Citation Nr: 18159360 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 17-28 513A DATE: December 18, 2018 ORDER Service connection for Lewy body dementia is granted. FINDING OF FACT The Veteran has submitted two opinions to establish a connection between his Lewy body dementia and his military service. CONCLUSION OF LAW The criteria for service connection for Lewy body dementia have been met. 38 U.S.C. §§ 1110, 1154, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active duty service from January 1965 to April 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). A hearing before the undersigned Veterans Law Judge was held in September 2018. A transcript is of record. 1. Service connection for Lewy body dementia Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury to prove service connection. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). A veteran who served in the Republic of Vietnam during the Vietnam era (January 9, 1962, to May 7, 1975) shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii). For veterans presumed to have been exposed to herbicide agents during the required period, a presumption of service connection exists for certain enumerated diseases, to include Parkinson’s disease. See 38 U.S.C. § 1116 (2012); 38 C.F.R. §§ 3.307, 3.309(e). Notwithstanding the regulations governing presumptive service connection, a Veteran may also establish service connection with proof of actual direct causation. 38 U.S.C. § 1110; 38 C.F.R. § 3.303; Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran seeks service connection for Lewy body dementia, which he claims is due to Agent Orange exposure. Service personnel records established that the Veteran served in the Republic of Vietnam during the Vietnam era; as such, his exposure to Agent Orange is presumed. The record contains three medical opinions, two from VA physicians and one from a private physician. The December 2016 opinion from a VA examiner is against the claim.   A September 2016 letter from Dr. M. M., a Board-certified neurologist, stated that Lewy body disease and Parkinson’s disease are closely related neurological disorders because the pathological hallmark of both is the presence of Lewy bodies inside neurons. It was Dr. M’s opinion that given how closely related they are, it is as likely as not that Agent Orange would increase the chance of one developing Lewy Body dementia, as the Veteran did. A May 2018 letter from Dr. J. E. D. reports that the Veteran was examined at the clinic of the Parkinson’s Disease Research Education and Clinical Center at the Philadelphia VA Medical Center and that the Veteran meets the criteria for probable dementia with Lewy bodies using the current diagnostic consensus criteria for dementia with Lewy bodies (DLB) published in 2017 that Dr. D. helped to establish. Dr. D. went on to say, however, that given the slow progression of the Veteran’s symptoms, it was difficult to determine the temporal relationship between the onset of his Parkinsonism and his dementia, which distinguishes DLB from Parkinson’s disease dementia by defining DLB ‘when dementia occurs before or concurrently with parkinsonism;’ otherwise, the condition is referred to as Parkinson’s disease with dementia. Therefore, Dr. D. stated it was impossible to definitely rule out a diagnosis of Parkinson’s disease with dementia. It was Dr. D’s opinion that Parkinson’s disease with dementia and dementia with Lewy bodies likely represent two presentations of the same pathologic process; therefore, it seemed appropriate to provide the same benefits to veterans with DLB, like the Veteran, as those diagnosed with Parkinson’s disease. (Continued on the next page)   While the VA examiner provided a negative opinion, given the September 2016 opinion provided by Dr. M. and the May 2018 opinion from Dr. D., the Board finds the competent evidence is at least in equipoise as to whether the Veteran’s Lewy body dementia is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for this Veteran’s Lewy body dementia is warranted. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Van Wambeke, Counsel