BVA9502521 DOCKET NO. 93-10 521 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to service connection for a neurologic disorder, to include multiple sclerosis. REPRESENTATION Appellant represented by: West Virginia Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL Appellant and John Strum ATTORNEY FOR THE BOARD R. P. Harris, Counsel INTRODUCTION The appellant had active service from December 1967 to August 1968 and March to December 1976. This matter came before the Board of Veterans' Appeals (Board) on appeal from 1990 rating decisions of the Pittsburgh, Pennsylvania, Regional Office (hereinafter RO), which denied service connection for a neurologic disorder, classified as multiple sclerosis. REMAND It is contended, in essence, that the appellant has a neurologic disorder manifested by a myriad of symptoms, including neurologic deficits of the extremities; and that the disorder had its origin in service. It is argued that although his neurologic disorder has been variously diagnosed as multiple sclerosis, spinocerebellar degeneration, and, most recently, central pontine myelinolysis, the abnormal neurologic symptomatology, whatever its diagnosis, had an inservice onset, and has progressively worsened ever since. In an August 1990 statement and in his substantive appeal, the appellant had expressed an intention to claim service connection for neurologic disorders in addition to multiple sclerosis. However, it appears that the RO has only formally adjudicated the issue of service connection for multiple sclerosis, not the other neurologic disorders that he has been diagnosed as having. A few months after military discharge from his second period of service, the appellant was evaluated by Joseph E. Hall, M.D., for symptoms of nervousness and very poor memory; and "Pathology of unknown etiology in the central nervous system" was diagnosed. The basis and meaning of this diagnosis is unclear. Additionally, Dr. Hall stated that laboratory and radiographic studies would be performed after the patient was referred to a central nervous system disorder specialist at the Wheeling Clinic, Wheeling, West Virginia. Dr. Hall's actual clinical records and those of the Wheeling Clinic are not currently associated with the claims folder, and there is no indication that the RO has attempted to obtain these. Additionally, the examiner on Department of Veterans Affairs (VA) neurologic examination in August 1992 diagnosed the appellant as having a "neurologic condition which became symptomatic while he was in the service"; suggested the possibility that this was multiple sclerosis; and referred to an impending hospitalization that would attempt to reach a more specific diagnosis. However, there is no definite indication that this examiner had reviewed the appellant's entire claims folder, including his service medical records, in rendering this diagnosis; but rather he appears to have relied upon the history of inservice neurologic impairment provided by the appellant, a history not clearly supported by the actual service medical records. See West v. Brown, 7 Vet.App. 70, 78 (1994), referring to inadequacy of the record where, in a case involving a service connection issue, the examiner rendered a diagnosis based upon a questionable history of events. The evidentiary record is presently unclear as to the nature and etiology of any neurologic disorder that may be currently manifest. VA has a duty to assist the veteran in the development of facts pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991). The Board must consider only independent medical evidence to support its findings rather than provide its own medical judgment. Colvin v. Derwinski, 1 Vet.App. 171 (1991). Accordingly, the case is REMANDED for the following: 1. The RO should contact the appellant and request the names and addresses of physicians and/or medical facilities which have provided him any relevant treatment for a neurologic condition, prior to each period of service and subsequent to service. In particular, since the service medical records relate a history of childhood measles encephalitis and, in February 1968, clinically noted deficient right-sided musculature despite his being right-handed, any clinical evidence prior to his initial period of service would be especially beneficial. Additionally, any relevant clinical records should be obtained from: Joseph E. Hall, M.D., Box 357, 6th Street, Newell, West Virginia, and the Wheeling Clinic, Wheeling, West Virginia. In the event that these addresses are not current, the RO should diligently pursue all avenues to obtain these records, including, but not limited to, contacting said healthcare providers by other reasonable means; and such efforts should be recorded in the claims folder. These records should be associated with the claims folder. The appellant should be requested to sign and submit appropriate consent forms to release private medical reports to the VA. 2. The RO should schedule a neurologic examination, preferably by a specialist in neuromuscular disorders and demyelinating diseases, to determine the current nature and severity of any neurologic disability currently manifested and its etiology. All indicated tests and studies should be performed. The claims folder shall be made available to the examiner prior to the examination, and the specialist should review the entire evidentiary record; correlate the findings with the laboratory and electrodiagnostic (including MRI) studies of record; express an opinion as to the nature, diagnosis, and etiology of any neurologic disorder currently manifested (including an opinion as to the degree of probability that any such disorder had its onset in service, or if not of service onset, the approximate date of onset); comment on the significance, if any, of the history contained in the service medical records of childhood measles encephalitis and inservice clinical notation of deficient right-sided musculature despite his being right-handed; and comment on the significance, if any, of the March 1977 statement from Dr. Hall, containing a diagnosis of "Pathology of unknown etiology in the central nervous system." If these matters are not medically capable of determination without resort to mere conjecture, this should be commented upon in the physician's report. 3. The RO should adjudicate or readjudicate entitlement to service connection for any and all neurologic disorders that may be presently manifested. In order to avoid undue delay in this case, the RO should make certain that the instructions contained in this REMAND decision, detailing the requested development, have, in fact, been substantially complied with. When this development has been completed, and if the benefit sought is not granted, the case should be returned to the Board for further appellate consideration, after compliance with appropriate appellate procedures, including issuance of a supplemental statement of the case. It is requested that this statement specifically set forth the reasons and bases for the decision. No action by the appellant is required until he receives further notice. The Board intimates no opinion, either legal or factual, as to the ultimate disposition warranted in this case, pending completion of the requested development. HOLLY E. MOEHLMANN 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. (CONTINUED ON NEXT PAGE) 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) (1993).