BVA9502023 DOCKET NO. 92-53 616 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Fort Harrison, Montana THE ISSUE Entitlement to service connection for multiple sclerosis. REPRESENTATION Appellant represented by: Keith D. Snyder, Attorney ATTORNEY FOR THE BOARD W. Pope, Counsel INTRODUCTION The veteran had active service in the United States Marine Corps (USMC) from December 1, 1958 to November 30, 1962. A June 1984 decision by the Board of Veterans' Appeals (Board) denied service connection for multiple sclerosis. In December 1990 the veteran reopened his claim of service connection for multiple sclerosis by submitting new and material evidence. An August 1992 decision by the Board denied service connection for multiple sclerosis. A January 1994 memorandum decision by the United States Court of Veterans Appeals (Court) vacated the Board's August 1992 decision and remanded the appeal to the Board with instructions to obtain an independent medical opinion. The opinion, requested by the Board in July 1994, was received in November 1994 from James N. Hayward, M.D., Professor and Chair of the Department of Neurology of the School of Medicine at the University of North Carolina at Chapel Hill. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection for multiple sclerosis is warranted because it was incurred during his active military service or was manifest to the required degree within the seven-year presumptive period following service. He asserts, in essence, that he has submitted medical and lay statements which show a chain of symptoms beginning with a lower right extremity problem during boot camp. In addition, the veteran and his representative have alleged that all of his service medical records are not present and that VA has not objectively considered all the evidence of record. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that a preponderance of the evidence supports the claim of service connection for multiple sclerosis. FINDINGS OF FACT 1. All relevant evidence referable to the current appeal has been requested by the RO. 2. Multiple sclerosis was probably first manifest within seven years following the veteran's separation from service. CONCLUSION OF LAW Multiple sclerosis may be presumed to have been incurred during the veteran's military service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137, 5107, 7104 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107, and that all relevant facts have been properly developed for this appeal. I. Lost Records The Board, upon review of the total evidence of record, finds that the veteran's service medical records are complete for the purposes of this appeal. During a hearing at the RO in November 1983 the veteran testified that some "pages...are missing" from his service medical records. Specifically, he asserted that his service medical records are numbered "on the top right corner [in the sequence] 1-2-3-4-5" with "[p]age number 2...missing." (See page two of the transcript of VA hearing held November 16, 1983.) However, a careful review of the veteran's service medical records discloses that the pages numbered two, four and six, are the back (flip) sides of the pages numbered one, three and five, respectively. Further, there is no indication that any "other" service medical records are missing. An August 1984 letter from the Department of the Navy, signed by Colonel Susan M. Mason, (Head of Records Branch, Personnel Management Division, by direction of the Commandant of the Marine Corps), stated that copies of "Unit Diaries" from the units in which the veteran served during 1962 were enclosed, but contained "no entries reflecting that he was sick." Colonel Mason also enclosed a "Standard Form 600," described as an "abstract" of service. The Board's examination revealed that the information in said "abstract" essentially matches the evidence contained in the veteran's service medical records. A November 1985 letter from the Department of the Navy, signed by Colonel C. T. Sweeney, (Head of Special Correspondence Branch, Personnel Management Division, by direction of the Commandant of the Marine Corps), acknowledged that "Daily Sick Call and Surgical Records/Logs" are not included in the veteran's service medical records. Colonel Sweeney explained that such documents are "neither kept on file nor are they part of the military health record" since their purpose was "logging patients in as well as to record the reason for the visit," and noted that "[a]s a matter of policy, doctors do not write in these logs, since they are usually destroyed one year after being closed out." Therefore, it seems clear to the Board that "Daily Sick Call and Surgical Records/Logs" would be of limited probative value concerning the veteran's symptomatology during service, since they are basically administrative documents in which physicians did not write. Finally, the Board finds that the information submitted by Donald J. Bullock concerning difficulties obtaining copies of his service medical records is irrelevant. While such information shows that mistakes are made in the keeping and/or maintenance of military records, it does not alter the fact that in this appeal the appellant's service medical records appear complete and that there is an adequate factual basis for the Board's decision. II. Service Connection for Multiple Sclerosis Service connection may be granted for a disability which is shown to have been incurred in or aggravated by active service. 