Citation Nr: 22051142
Decision Date: 09/08/22	Archive Date: 09/08/22

DOCKET NO. 18-18 130
DATE: September 8, 2022

REMANDED

Entitlement to service connection for a bilateral lower extremity nerve disability, to include peripheral neuropathy and multiple sclerosis (MS), is remanded.

REASONS FOR REMAND

The Veteran served on active duty from January 1968 to June 1969, to include service in the Republic of Vietnam. 

The appeal was most recently before the Board in May 2021 and was denied.  The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (CAVC) which granted a Joint Motion for Remand (JMR) vacating the Board's decision and remanding for further development.  The parties to the JMR agreed that the claim should be expanded to include consideration of whether the Veteran's bilateral lower extremity symptoms are due to MS and if so, whether the MS is related to service.  Clemons v. Shinseki, 23 Vet. App. 1 (2009).

1. Entitlement to service connection for a bilateral lower extremity nerve disability, to include peripheral neuropathy and MS.

The claim is remanded to obtain outstanding treatment records and medical opinions. The parties to the JMR noted private treatment records from Dr. Mandell and Manon at Jefferson hospital in 2002 have a reasonable possibility of substantiating the claim. Those records should be obtained on remand. 

After any available records are obtained, a medical opinion is needed to address whether the Veteran's lower extremity neurological symptoms are related to the diagnosed MS and whether the MS is related to service.

The matters are REMANDED for the following action:

1.  Ask the Veteran to complete a VA Form 21-4142 for any physician treating his MS at Jefferson Hospital in 2002 or any other records from Dr. Mandell and Manon.  Make two requests for the authorized records from Jefferson Hospital, unless it is clear after the first request that a second request would be futile.

2. Ask the Veteran to identify any treatment providers who treated him for MS after service. Take all appropriate action to obtain any related records.

3.  After the above development, schedule the Veteran for an examination with an appropriate clinician (preferably a neurologist) to determine the nature and likely etiology of any diagnosed lower extremity nerve disability. Copies of all pertinent records must be made available to the examiner for review. 

The examiner is asked to provide a response to the following:

(a) Identify all nerve-related disabilities affecting the lower extremities; does the Veteran have a neurological disability affecting the lower extremities that is distinct from the diagnosed MS? 

(b) For any lower extremity neurological disability other than MS, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosed disability was incurred in or related to the Veteran's service, to include the conceded exposure to herbicides? 

(c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that that diagnosed MS (i) begin during active service; (2) manifest within seven years after discharge from service, or; (3) is otherwise related to service?  

A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made.

 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	P.S. McLeod

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.