On appeal from the Department of Veterans Affairs (VA) Regional Office in Columbia, South Carolina
THE ISSUE
Entitlement to service connection for amyotrophic lateral
sclerosis (ALS).
REPRESENTATION
Appellant represented by: Paralyzed Veterans of America, Inc.
WITNESS AT HEARING ON APPEAL
The Veteran
ATTORNEY FOR THE BOARD
Julie L. Salas, Associate Counsel
INTRODUCTION
The veteran served on active duty from June 1983 to October
1983 and February 1985 to January 31, 1991.
This matter comes to the Board of Veterans’ Appeals (Board)
on appeal of a March 1997 rating decision of the RO.
The Board notes that the veteran’s original claim raised the
issue of permanent and total disability for pension purposes.
This issue has not been developed for appeal and is referred
to the RO for appropriate action.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that symptoms consistent with ALS
existed during service. He alleges that episodes of muscle
twitching, cramping and weakness in his extremities
experienced during service were the early manifestations of
ALS which was ultimately diagnosed in December 1992.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
§ 7104 (West 1991 & Supp. 1998), 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 the evidence is in relative
equipoise with respect to the claim of service connection.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran’s appeal has been obtained.
2. The veteran was diagnosed as having ALS in December 1992,
shortly after his discharge from active duty service.
3. The currently demonstrated disability due to ALS is shown
as likely as not to have been first manifested by muscle
twitching, cramping and weakness which the veteran has
reported experiencing in service.
CONCLUSION OF LAW
By extending the benefit of the doubt to the veteran, his ALS
is due to disease which was incurred in service. 38 U.S.C.A.
§§ 1101, 1110, 1112, 1113, 1131, 1137, 5107, 7104 (West 1991
& Supp. 1998); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
As a preliminary matter, the Board finds that the veteran’s
claim is plausible and capable of substantiation, and thus
well grounded within the meaning of 38 U.S.C.A. § 5107(a).
When a veteran submits a well-grounded claim, VA must assist
him in developing facts pertinent to the claim. 38 U.S.C.A.
§ 5107(a). The Board is satisfied that all available
relevant evidence has been obtained regarding the claim, and
that no further assistance to the veteran is required to
comply with 38 U.S.C.A. § 5107(a).
Service connection may be established for disability
resulting from personal injury suffered or disease contracted
in line of duty, or for aggravation of a pre-existing injury
suffered or disease contracted in line of duty. 38 U.S.C.A.
§§ 1110, 1131; 38 C.F.R. § 3.303. The regulations provide
that 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). If the disorder
is a chronic disease, service connection may be granted if
manifest to a degree of 10 percent within the presumptive
period; the presumptive period for organic diseases of the
nervous system is one year. 38 U.S.C.A. §§ 1101, 1112, 1113,
1137; 38 C.F.R. §§ 3.307, 3.309.
In determining whether service connection is warranted for a
disability, VA is responsible for determining whether the
evidence supports the claim or is in relative equipoise, with
the veteran prevailing in either event, or whether a
preponderance of the evidence is against the claim, in which
case the claim is denied. Gilbert v. Derwinski, 1 Vet.App.
49 (1990).
The veteran and his service representative maintain that he
contracted ALS during military service. The veteran
testified at his recent hearing that, beginning in 1988, he
had begun to experience twitching, cramping and weakness in
the muscles of his extremities; symptoms that were later
determined by a physician to be the early symptoms of ALS.
The veteran specifically recalled experiencing on a weekly
basis a cramping of his fingers and feelings of fatigue from
his hands to his elbows while performing administrative
functions for his unit. He also testified that, in 1988, he
began to experience difficulty in passing the Army Physical
Fitness Test (APFT) which included requirements for push-ups,
sit-ups and completion of a two-mile run. According to the
veteran, his difficulty in completing the test varied. He
explained that, on some days, he would not be able to
complete the two mile run but would have no problem
completing the other requirements. On other days, he related
having only difficulty with the push-ups or the sit-ups.
Records of the veteran’s APFT Scorecard indicate that on
several occasions, beginning in October 1988, the veteran did
not complete or pass aspects of the test. In fact, in both
October and November 1988, remedial physical therapy was
directed in order to prepare the veteran for subsequent re-
tests. The service personnel records indicate that the
veteran’s failure to complete the APFT was largely
responsible for his discharge from service.
The veteran testified that, approximately eight months
following his discharge from service, his mother and ex-wife
noticed drooping of his hands. He also recalled an incident
where he was attempting to jog across a road and thinking he
was not going to make it. It was this incident, according to
the veteran, that forced him to seek medical treatment for
his symptoms in June or July of 1992. The veteran’s
testimony indicates that ALS was finally diagnosed in
December 1992. A discharge summary prepared by the VA
Medical Center in Charleston, South Carolina, is consistent
with the veteran’s testimony as to his diagnosis.
In support of his claim, the veteran submitted an April 1997
statement from John A. Gross, M.D., from the Medical
University of South Carolina. Dr. Gross indicated that the
veteran had been followed for motor neuron disease at the
Medical University of South Carolina Muscular Dystrophy
Association Clinic since 1992. It was his opinion that the
cramps and impairment of manual dexterity allegedly
experienced by the veteran in service, as well has his
inability to pass his physical fitness test, “were likely
manifestations of his motor neuron disease that he did not
recognize and thus did not seek medical treatment.”
In support of the veteran’s claim, a June 1998 statement has
been received from Craig N. Bash, M.D., of the Uniform
Services University of Health Sciences. Dr. Bash concurred
with the assessment offered by Dr. Gross and added that
“this patient in service had manifestations of his motor
neuron disease (ALS) documented in the record as cramps,
decreased manual dexterity and decreased physical
endurance.”
Against the veteran’s claim is the contemporaneous medical
evidence showing an initial diagnosis of ALS in December 1992
when a history of difficulty in grasping objects for one year
was recorded.
Based on its review of the evidence as a whole, the Board
finds that the “negative evidence” is at least balanced by
the “positive evidence” that the veteran first began to
experience manifestation of muscle twitching, cramping and
weakness in service. The Board concludes, by extending the
benefit of the doubt to the veteran, that the medical
opinions, when read with this history of service-related
manifestations, support the grant of service connection for
ALS.
ORDER
Service connection for ALS is granted.
STEPHEN L. WILKINS
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1998), 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, 102 Stat. 4105, 4122 (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.