38 U.S.C.A. § 1131. When a veteran has sufficient service and multiple sclerosis becomes manifest to a degree of 10 percent within seven years from the date of termination of service, such disease shall be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Furthermore, service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The veteran's service medical records include a "Report of Medical History" questionnaire check-list signed by the veteran and accompanying a November 26, 1958 preenlistment examination, on which he reported past or current mumps, whooping cough, eye trouble, hay fever, palpitation or pounding heart, appendicitis, and motion sickness. The explanation portion of the questionnaire indicated that the veteran had had the usual childhood diseases, had undergone an appendectomy at age 14, wore glasses, and had mild hay fever which did not require prescription medication. The examination was reported as normal with the exception of bilateral refractive error. Subsequent service medical records reveal that the veteran received a visual acuity examination on December 4, 1958; was treated for rubella from February 21, to February 23, 1959; was found physically qualified for transfer in March, April and June 1959; received a visual acuity examination in July 1961; had a wart removed in January 1962; and was seen for "[p]ain in testes" on March 21, 1962. A separation examination in November 1962 was reported as normal with the exception of bilateral refractive error. On an "Annual Certificate of Physical Condition" questionnaire check-list signed by the veteran and postmarked March 12, 1963, he reported past or current hay fever or sinusitis, and palpitation or pounding heart. In the space on the questionnaire provided for required explanations concerning affirmatively "checked" items, the veteran reported that he usually had hay fever throughout the summer and a pounding heart, "occasionally." An unsigned "Annual Certificate of Physical Condition" questionnaire check-list, postmarked January 23, 1964, indicates that the veteran reported past or current hay fever or sinusitis, appendicitis, foot trouble, shortness of breath or asthma, pain or pressure in chest, leg cramps, night sweats, paralysis, loss of memory or amnesia, excessive drinking habit, and motion sickness. The space on the questionnaire provided for required explanations concerning affirmatively "checked" items was blank. The earliest post-service clinical records are reports from Douglas Schumacher, M.D., confirming that the veteran was seen for a left ankle injury on December 1, and again on December 5, 1964, and for a "College Physical." He was next seen by Dr. Schumacher in February 1966 with a three week history of a dull ache and lump in the epigastric region, which was "somewhat relieved by milk." The initial episode of the epigastric discomfort was associated with "excessive beer." The veteran was treated with "2nd week ulcer diet [and] Mylanta," and advised to return in four days. On a "Report of Medical History" questionnaire check-list signed by the veteran and accompanying a January 1969 USMC Reserve examination, he reported past or current mumps, hay fever, palpitation or pounding heart, and appendicitis. The explanation portion of the questionnaire contained a notation of "[n]o significant history." The examination was reported as normal with the exception of a few small scars and bilateral refractive error corrected by lenses. Clinical records received from The Western Montana Clinic cover a period from June 1969 through May 1981. During his initial visit the veteran reported a history of a tonsillectomy at age 5 years, an appendectomy at age 14 years, pneumonia in high school, measles in service, allergies, and an old fracture of the right hand. A physical examination was reported as negative with the exception of mild conjunctivitis and nasal congestion. The examiner's impression was seasonal rhinitis. The veteran was next seen in September 1969 following a 20 minute episode of paroxysmal rapid heart beat associated with anterior chest pain. He reported a history of paroxysmal rapid heart action since age 14 years, with approximately 50 attacks per year. The examiner's impression was "[n]o heart disease. Paroxysmal rapid heart action probable. No treatment indicated." The veteran was instructed regarding methods of stopping attacks, and advised to avoid coffee and cigarettes. The Western Montana Clinic records disclose that the veteran was seen exclusively by W. A. Reynolds, M.D., between February and December 1970. The record of his first visit with Dr. Reynolds, dated February 12, 1970, noted complaints related to