Citation Nr: 18142949 Decision Date: 10/18/18 Archive Date: 10/17/18 DOCKET NO. 13-02 594 DATE: October 18, 2018 REMANDED Entitlement to service connection for Parkinson’s disease, to include as due to herbicide exposure, is remanded. Entitlement to service connection for cervical dystonia, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1964 to December 1966, and from June 1969 to June 1972, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In May 2015, the Board denied the issue of entitlement to service connection for Parkinson’s disease, and remanded the issue of entitlement to service connection for cervical dystonia. The appellant appealed. In a November 2 016 Memorandum Decision, the United States Court of Appeals for Veterans Claims (Court) vacated and remanded the Board’s May 2015 decision which denied entitlement to service connection for Parkinson’s disease. Thereafter, the Board remanded both claims in June 2017.   Parkinson’s Disease The Veteran was provided with a Parkinson’s disease and neck examinations in September 2017. After reviewing the VA opinions, the Board finds that they are insufficient to decide the Veteran’s claims. In this regard, the September 2017 examining nurse practitioner determined the Veteran’s records did not support a diagnosis of Parkinson’s disease. The examiner explained that Parkinson’s disease is primarily caused by low and falling dopamine levels. As a result, the examiner noted a person with Parkinson’s has abnormally low dopamine levels because the dopamine-generating cells have died. The nurse practitioner then stated the Veteran’s Parkinson’s was less likely than not incurred in or caused by his active service. The Board finds the September 2017 opinion to be insufficient for several reasons. First, the opinion does not address or provide a discussion of the lay evidence or medical evidence of record, to include the Veteran’s statements and Dr. Sarwar’s April 2012 letter. Indeed, the Board’s June 2017 remand instructions specifically directed that Dr. Sarwar’s letter must be addressed. Second, the nurse practitioner did not explain whether Parkinson’s disease was caused by the Veteran’s exposure to herbicides during his active service or whether any herbicides would have had an effect on his dopamine-generating cells. Rather, the nurse practitioner stated what appears to be medical facts before providing an opinion without any rationale or a connection between this Veteran’s record and those facts or what the medical community knows about herbicides and Parkinson’s disease. Accordingly, the Board will remand this claim to obtain an addendum opinion. Cervical dystonia A VA opinion was obtained in September 2017. The nurse practitioner noted cervical dystonia is a rare neurological disorder that originates in the brain and determined the record did not support the condition as being caused by the Veteran’s active service. The Board finds the September 2017 opinion to be insufficient because the nurse practitioner did not provide a rationale or an explanation as to why the record did not support the condition as being caused by the Veteran’s active service. The nurse practitioner merely provided a medical definition of cervical dystonia followed by a negative opinion. On remand, the AOJ should attempt to obtain an addendum opinion that is sufficient so the Board may decide the Veteran’s claim. The matters are REMANDED for the following action: 1. Obtain any outstanding private and VA treatment records identified by the Veteran to be pertinent to his claims. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, obtain addendum opinions from a neurologist addressing whether at any time since April 2011 the appellant has suffered from Parkinson’s disease and/or cervical dystonia or both. The Veteran’s VBMS and Virtual VA/Legacy folders must be available to the neurologist for review. (a.) The neurologist must opine whether it is at least as likely as not (50 percent or greater probability) that Parkinson’s disease had its clinical onset during active service or is related to any in service disease, event, or injury, to include his exposure to herbicides. (b.) The neurologist must opine whether it is at least as likely as not (50 percent or greater probability) that cervical dystonia had its clinical onset during active service or is related to any in service disease, event, or injury, to include his exposure to herbicides. In forming any opinion, the neurologist is reminded VA has acknowledged the Veteran was exposed to herbicides during his active service in the Republic of Vietnam, and that VA will presume that Parkinson’s disease is related to service if the veteran was exposed to herbicides in the Republic of Vietnam. In developing the opinions, the neurologist must consider the medical and lay evidence of record, including (a.) The Veteran’s July 2016 statement that he began experiencing odd health issues after service but before the bicycle-automobile accident in 2002; (b.) The contentions contained in the Veteran’s January 2013 VA Form 9; (c.) The representative’s December 2012 argument regarding a connection between cervical dystonia and Parkinson’s disease; and (d.) Dr. Sarwar’s April 2012 letter. A complete rationale must be provided for all opinions rendered. If the clinician cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting   rationale as to why an opinion cannot be made without resorting to speculation. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck