Citation Nr: 18144202 Decision Date: 10/24/18 Archive Date: 10/23/18 DOCKET NO. 18-45 034 DATE: October 24, 2018 ORDER Entitlement to service connection for Parkinson’s disease is denied. FINDING OF FACT A chronic neurological disability such as Parkinson’s disease did not manifest during service, is not attributable to service, and may not be presumed related to service. CONCLUSION OF LAW Parkinson’s disease was not incurred in or aggravated by service, and may not be presumed related to service. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1956 to July 1959. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for Parkinson’s disease is denied. In September 2016, the Veteran filed an original claim of service connection for Parkinson’s disease. He asserts that he developed the disability as the result of trauma to his head during service. Service connection for VA compensation purposes will be granted for a disability resulting from disease or personal injury incurred in the line of duty or for aggravation of a preexisting injury in the active military, naval or air service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2018). To establish direct service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). Neurological disabilities may be presumed incurred in service if manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38 C.F.R. § 3.309(a)). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The evidence in this matter consists of service treatment records (STRs), VA and private treatment records, lay assertions from the Veteran and his brother, and VA compensation examination reports dated in July and August 2017. This evidence documents that the Veteran has had Parkinson’s disease during the appeal period. This is evidenced most recently in the July and August 2017 VA reports, which indicate an onset of Parkinson’s disease in the early 2000s. Moreover, the evidence documents that the Veteran experienced an accident during service that likely injured his head. A STR dated in December 1956 notes treatment for injuries sustained during a bus accident. The record indicates, however, that the in-service accident and consequent injuries are unrelated to current Parkinson’s disease. See 38 C.F.R. §§ 3.303, 3.307, 3.309. The STRs dated between December 1956 and July 1959 – i.e., following the bus accident – are negative for neurological problems. The June 1959 discharge report of medical examination notes the head and neurological systems as normal upon examination, and does not note any issue related to neurological disability. The earliest post-service medical evidence noting any symptoms of Parkinson’s disease is found in private treatment records dated in the early 2000s, over 40 years after discharge from service. These records indicate neurological symptoms indicating possible Parkinson’s disease. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Thus, no medical evidence dated between December 1956 and the early 2000s indicates neurological disability such as Parkinson’s disease. The record does not document the existence of such a chronic disability during service or for many years following service. The evidence indicates that, for over four decades following service, the Veteran did not have characteristic manifestations sufficient to identify a chronic disease entity related to Parkinson’s disease. See 38 C.F.R. §§ 3.303, 3.307, 3.309. Further, the evidence of record addressing the issue of medical nexus weighs against the claim. See Alemany and Gilbert, both supra. The record contains two VA medical opinions addressing the issue of service connection, dated in July and August 2017. The July 2017 examiner indicated that it was less than likely that “Idiopathic Parkinson’s Disease was incurred in or caused by active duty service to include blunt force trauma incurred in or caused by the bus accident with laceration under left eye during service.” In support of the finding, the examiner explained that “Idiopathic Parkinson’s disease is an acquired condition secondary to neurodegeneration of the brain caused by accumulation of abnormal proteins in brain cells[.]” The examiner stated that the Veteran’s medical history indicated “the expected course of idiopathic Parkinson’s disease with documented reported … onset around 2003 when the patient was in his mid-60’s.” Furthermore, the July 2017 examiner discounted the impact of the in-service bus accident on the development of Parkinson’s disease, stating that the bus accident and any possible head injury “would not precipitate the onset of Parkinson’s disease nearly 50 years later.” The examiner went on to distinguish “Parkinsonism” which can be caused by head trauma, and the Veteran’s idiopathic Parkinson’s disease. The examiner stated that, “[if] the Veteran had suffered an injury in 1956 severe enough to damage those deep lying cells and induce Parkinsonism, the Parkinsonian symptoms would have manifested acutely and, more to the point, the Veteran would have had significant damage to other structures of the brain resulting in significant neurologic impairment acutely.” The August 2017 examiner also found it unlikely that Parkinson’s disease related to service. After noting the bus accident and reported injuries, the examiner stated that the Veteran was diagnosed with Parkinson’s disease in 2004, but that “[n]o other evidence of repeated head trauma is found.” The examiner concluded that “[i]t is not medically reasonable to conclude that this single traumatic event to the head is at least as likely as not responsible for his Parkinson’s disease.” Each examiner reviewed the claims file, summarized medical evidence in the claims file, noted the in-service accident and possible head injury, noted VA and private medical evidence indicating initial onset of neurological disability in the early 2000s, and noted the Veteran’s theory that the bus accident and head injury led to Parkinson’s disease. Each examiner also cited the absence of evidence of chronicity of neurological disability, again noting the earliest evidence documenting neurological disability in the early 2000s. As their findings are based on the evidence of record, and are explained, the Board finds them of probative value in this matter. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the value of a physician’s statement is dependent, in part, upon the extent to which it reflects clinical data or other rationale to support the opinion). In assessing this claim, the Board has considered the lay assertions of record from the Veteran and his brother, who theorize that the bus accident caused injuries that ultimately led to the development of Parkinson’s disease. These lay witnesses are competent to report observable symptoms such as the trembling, limitations, and pain associated with Parkinson’s disease. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, they are not competent to determine issues such as diagnosis and etiology. The development of a neurological disability such as Parkinson’s disease is an internal pathology beyond their capacity to observe, sense, or feel. Its development is a complex medical question. Issues concerning diagnosis of Parkinson’s disease, and any type of possible neurological injury during service, following service, and since treatment began in the early 2000s, are complex medical issues. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). On these more complex questions, the lay evidence is outweighed by the medical evidence. (Continued on the next page)   In sum, the preponderance of the evidence indicates that the Veteran neither incurred Parkinson’s disease in service, nor manifested such a chronic disorder in the first year after separation from service. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. BISWAJIT CHATTERJEE Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher McEntee, Counsel