Citation Nr: 18148127 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 15-35 404A DATE: November 6, 2018 REMANDED Entitlement to service connection for Parkinson’s disease with leg weakness, falls, and head trauma, is remanded. Entitlement to service connection for migraine headaches is remanded. Entitlement to service connection for a psychiatric disability, to include adjustment disorder, depression, anxiety, dementia, and insomnia, is remanded. Entitlement to service connection for kidney stones is remanded. Entitlement to service connection for liver condition is remanded. Entitlement to special monthly compensation based on aid and attendance, or on account of being housebound, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1962 to September 1966. 1. Entitlement to service connection for Parkinson’s disease with leg weakness, falls, and head trauma, is remanded. 2. Entitlement to service connection for migraine headaches is remanded. 3. Entitlement to service connection for a psychiatric disability, to include adjustment disorder, depression, anxiety, dementia, and insomnia, is remanded. 4. Entitlement to service connection for kidney stones is remanded. 5. Entitlement to service connection for liver condition is remanded. 6. Entitlement to special monthly compensation based on aid and attendance, or on account of being housebound, is remanded. The Veteran asserts that his Parkinson’s disease is related to events in service, to include exposure to herbicide agents and other hazardous materials from cleaning and repairing parachutes and other equipment that returned stateside following use in Vietnam. He also reported exposure to hazardous materials from fighting a fire during service. He also asserts a connection between Parkinson’s disease and participation in a medical research project in service. A March 2011 VA examiner noted the Veteran’s diagnosis of Parkinson’s disease. However, the VA examiner did not opine as to whether such disease is related to service. Accordingly, remand is appropriate to obtain VA medical opinion. As to kidney stones, the Veteran asserts that his kidney stones are due to medications taken for his Parkinson’s disease. While on remand, VA medical opinion regarding whether the Veteran’s Parkinson’s disease, including any medications taken for such disease, caused or aggravated his kidney stones should be obtained. The Veteran also asserts that his liver condition is due to medications taken for his Parkinson’s disease. A March 2011 VA examiner opined that the Veteran’s liver lesions are less likely than not caused by or contributed to by his medication, and provided a rationale. However, the Veteran’s VA treatment records show a new diagnosis of fatty liver disease or steatosis of liver. See October 2013 VA Treatment Record; December 2016 VA Problem List. While on remand, further VA medical opinion should be obtained. During the March 2017 VA contract audiology examination, the Veteran asserted that his service-connected tinnitus causes sleeping problems, agitates him, and causes headaches. Accordingly, remand is appropriate to obtain VA medical opinion regarding whether the Veteran’s headaches and/or psychiatric disability are caused by or aggravated by his service-connected tinnitus. In addition, the Veteran is receiving disability benefits from the Social Security Administration (SSA). A print screen in the Veteran’s file shows a disability onset date of October 1983 and a date of initial entitlement of April 1984. As SSA disability materials may be relevant to the Veteran’s service connection claims, remand is appropriate to obtain the complete medical and administrative records related to any application for SSA disability benefits. Murincsak v. Derwinski, 2 Vet. App. 363, 369-70 (1992) (where VA has actual notice of the existence of records held by SSA which appear relevant to a pending claim, VA has a duty to assist by requesting those records from SSA). While this matter is on remand, outstanding private and VA treatment records should be obtained, including records from Jacobetti Home for Veterans and VA treatment records from December 2016 to the present. The claim for special monthly compensation based on aid and attendance is intertwined with the remanded issues and will also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to his claims. 2. Take appropriate actions to obtain the Veteran’s records from Jacobetti Home for Veterans. 3. Obtain outstanding VA treatment records, to include treatment records from December 2016 to the present. 4. Contact SSA and request the Veteran’s complete SSA records, including any administrative decisions on any application for disability benefits and all underlying medical records which are in SSA’s possession. A copy of any requests sent to SSA, and any reply, to include any records obtained from SSA, must be included in the claims file. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records. 