptoms of MS long before his 2006 diagnosis. Specifically, he described being nicknamed "Burly" because of his abnormal gait and propensity to fall and tumble into things on the ship. Also, the Veteran described experiencing symptoms of achy/numb arms, hands, and fingers, which began in 1975. And the Veteran's ex-wife reported that the Veteran would ask her to sleep on his hands to help with the pain. As such, the Veteran contends that service connection is warranted as his symptoms of MS manifested within 7 years of service discharge. See 38 C.F.R. § 3.307(a)(3). Although the Veteran is competent to report the above symptoms, he is not competent to medically relate such symptoms to his current MS diagnosis, as he does not possess the requisite medical training. MS is a medically complex disease process because of its multiple possible etiologies, requires specialized testing to diagnose, and manifests symptomatology that may overlap with other disorders. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (holding that rheumatic fever is not a condition capable of lay diagnosis). The etiology of the Veteran's MS is a complex medical etiological question involving internal and unseen system processes unobservable by the Veteran. Nonetheless, the Veteran has submitted a medical article discussing a potential association between auto-immune diseases and asbestos exposure. A November 2011 medical statement found that it was "possible" that the Veteran's multiple sclerosis "may be" related to asbestos exposure. This evidence meets the low threshold for obtaining a medical opinion. McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4)(i). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records, including all paper and electronic records since 1990. See VA Form 10-7131 dated June 1990 and VA Form 10-7131 dated January 1995 (noting Veteran had been seen at VA in June 1990). 2. Schedule the Veteran for a VA examination to determine whether his MS is related to service. The examiner must opine: (a.) Whether there is a nearly equal or greater probability that the Veteran's MS had its onset in service or within 7 years from his discharge in April 1973? The examiner is requested to discuss whether there is any medical reason to accept or reject that the witness observations the Veteran's symptoms of arm and finger aching, as well as gait abnormality, during service represented the onset of multiple sclerosis? (b.) Whether there is a nearly equal or greater probability that the Veteran's MS is medically related to an in-service injury, disease, or event, to specifically include exposure to asbestos? The examiner requested to discuss whether there is any medical reason to accept or reject the Veteran's belief that asbestos exposure caused his multiple sclerosis with specific discussion of the medical article entitled Autoimmunity and Asbestos Exposure (see Correspondence received November 12, 2021) and the medical opinion dated November 1, 2021 (see Medical Treatment Record Non Government Facility received November 9, 2021). In rendering this opinion, the examiner's attention is directed towards the following: Service Treatment Records; Post-service treatment records; March 2016 correspondence, wherein the Veteran describing the in-service event, where, while loading food, a 90-pound bag of potatoes was dropped on the Veteran's knocking him unconscious; March 2016 third party correspondence, wherein the Veteran's ex-wife describes having to sleep on the Veteran's arms because they ached all the time; March 2016 third party correspondence from the Veteran's daughter who also reports being diagnosed with multiple sclerosis; October 2021 hearing testimony; November 2021 correspondence, containing an article discussing the connection between asbestos exposure and autoimmune diseases; and November 2021 medical opinion, wherein Dr. I.P. opines that "it is possible [the Veteran's] diagnosis of multiple sclerosis may be related to his exposure to asbestos in service." A complete rationale for any opinion should be provided. The examiner must not rely solely on the absence of a diagnosis or symptoms in service as the basis for a negative opinion. It is also noted that the mere passage of time without treatment is not a sufficient basis for finding that no relationship between a current disability and service exists. Any opinion should be reconciled with the service treatment and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. If the lay evidence is rejected, an explanation must be provided. If an opinion cannot be made without resort to speculation, please state so and include an explanation for that conclusion. 3. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the issue on appeal. If the benefits sought are not granted, issue a Supplemental Statement of the Case (SSOC), and allow the Veteran and his representative an opportunity to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Patrick C. Brady, 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.