Citation Nr: 18152362 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 08-23 073 DATE: November 21, 2018 ORDER Entitlement to service connection for Parkinson’s disease is granted. FINDING OF FACT The Veteran’s Parkinson’s disease is attributable to service. CONCLUSION OF LAW Parkinson’s disease was incurred in service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1975 to August 1978. The claim was previously entitled as service connection for cerebral atrophy and right anterior cerebral dysfunction. According to a June 2018 private opinion by Dr. D. D., the Veteran has Parkinson’s disease and cerebral atrophy and cerebral dysfunction are symptoms or manifestations of Parkinson’s disease. The Veteran’s attorney requested the claim be considered as one for service connection for Parkinson’s disease per Clemons v. Shinseki, 23 Vet. App. 1 (2009). As a result, this decision reflects that the Veteran’s claim is for Parkinson’s disease. 1. Parkinson’s disease The Veteran claims Parkinson’s disease is due to service, including exposure from an unknown (possibly chlorine) gas, formaldehyde, and other unknown gases or chemicals. Service connection may be established for disability resulting from personal injury or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1131 (2012). To establish a right to compensation for a present disability, a Veteran must show: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303(a); see also Davidson v. Shinseki, 581 F.3d 1313, 1315–16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For a medical opinion (i.e., medical evidence) to be given weight, it must be: (1) based upon sufficient facts or data; (2) the product of reliable principles and methods; and (3) the result of principles and methods reliably applied to the facts. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). Service treatment records dated in August and October 1977 report the Veteran was treated for muscle tremors in the limbs as well as nausea and shaking. Based on the above and an April 2017 VA examination, a May 2017 rating decision granted service-connection for essential tremors due to in-service onset. The Veteran had several VA examinations. In March 2016, the Board noted that two VA opinions dated in January 2010 and May 2010 did not fully reflect the record and remanded for a new examination. The VA examination report, dated in April 2017, stated that an opinion on this issue could not be given without mere speculation. The examiner stated that it was not possible to objectively determine whether the cerebral atrophy and right anterior cerebral dysfunction were caused or aggravated to any degree by military service or any of the events thereof. There is also a private opinion, referenced above, dated in June 2018, by a Dr. D. D., a neurologist. Dr. D. D. reported he had treated hundreds of people with Parkinson’s disease. He stated that brain atrophy and neuropsychological impairments (here, right anterior cerebral dysfunction) are sequelae of essential tremor (ET) and Parkinson’s disease (PD) (ET-PD neurodegenerative disorder). Dr. D. D. reviewed the treatment records and the examinations. He also noted recent treatment records showed Parkinson’s disease and the Veteran had stage 3 of 5 total stage Parkinson’s disease. The Veteran’s symptoms were hallmark features of Parkinson’s disease, including resting tremor, unilateral onset, difficulties with balance, halting or festinating speech, and dystonic posturing. These features of Parkinson’s disease were identifiable in VA treatment records at least from 2009. Dr. D. D. noted essential tremor and Parkinson’s disease have overlapping symptoms and there are clinical, epidemiologic, imaging, genetic, and pathologic studies supporting a link between essential tremor and Parkinson’s disease. A subset of people with long-standing essential tremors develop subsequent Parkinson’s disease, between 3 to 60 years after the development of essential tremors. People with Parkinson’s disease experience dementia at about a 50 to 80 percent rate and dementia significantly increases rates of brain atrophy. The examiner also reported that he considered and did not find any age, gender, ethnicity, or employment risk factors that would cause Parkinson’s disease. Dr. D. D. reported that the essential tremors were early symptoms of Parkinson’s disease and that Parkinson’s disease and the resulting neuropsychological impairment (right cerebral dysfunction, speech abnormalities, and balance issues) were at least as likely as not due to service (50 percent or greater probability). The private opinion stated that the Veteran’s current Parkinson’s disease was a progression of symptoms first manifested in service. That essential tremors were manifested in service is established, as the Veteran was granted service connection for tremors due to in-service onset. Dr. D. D. is a medical professional, he reviewed the treatment and service records, referenced relevant studies, and stated that the Veteran’s essential tremor was an early manifestation of Parkinson’s disease. The Board finds this opinion carries probative weight. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295, 302 (2008). VA opinions did not give etiology for the Veteran’s symptoms. Therefore, the only probative medical opinion regarding etiology is the private opinion, which supports a finding that Parkinson’s disease was manifested by early symptoms (tremors) in service. As a result, the Board concludes that service connection for Parkinson’s disease is warranted. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Yoffe, Associate Counsel