Citation Nr: 21000783 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 19-03 902 DATE: January 6, 2021 REMANDED Entitlement to service connection for Parkinson's disease is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1977 to November 1977. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for Parkinson’s disease. Entitlement to service connection for Parkinson's disease is remanded. The Veteran contends that his Parkinson’s disease is secondary to his service-connected acquired psychiatric disorder. Alternatively, the Veteran contends that his Parkinson’s disease is related to in-service toxin exposure. See February 2019 VA Form 9. In his February 2019 VA Form 9, the Veteran cited to medical literature indicating that depression may represent an early symptom of Parkinson’s disease and/or a causal risk factor. Specifically, he noted an article published by the Cleveland Clinic, as well as a nationwide cohort study, regarding depression and the subsequent risk of Parkinson’s disease. The Board notes that the Veteran has not been afforded a VA examination in connection with his claim for Parkinson’s disease. The VA has a duty to assist the Veteran in obtaining a medical examination or opinion in certain circumstances. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4). A VA examination must be obtained in a disability compensation claim if there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; establishment of an in-service event, injury, or disease; an indication that the current disability may be associated with an in-service event; and insufficient competent medical evidence to make a decision on the claim. McClendon v. Nicholson, 20 Vet. App. 79, 81-6 (2006). Because the Board cannot make a fully informed decision on the issue of the Veteran’s Parkinson’s disease without an examination, the Board concludes that a VA examination is warranted. Accordingly, the matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his current Parkinson’s disease. Access to the Veteran’s electronic VA claims file must be made available to the examiner for review in connection with the examination. After examining the Veteran and reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: (a) Is it at least as likely as not that the Veteran’s current Parkinson’s disease had its inception during active duty or is otherwise causally related to active service or any incident therein, to include the Veteran’s alleged in-service toxin exposure? (b) If not, is it at least as likely as not that the Veteran’s current Parkinson’s disease is caused by his service-connected acquired psychiatric disorder? (c) If not, is it at least as likely as not that the Veteran’s current Parkinson’s disease is aggravated by his service-connected acquired psychiatric disorder? If aggravation is found, the examiner must attempt to establish a baseline level of severity of the disability, prior to aggravation. A complete explanation must be provided for any opinion offered. In providing the requested opinion, the examiner should reference any relevant evidence of record, to include an article published by the Cleveland Clinic, as well as a nationwide cohort study, indicating that depression may represent an early symptom of Parkinson’s disease and/or a causal risk factor. See https://my.clevelandclinic.org/health/diseases/9379-depression-overview-and-its-role-in-parkinsons-disease; see also https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478031/. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ruddy, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.