MULTIPLE SCLEROSIS

Summary

The Veteran, who served from November 1990 to March 1997 and again from June 1998 to November 1998, appeals the denial of service connection for multiple sclerosis (MS). The Veteran claims she began experiencing symptoms consistent with MS during service, including leg spasms and episodes of pseudobulbar affect, but was not diagnosed until after separation. The Board reviewed evidence including the Veteran's testimony from a November 2024 hearing, her separation medical history from January 1997, and three post-hearing medical opinions from her VA treating neurologist, Dr. J.L. The Veteran testified to experiencing leg spasms and uncontrollable crying during service, and believes her extended deployment to Cuba delayed her diagnosis. Dr. J.L. opined that the in-service symptoms were likely early manifestations of MS and that earlier treatment could have prevented current deterioration. The Board found Dr. J.L.'s opinion highly probative due to its detailed rationale and consideration of all evidence. While acknowledging a negative opinion from a June 2021 VA examiner, the Board found it inadequate for failing to address the in-service symptoms. The Board determined the evidence regarding the onset of MS during service was in approximate balance, thus applying the benefit of the doubt in the Veteran's favor. Service connection for multiple sclerosis was granted.

Rationale

Favorable opinion from VA treating neurologist Dr. J.L. linking in-service symptoms to MS.; Inadequate negative opinion from June 2021 VA examiner who failed to address in-service symptoms.; Application of benefit of the doubt due to approximate balance of evidence.

Full Decision Text

Citation Nr: A26036318
Decision Date: 04/20/26	Archive Date: 04/20/26

DOCKET NO. 210629-169223
DATE: April 20, 2026

ORDER

Entitlement to service connection for multiple sclerosis is granted.

FINDING OF FACT

The evidence is at least approximately balanced as to whether the Veteran's multiple sclerosis had an in-service onset.

CONCLUSION OF LAW

Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for multiple sclerosis are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1990 to March 1997 and from June 1998 to November 1998.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2021 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on November 8, 2024.

Therefore, the Board may only consider the evidence of record at the time of the June 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires competent evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).  

VA has also established certain rules and presumptions for chronic diseases, including multiple sclerosis.  See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).  With chronic diseases shown in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b).  If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim.  38 C.F.R. § 3.303(b).  In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within a certain period after separation from service. For multiple sclerosis, that period is 7 years. 38 C.F.R. §§ 3.307(a)(3), 3.309(a).

After careful consideration of the evidence, any reasonable doubt remaining is to be resolved in favor of the Veteran. ?38?U.S.C. §?5107;?38?C.F.R. §?3.102.  If the evidence is not in approximate balance or nearly equal, the claim is to be denied.  Lynch?v. McDonough,?999 F.3d 1391 (2021).

Entitlement to service connection for multiple sclerosis is granted.

The Veteran is seeking service connection for multiple sclerosis. Specifically, she asserts that she began to have symptoms of multiple sclerosis during service that was not diagnosed until after her separation. 

The AOJ has favorably found that the Veteran has a current diagnosis of multiple sclerosis and has
 careful consideration of the evidence, any reasonable doubt remaining is to be resolved in favor of the Veteran. ?38?U.S.C. §?5107;?38?C.F.R. §?3.102.  If the evidence is not in approximate balance or nearly equal, the claim is to be denied.  Lynch?v. McDonough,?999 F.3d 1391 (2021).

Entitlement to service connection for multiple sclerosis is granted.

The Veteran is seeking service connection for multiple sclerosis. Specifically, she asserts that she began to have symptoms of multiple sclerosis during service that was not diagnosed until after her separation. 

The AOJ has favorably found that the Veteran has a current diagnosis of multiple sclerosis and has favorably found that multiple sclerosis is a chronic disease. See June 2021 Rating Decision - Narrative. As noted above, multiple sclerosis has a 7 year presumptive period. 38 C.F.R. § 3.307(a)(3). However, the Board finds that service connection on a direct basis is warranted.