hay fever. The diagnosis was "allergic rhinitis." During the second visit, dated March 24, 1970, Dr. Reynolds recorded: Intermittent muscular twitching, muscle [right] side of face - chin cheek & under [right] eye. Occurred initially [after] mid day, worse as day wears on. No prev Hx same. Has been tense - up tight - for couple weeks or months. Some stress [with] job no major problems. Sleeps ok. Every spring - unusual Sx - flex neck - shock on abd[omen]. Feet cold one spring. Others in family have similar Sx (2 sibs) Tranquilizer in past no help. Feeling scratching leg through screen on legs. - Exam - Constant fibrillating motor activity - muscle twitching [right] side face from eye to chin - esp under [right] eye. Impression - Muscle twitching - ? etiology ? demyelinating synd Rx - Valium 5 g 4 hr prn doubt. If not relieved - return for neuro exam. The record of the veteran's third visit with Dr. Reynolds, dated March 30, 1970, noted that the twitching of the face persisted and was not relieved with Valium. The veteran reported getting upset and flying "off the handle" after having "[h]ad beer" the preceding day, and having feeling of frustration and paranoia related to his employment. The report also noted that he was "[t]ired - not much energy. Doesn't much care about life. Suicide thoughts but rejected." He complained of occasional dull pain in the right eye and occasional roaring in the ears. An examination revealed constant fibrillating twitching of the right side of the face. Hyperventilation produced marked increase twitching of the neck and "2+ droop [right] side of the face - (lips)." The impression was "[d]epression. Fibrillating twitching [right] side face & neck. Hyperventilation. [Rule out] angle tumor. See tests." Dr. Reynolds' opined that the veteran's symptoms were "all [secondary] to depression, anxiety and hyperventilation." Elavil and Valium were prescribed. The veteran was instructed to refrain from using alcohol and to return to the clinic the following Monday. Dr. Reynolds' clinical report dated April 6, 1970 noted that the veteran's twitching and depression had decreased. An April 28, 1970 clinical notation stated that "Valium relieves twitching." Clinical notations from May and June 1970, and from the veteran's eighth visit in September 1970, were devoted to problems resulting from stress and his employment. An October 10, 1977 statement by F. Tempel Riekhof, M.D., disclosed that the veteran had reported an approximate five day history of a temporal defect in the left eye when examined on October 5, 1977. He had also reported a rather severe headache on September 15, 1977. An examination confirmed defects in the veteran's left eye and "at least the suggestion of" an inferior nasal defect in the right eye. Dr. Riekhof suspected that the veteran was suffering from an episode of retrobulbar neuritis and, in the absence of intrinsic ocular pathology which would explain such visual field defect, strongly recommended that the veteran be examined by a neurologist in the near future. The veteran was hospitalized by VA on October 10, 1977 for neurological evaluation. He reported progressive left visual loss 10 days prior to admission and denied all "other neurological complaints...except for occasional shooting pain in his left temporal region." He gave a history including two episodes of left peripheral visual loss and left arm clumsiness in approximately 1972 which were about three months apart and lasted a total of approximately four hours, and a 1974 episode during which his legs felt "asleep." An ophthalmological examination during the hospitalization produced results similar to those reported by Dr. Riekhof. Laboratory studies disclosed an elevated "IGG albumin ratio [of] 34.1%." The hospital report indicated that such a reading "could suggest" a demyelinating disease. The veteran was discharged on October 20, 1977 with diagnoses of "[u]ndiagnosed disease of the central nervous system manifested by left inferior quadrantanopia", and left maxillary sinusitis. A January 1978 examination report by Stephen F. Johnson, M.D., of The Western Montana Clinic, stated that the veteran's complaints were "quite complex. He [had] considered himself perfectly healthy until around the first of Oct[ober] of 1977 when he began to have" visual problems in the left eye. The veteran also reported episodes of weakness, numbness and tingling of the extremities, and urinary problems. He indicated that these difficulties had improved, but "become evident again when he goes out in the cold weather." Dr. Johnson's summary of the veteran's medical history noted "as stated, has been entirely unremarkable. There were no neurologic symptoms prior to Oct[ober] of 1977." Dr. Johnson's analysis, following a neurological examination, was "[o]ptic neuritis [and] [p]robable multiple sclerosis." A March 1978 report of neurological examination by Dale M. Peterson, M.D., stated that the veteran had a history of "some bilateral abdominal numbness in 1967 that lasted about four weeks and then cleared up"; relatively short "spells