Citation Nr: 9821887	
Decision Date: 07/20/98    Archive Date: 08/03/98

DOCKET NO.  95-31 561	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Louisville, 
Kentucky


THE ISSUE

Entitlement to service connection for multiple sclerosis.


REPRESENTATION

Appellant represented by:	Paralyzed Veterans of America, 
Inc.


ATTORNEY FOR THE BOARD

D. S. Nelson, Associate Counsel


INTRODUCTION

The veteran had active service from September 1967 to 
September 1970.  This matter comes before the Board of 
Veterans’ Appeals (BVA or Board) on appeal from a July 1994 
rating decision of the Department of Veterans Affairs (VA) 
Regional Office (RO) in Louisville, Kentucky, which denied 
the benefit sought on appeal.


REMAND

Since the January 1995 Statement of the Case, additional 
evidence has been received without a waiver of the veteran's 
right to initial RO consideration.  Specifically, a four page 
summary of the veteran’s medical records and an opinion, 
dated in June 1998 and signed by Craig Bash, M. D., a 
neuroradiologist with the Uniform Services University of 
Health Sciences, is of record and has not been considered by 
the RO.  Any pertinent evidence submitted by the veteran 
which is accepted by the Board must be referred to the RO for 
review and preparation of a supplemental statement of the 
case, unless this procedural right is waived by the 
appellant.  38 C.F.R. § 20.1304(c) (1997).  Since the veteran 
has not waived this procedural right, this case must be 
remanded so that the RO can review of the medical evidence in 
question.  Id.

The Board further notes that, while the medical evidence 
currently of record does not show a diagnosis of multiple 
sclerosis until 1984 or well beyond the 7 year presumptive 
period that applies to the disability at issue (see 38 C.F.R. 
§§ 3.307, 3.309 (1997), Dr. Bash indicated in his June 1998 
statement that he reviewed the veteran's medical records and 
he opined that there was positive evidence that multiple 
sclerosis symptoms began in service.  Dr. Bash based his 
opinion in part on visual changes that the veteran had 
undergone in service, and on a MRI study conducted in 1988 
that revealed white matter lesions distributed in the 
periventricular regions as well as throughout both cerebral 
hemispheres, along with atrophy of the corpus callosum.  Dr. 
Bash did note that some of the veteran’s loss of visual 
acuity was present upon entry into service and service 
medical records show evidence of eye disease.  Moreover, the 
MRI findings cited by Dr. Bash were from a study performed in 
1988, more than 17 years after service.  

If the medical evidence of record is insufficient, or, in the 
opinion of the Board, of doubtful weight or credibility, the 
Board is always free to supplement the record by seeking a 
medical opinion.  Colvin v. Derwinski, 1 Vet. App. 171, 175 
(1991).  It is the Board’s judgment that an opinion from a 
neurologist would be helpful in resolving the issue at hand.  
Green v. Derwinski, 1 Vet. App. 121 (1991). 
 
The Board also finds that there may be additional medical 
records available that are relevant to the veteran’s claim.  
The veteran indicates that she was treated at Walter Reed 
Army Medical Center for eye problems while she was on active 
duty.  Her representative indicates that there may be 
additional relevant medical records from the University of 
Missouri Columbia School of Medicine relating to treatment 
that the veteran received in 1973-1974.  The VA's statutory 
duty to assist the veteran includes the obligation to obtain 
pertinent treatment records, the existence of which has been 
called to its attention.  Murphy v. Derwinski, 1 Vet. App. 78 
(1990); Ivey v. Derwinski, 2 Vet. App. 320 (1992); Murincsak 
v. Derwinski, 2 Vet. App. 363 (1992). 

Accordingly, this case is REMANDED for the following actions: 

1.  The RO should obtain copies of any 
additional service medical records that 
may be available from the Walter Reed 
Army Medical Center Opthamology clinic, 
and copies of any additional post-service 
medical records that may be available 
from the University of Missouri Columbia 
School of Medicine, Department of 
Neurology, relating to treatment the 
veteran received there in 1973-1974.  The 
RO should also contact the veteran and 
have her identify (names, addresses and 
dates) any other sources of relevant VA 
or non-VA treatment or examination.  The 
RO should then secure copies of all 
identified records that are not already 
on file and associate them with the 
claims folder.  38 C.F.R. § 3.159.

2.  Thereafter, the claims file and a 
copy of this remand must be referred to a 
VA neurologist.  After a review of the 
relevant medical evidence, including the 
service medical records and the four page 
medical statement from Dr. Bash, the 
neurologist should opine whether it is at 
least as likely as not that (a) the 
veteran’s multiple sclerosis is causally 
related to symptoms reported during 
service (September 1967 to September 
1970); and (b) the veteran’s multiple 
sclerosis had its onset during service or 
within 7 years of service.  Any opinion 
expressed must be supported by a written 
rationale, and a discussion of the facts 
and medical principles involved would be 
of considerable assistance to the Board.

3.  When the development requested has 
been completed, the case should again be 
reviewed by the RO.  If the benefit 
sought is not granted, the veteran and 
her representative should be furnished a 
supplemental statement of the case, which 
reflects a review of all additional 
evidence, including Dr. Bash’s June 1998 
medical statement and opinion, and be 
afforded a reasonable opportunity to 
respond before the record is returned to 
the Board for further review.

The purpose of this REMAND is to obtain additional 
development, and the Board does not intimate any opinion as 
to the merits of the case, either favorable or unfavorable, 
at this time.



		
	R. F. WILLIAMS	
	Member, Board of Veterans' Appeals

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the 
Board of Veterans' Appeals is appealable to the United States 
Court of Veterans Appeals.  This remand is in the nature of a 
preliminary order and does not constitute a decision of the 
Board on the merits of your appeal.  38 C.F.R. § 20.1100(b) 
(1997).



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