5. After obtaining any outstanding records, ask the appropriate examiner (for Parkinson’s disease) to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s Parkinson’s disease is related to an in-service injury, event, or disease. The examiner should consider all medical and lay evidence of record. The Veteran served as a parachute rigger while stationed at North Island Naval Air Station near San Diego. He served there for approximately three years. He reported that Phantom F-4 aircraft came in from carriers coming back from service in Vietnam. He reported that he was responsible for cleaning and repacking the drag parachutes for the aircraft. The drag parachutes were used in landing the aircraft on land and would come out of the aircraft and drag across the land to slow the aircraft down. The Veteran was responsible for cleaning and repairing equipment, including these parachutes. He reported that material would come down on him when the hatch was opened to take out the drag parachute. He believes that in opening the hatch and cleaning and repairing the parachutes and other equipment, he was exposed to soil, solvents, grease, oil, jet fuel, pesticides, herbicide agents, and other hazardous materials. He reported that he was working in an enclosed environment and would breathe in the hazardous materials. He also reported that he was not provided gloves, masks, or other protective gear. The Veteran also asserted that he was exposed to hazardous materials during service at Lakehurst Naval Air Station. The Veteran jumped into parachute circles, which he asserts were kept clear using pesticides. He also asserts exposure to hazardous materials when fighting a fire there in April 1963. He reported that he had to dig soil and was breathing in the air from the fire. He submitted material explaining that dioxin can contaminate air if material with the chemical is burned. He submitted a report from the Environmental Protection Agency regarding hazardous materials at Lakehurst Naval Air Station. The report notes that groundwater and soil sampling during the late 1980s revealed the presence of volatile organic compounds including benzene and trichloroethylene, and petroleum hydrocarbon. The Veteran asserted that bases were sprayed to keep down foliage and insects that attracted birds. The Veteran also reported that he was a participant in a medical research project. He reported that he was told the tests involved neurology, but that he was not told more about the study. The immunization page from the Veteran’s service treatment records notes participation in a medical research project. The Veteran and his wife reported that his symptoms began in the 1970s. A complete rationale should be given for all opinions and conclusions expressed. 6. After obtaining any outstanding records, ask the appropriate examiner (for kidney stones) to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s kidney stones: (a) are related to an in-service injury, event, or disease; or (b) are caused by or aggravated by his Parkinson’s disease, to include medications for such disease. The examiner should consider all medical and lay evidence of record. The Veteran asserts that his kidney stones are due to medications taken for his Parkinson’s disease. A complete rationale should be given for all opinions and conclusions expressed. 7. After obtaining any outstanding records, ask the appropriate examiner (for liver conditions) to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should identify any liver disability the Veteran has presented during the claim period (from January 2011 to the present). For each liver disability, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that such disability: (a) is related to an in-service injury, event, or disease; or (b) is caused by or aggravated by the Veteran’s Parkinson’s disease, to include medications for such disease. The examiner should consider all medical and lay evidence of record. The Veteran asserts that his liver condition is due to medications taken for his Parkinson’s disease. The Veteran submitted a statement indicating that over 800 over the counter and prescription drugs, including acetaminophen, can cause liver damage. The Veteran reported that he takes acetaminophen for pain relating to his Parkinson’s disease. A complete rationale should be given for all opinions and conclusions expressed. 8. After obtaining any outstanding records, ask the appropriate examiner (for headaches) to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should opine as to whether the Veteran’s headaches at least as likely as not (a 50 percent or greater probability): (a) had an onset in service; (b) are related to an in-service injury, event, or disease; (c) are caused by or aggravated by his tinnitus; or (d) are caused by or aggravated by his Parkinson’s disease. The examiner should also opine as to whether the Veteran’s migraine headaches at least as likely as not (a 50 percent or greater probability) manifested to a compensable degree within a year of separation from service (i.e., by September 1967). The examiner should consider all medical and lay evidence of record. The Veteran asserts that his service-connected tinnitus causes headaches. A complete rationale should be given for all opinions and conclusions expressed. 9. After obtaining any outstanding records, ask the appropriate mental health examiner to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should identify any psychiatric disability the Veteran has presented during the claim period (from January 2011 to the present). For each disability, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the disability is caused by or aggravated by the Veteran’s tinnitus. For any disability other than anxiety, depression, insomnia, and dementia, the examiner should also opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the disability: (a) is related to an in-service injury, event, or disease; or (b) is caused by or aggravated by his Parkinson’s disease. The examiner should consider all medical and lay evidence of record. The Veteran asserts that his service-connected tinnitus causes sleeping problems and agitates him. A complete rationale should be given for all opinions and conclusions expressed. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Purcell, Associate Counsel