of weakness of the left face, arm and leg" in 1972; "loss of peripheral vision in the left eye" with other significant examination results during hospitalization in October 1977; and "three [subsequent] spells [of] generalized weakness and ataxia of subacute onset which resolved." The veteran's current complaints included urinary urgency, some impotence and Lhermitte's phenomenon when he flexed his neck. An examination disclosed some decreased reflexes in the left upper arm, some absent abdominal reflexes, slightly increased knee and ankle jerks on the right, and a slight terminal tremor on finger to nose testing. Dr. Peterson concluded that "[a]lthough there are a paucity of neurological findings at present, the history of multiple episodes of dysfunction in the central nervous system in space and time would make me feel that [the veteran] does indeed have a mild form of multiple sclerosis." Following examination of the veteran during "an outpatient visit" in April 1978, a VA physician provided a summary of the veteran's neurological history and expressed the opinion that his "present illness may go back as far as 1967 at which time he had a peculiar sensation of numbness...like 'scratching through a screen' in his lower abdominal area on both sides." Copies of a "flow sheet" concerning the veteran's treatment from June 1975 through November 1980 were received from Warren M. Swager, Jr., M.D., in November 1982. A handwritten entry indicated the "onset of MS" beginning on February 5, 1977, although the clinical notes recorded on that date are not legible. In an April 1983 statement Dr. Reynolds attempted to explain the clinical notes (quoted above) he recorded on March 24, 1970. Dr. Reynolds concluded: In retrospect, I think it is quite clear that the twitching and fibrillatory movements of the face and the unusual symptom described March 24, 1970 of flexion of the neck causing shock on the abdomen was probably a Lhermitte's sign, which is suggestive of multiple sclerosis. My note at that time does not say how many years that had been going on, but the implication was that it had been there for a number of years. I would have said two years if [it] had only been that long, and so it must have been three or more years by saying every spring. My impression was indeed a concomitant of his problem, but certainly not the cause of the muscle twitching, therefore, in retrospect, I think it is reasonable to say that the symptoms of multiple sclerosis began prior to 1967. The veteran, Don Bullock, Jay Dixon and Ford Bovey testified during a hearing at the RO in November 1983. The veteran testified that he had been treated for a problem with his right ankle while "in boot camp," but that his service medical records did not show this because some of the "pages...are missing." As previously noted, he asserted that his service medical records were numbered "on the top right corner [in the sequence] 1-2-3-4- 5" with "[p]age number 2...missing," and that "[p]age 2 would have had the record where I had gone to sick bay and was consequently transferred to the hospital in San Diego, examined and then sent back to duty." See page two of the transcript of VA hearing held November 16, 1983. A September 1987 letter from David J. Thurman, M.D., revealed that he had examined the veteran on September 18, 1987. It was reported that the veteran had multiple sclerosis with a history of "first symptoms...in early 1959....with a right-sided foot drop associated with numbness in the right lower extremity which resolved. [The veteran] recalls further symptoms in 1967 when he had some numbness and dysesthesias in the lower abdominal regions bilaterally." The veteran's history also included left facial muscle twitching "around 1970" and subsequently recorded symptomatology. The letter disclosed that Dr. Thurman had been a "staff physician in neurology" at a VA Hospital in May 1985, when the veteran was admitted because of increased difficulties in the lower extremities. It was stated that "a definite diagnosis of multiple sclerosis" had been made in May 1985, and that the veteran had provided "the aforementioned history at that time." The letter also disclosed that Dr. Thurman had examined the veteran a second time in April 1986. Dr. Thurman further stated that he was aware that the veteran's service medical records "do not contain mention of his transient right lower extremity symptoms during 1959 or 1960." However, noting that the veteran had given "a consistent and very reasonable description of his medical history on each [prior] occasion," and noting "the fact that some of [the veteran's] Marine Corps service medical records were apparently lost," Dr. Thurman concluded that the veteran "deserves the benefit of the doubt regarding his application for disability." A second letter from Dr. Thurman, dated in January 1988, reported that he had reviewed Dr. Reynolds' April 1983 statement and agreed that the veteran's 1970 "shock" on his abdomen associated with neck flexion represented Lhermitte's sign, and was "another symptom supporting an