Turning to the evidence, during a November 2024 Board hearing, the Veteran testified that she first began experiencing symptoms later attributed to her multiple sclerosis during her active duty service. Specifically, she reported that while attending interrogation school, she experienced spasms in her legs and episodes consistent with pseudobulbar affect. She described one such episode, stating, "I did an entire two and a half hour interrogation crying," without knowing why she was crying or being able to stop it. The Veteran further asserted that her extended deployment to Cuba contributed to a delay in the diagnosis and treatment of her multiple sclerosis. See November 2024 Hearing Transcript. In her January 1997 Report of Medical History at separation, she reported swollen or painful joints, dizziness or fainting spells, frequent or severe headaches, and eye trouble. She also reported experiencing severe leg cramps from September 1991 through Fall 1995, for which she sought treatment at sick call. However, the reasons for her cramps were not defined and she was not prescribed medication. See January 1997 Report of Medical History (Labeled December 2018 STR). 

The Veteran submitted three statements from her VA treating neurologist (Dr. J.L.) during the post-hearing evidentiary window. In these statements, Dr. J.L. opined that, based on his review of the Veteran's medical records and his treatment of her, the muscle cramps she experienced during service may have been spasms and were likely early manifestations of multiple sclerosis, indicating an onset of the disease in September 1991. He further explained that the pseudobulbar affect demonstrated by her uncontrolled crying during interrogations was most likely also an additional initial symptom of her multiple sclerosis. Dr. J.L. also opined that an earlier diagnosis and treatment with disease modifying therapy could have prevented her current level of deterioration. He indicated that the Veteran currently has secondary progressive multiple sclerosis, has not responded to treatment with rituximab, and is unable to treat with siponimod due to her higher risk for progressive multifocal leukoencephalopathy (PML). Dr. J.L. stated that there are currently no other disease modifying therapies that can help prevent further progression of her condition. 

The Board assigns significant probative value to the medical opinion of VA neurologist Dr. J.L., finding that he clearly considered all of the pertinent evidence of record, to include the Veteran's statements and her relevant medical history, and provided a complete and detailed rationale. Moreover, in concluding that the Veteran's multiple sclerosis was symptomatic while the Veteran was on active duty, Dr. J.L. offered a clear conclusion with supporting data and a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining that lay evidence can be competent and sufficient to establish a diagnosis of a condition when it is describing symptoms at the time that support a later diagnosis by a medical professional).

The Board acknowledges that a June 2021 a VA examiner provided a negative nexus opinion regarding the Veteran's multiple sclerosis. However, the Board finds this opinion to be inadequate for adjudicative purposes. Although the examiner stated that all the available records were reviewed and findings were considered when completing her opinion, this assertion is not reconciled with the
 conclusion with an analysis that the Board can consider and weigh against contrary opinions"); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (explaining that lay evidence can be competent and sufficient to establish a diagnosis of a condition when it is describing symptoms at the time that support a later diagnosis by a medical professional).

The Board acknowledges that a June 2021 a VA examiner provided a negative nexus opinion regarding the Veteran's multiple sclerosis. However, the Board finds this opinion to be inadequate for adjudicative purposes. Although the examiner stated that all the available records were reviewed and findings were considered when completing her opinion, this assertion is not reconciled with the examiner's conclusion that there was no medical evidence demonstrating that the Veteran developed multiple sclerosis during service. In particular, the examiner failed to discuss the Veteran's documented in-service symptoms, including those discussed by Dr. J.L., when reaching her conclusion. Thus, the opinion is afforded minimal probative value.    

In sum, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary is required to give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. Here, the Board finds the evidence addressing when the Veteran's currently diagnosed multiple sclerosis likely arose creates such a state of approximate balance as to all elements required to establish service connection. Accordingly, reasonable doubt must be resolved in the Veteran's favor, and service connection for multiple sclerosis is granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Hampl, Samantha

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.