earlier onset of multiple sclerosis..." In an October 1988 statement Ray O. Bjork, M.D., suggested 1962 as the onset date of the veteran's multiple sclerosis, based upon a March 21, 1962 entry of "[p]ain in testes" in his service medical records. In a November 1989 statement Gene C. Wilkins, M.D., suggested the possibility that the March 21, 1962 entry was symptomatic of the veteran's subsequently diagnosed multiple sclerosis. Dr. Johnson, in an August 1990 letter, stated that he agreed with Dr. Reynolds' 1983 analysis concerning the onset of the veteran's multiple sclerosis symptoms. The veteran's claims file contains lay statements from numerous friends and colleagues, including some fellow veterans, received between 1982 and 1990. The aforementioned January 1994 decision by the Court stated that the Board's 1992 decision did "not adequately address" the opinions of two physicians and "was silent" as to the "appellant's 1964 'Annual Certificate of Physical Condition' on which appellant indicated foot trouble, leg cramps, night sweats, paralysis, and loss of memory." Concerning the physicians' opinions, the Court noted that: [W]hile numerous physicians have opined onset dates before or during the seven-year presumptive period for appellant's multiple sclerosis, only two of such opinions are based upon, and corroborated by, chronologically contemporaneous medical records. Dr. Reynolds posits that the onset date is prior to 1967 based upon his 1970 medical entries regarding appellant's past and then-current complaints, entries which are dated only four months after the expiration of the presumptive period. Dr. Bjork opines 1962 as the onset date based upon appellant's 1962 service medical record entry of 'pain in the testes.' Accordingly, the Board was instructed to: supplement the record by requesting an independent medical opinion to determine whether there is a relationship between the symptoms evidenced in appellant's 1962 service medical record, appellant's 1964 'Annual Certificate of Physical Condition,' and Dr. Reynolds' 1970 medical entry and the onset of appellant's multiple sclerosis. Dr. Hayward's November 1994 written opinion stated that the most widely used scheme for the clinical diagnosis of multiple sclerosis were the "Schumacher criteria...developed for use in treatment protocols...provid[ing] objective criteria for critical neurological judgements." Dr. Hayward reported that the Schumacher criteria: [C]ategorizes the patients as 'clinically definite MS', 'clinically probable MS' or 'clinically possible MS', according to the number of following criteria that were satisfied: 1) Age of onset between 10 and 50 years; 2) Objective neurological signs present on examination; 3) Neurologic symptoms and signs indicative of [central nervous system] white matter disease; 4) Dissemination in time: (a) two or more attacks (lasting at least 24 hours) and separated by at least a month. (An attack is defined as the appearance of new symptoms or signs of worsening of previous ones); or b) progression of symptoms and signs for at least six months; 5) Dissemination in space: two or more noncontiguous anatomical areas involved; 6) No alternative clinical explanation. Patients are classified as 'clinically definite MS' if they meet five or six criteria, always including number 6. Following the explanation of the criteria utilized, Dr. Hayward evaluated the three groups of evidence presented. In consideration of Dr. Bjork's opinion providing 1962 as the onset date for the veteran's multiple sclerosis, Dr. Hayward stated that: [T]he March 21, 1962 service medical record of pain in the testes, other than age, does not meet any of the remaining five Schumacher criteria for the diagnosis of sclerosis and therefore does not support the case of service connection for multiple sclerosis at this time. Pain in the testes is rarely seen in [central nervous system] white matter disease. In consideration of the past or present symptoms reported on the veteran's 1964 Annual Certificate of Physical Condition, Dr. Hayward stated that the items checked: [I]ncludes some items which may be symptoms caused by [central nervous system] white matter disease...However, other than Schumacher criteria # 1) age and # 3) symptoms of [central nervous system] white matter disease, this check list...do[es] not satisfy the other Schumacher criteria for the diagnosis of clinically definite multiple sclerosis. Without more information regarding the other Schumacher criteria, particularly # 2, # 4, # 5 and # 6 it is not possible to classify these symptoms as either clinically probable MS or clinically possible MS. In consideration of Dr. Reynolds' opinion providing an onset date in 1970 for the veteran's multiple sclerosis, Dr. Hayward stated that: [T]he 1970 medical entries of Dr. Reynolds,...do satisfy most of the Schumacher criteria. Brain stem demyelination of the seventh nerve with hemifacial spasm (right facial muscular twitching) is a common symptom and sign in multiple sclerosis. Demyelination of the dorsal columns in the cervical spinal cord with the resulting heightened mechanosensitivity upon neck flexion, with an electrical sensation (shock) radiating down the arms, spine, or legs and into the abdomen or pelvic, namely Lhermitte's symptoms and sign, is a common finding in multiple sclerosis. These brain stem and spinal cord demyelinating episodes satisfy both Schumacher criteria # 4) Dissemination in Space, and criteria # 5) Dissemination in Time. These data would indicate that the [veteran] satisfied most of the criteria for the diagnosis of clinically definite multiple sclerosis in 1970. Initially, it should be noted that there is no conflict concerning the fact that the veteran has multiple sclerosis. However, the Board finds no competent evidence confirming symptoms of multiple sclerosis during the veteran's active military service. Despite the veteran's assertions, his early service medical records (page number two, etc.) are of record and are negative for any evidence of his alleged right lower extremity difficulties during service. In fact, the first clinical record of such abnormalities is a March 1970 report by Dr. Reynolds. While the veteran did experience an episode of testicular pain in March 1962, there is no clinical evidence which substantiates that such a symptom is indicative of multiple sclerosis. To the contrary, Dr. Hayward specifically stated in his November 1994 report that "[p]ain in the testes is rarely seen in [central nervous system] white matter disease." Furthermore, it is quite evident that the various post-service clinical reports of symptomatology related to multiple sclerosis during service are based on histories provided by the veteran, but are not substantiated by the contemporaneous medical records. In the absence of evidence of multiple sclerosis during the veteran's service, the question remaining before the Board is whether entitlement to service connection is warranted based on the presumption of incurrence. In this regard, the veteran's representative contends that "the fact" that the November 1994 independent medical opinion "categorized the veteran's [multiple sclerosis] as clinically definite in March 1970... a grant of service connection [is warranted] even though this diagnosis falls four months outside the seven-year presumptive period." See page one of Mr. Snyder's December 1994 written argument. The evidence of record shows that multiple sclerosis was initially confirmed by Dr. Peterson in March 1978, following findings of objective evidence of relevant symptomatology during an ophthalmological examination by Dr. Riekhof in October 1977, evaluation and testing during hospitalization by VA in October 1977, and a neurological examination by Dr. Johnson in January 1978. Dr. Peterson's report revealed numerous relevant symptoms supporting his diagnosis of "a mild form" of multiple sclerosis, including the veteran's complaint of Lhermitte's phenomenon when he flexed his neck. In searching for earlier evidence of multiple sclerosis, the Board found that the earliest post-service evidence were the "Physical Condition" questionnaires from March 1963 and January 1964. As noted, the questionnaire with the more extensive list of symptoms, the January 1964 document, did not include explanations concerning the symptoms reported. While the veteran's failure to provide the requested contemporaneous information is unfortunate, it is clear from Dr. Hayward's report that the January 1964 evidence is insufficient to satisfy the criteria for the diagnosis of clinically definite multiple sclerosis. If fact, Dr. Hayward noted that the absence of additional evidence, including the lack of objective neurological signs, negated the possibility of a classification of clinically probable or clinically possible multiple sclerosis. The first post-service evidence of objective neurological signs was Dr. Reynolds' March 24, 1970 clinical report noting muscle twitching on the right side of the veteran's face and abdominal "shock" with neck flexion. Dr. Reynolds' impression of "possible" demyelinating syndrome was subsequently confirmed by Dr. Hayward's November 1994 finding that the hemifacial spasm and Lhermitte's sign fulfilled most of the criteria required "for the diagnosis of clinically definite multiple sclerosis in 1970." In addition, Dr. Hayward's opinion concerning such findings provides independent confirmation of the earlier statement by Dr. Reynolds that the multiple sclerosis was present prior to March 24, 1970 during the presumptive period. In view of all the evidence of record, including consideration of the recently obtained independent medical opinion, the Board finds that a reasonable basis has now been presented for concluding that the veteran's multiple sclerosis was present to a degree of 10 percent or more during the seven-year presumptive period ending in November 1969. Accordingly, the Board finds that a grant of service connection for multiple sclerosis is warranted. ORDER Service connection for multiple sclerosis is granted. STEPHEN L. WILKINS Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.