Citation Nr: 21001547 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 13-23 893 DATE: January 8, 2021 REMANDED Entitlement to service connection for a neurological disorder, claimed as Parkinson's disease and also noted as possible ataxia, mild degenerative cerebellar disease and peripheral neuropathy, to include as due to in-service exposure to herbicides, and also claimed as secondary to the service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from September 1964 to September 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2011 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In September 2014, the Veteran testified at a Board videoconference hearing before a Veterans Law Judge who is no longer at the Board. Subsequently, notices to the Veteran and his representative were sent on October 14, 2020 and again November 24, 2020 informing them of this development. The notices further informed the Veteran that he had a choice to request a new hearing in person or via teleconference or to allow the case to be considered by a different judge based on the evidence of record. As of the date of this decision, neither the Board nor the VA has received a response. Therefore, as the notices above indicated, since the Veteran did not respond within 30 days from the date of the notices, the Board will assume that the Veteran does not want another hearing and will proceed to adjudicate the claim on the evidence of record. The hearing transcript is associated with the record as was considered by the Board in the following decision. This matter was previously remanded by the Board in September 2015 for additional development. Again, in March 2018 the Veteran’s claims were remanded by the Board to properly develop the Veteran’s claims of herbicide exposure in-service. The Board also instructed the RO to afford the Veteran a new VA examination to determine what, if any, neurological conditions the Veteran has and to provide a medical opinion as to whether they are etiologically related to herbicide exposure in-service. As will be discussed below, the resulting opinion was not responsive to the Board's directive and, therefore, further remand is required. See Stegall v. West, 11 Vet. App. 268, 271(1998). At the time of the prior Board action, the claim was characterized as a claim for service connection for Parkinson’s disease. Further review of the claims file revealed clinical notes suggesting the proper diagnosis may be either mild degenerative cerebellar disease or a slowly progressive ataxia. After the latest remand and development in 2018, more evidence suggests the Veteran’s proper diagnosis may in fact be peripheral neuropathy. The claim has, therefore, been recharacterized as a claim for a neurological disorder, to include Parkinson’s disease, mild degenerative cerebellar disease, slowly progressive ataxia, or peripheral neuropathy. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for a neurological condition to include Parkinson’s, ataxia, degenerative cerebellar disease and peripheral neuropathy is remanded. The Veteran contends he has Parkinson’s disease, which he believes was caused by in-service exposure to Agent Orange. Alternatively, the Veteran contends that any neurologic condition he current suffers from is secondarily related to his already service-connected post-traumatic stress disorder (PTSD). Since the Board’s prior remands, the Veteran’s in-service exposure to herbicide agents, to include Agent Orange has been conceded according to the Blue Water Navy Vietnam Veterans Act of 2019. Therefore, the remaining issues before the Board are whether the Veteran has a current neurological condition and whether they are related to the now conceded in-service herbicide exposure. The Board previously remanded the claim to afford the Veteran a VA examination, in part, to resolve the issue of the Veteran’s diagnosis. Although the Board sincerely regrets additional delay, the resulting examination was not responsive to the Board’s prior remand directives and the evidence remains ambiguous as to the Veteran’s current disability. In particular, the Veteran underwent a VA examination in October 2019 to determine whether he has a current diagnosis and etiology of any neurologic condition. The October 2019 VA examiner found no ataxia, cerebellar disease, or Parkinson’s disease… “no pathology to render a diagnosis.” On the other hand, VA outpatient treatment records show the Veteran is housebound and requires assistance on a daily basis because of limited mobililty due to “progressive supranuclear palsy,” abnormal/slurred speech, and difficulty swallowing since at least 2011. The October 2019 VA examiner did not seem to fully consider all these neurologic symptoms or otherwise reconcile the Veteran’s medical history. While the examiner reported the difficulty of speech within the examination, stating the Veteran’s speech was “slow,” the rendered medical opinion found “no pathology to render a diagnosis” in reference to ataxia, degenerative cerebellar disease and Parkinson’s. In light of the incomplete, and at times, inconsistent findings of the 2019 VA examiner’s report, the Board finds the examination inadequate to render a decision. Clarification of the Veteran’s diagnosis is necessary in light of his medical history of symptoms since 2011 and continued decreased mobility. It is further worth noting that effective January 1, 2021, Agent Orange presumptions now include, in addition to Parkinson’s Disease, “Parkinsonism.” In light of the Veteran’s presumed Agent Orange exposure, it is further necessary to clarify his current neurological condition(s). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Then schedule the Veteran for a VA examination with an appropriate examiner to clarify whether the Veteran has a neurologic disorder. The entire claims file should be made available to the examiner and the examiner should conduct any and all diagnostic tests deemed necessary to clarify the Veteran’s condition(s). Following a review of the claims file, and after a thorough examination and completion of any and all necessary diagnostic testing, the examiner is asked to identify all neurologic conditions, to include Parkinson’s, Parkinsonism, ataxia, mild degenerative cerebellar disease, peripheral neuropathy, or any other found neurologic disability. If there is no pathology warranting a diagnosis, the examiner is asked to reconcile or explain the Veteran’s conflicting medical history showing, at times, varying neurological symptoms and diagnoses through the years, at least as early as 2011 and symptoms, to include slurred speech, difficulty swallowing, and difficulties with mobility. The examiner should provide a well-reasoned rationale supported by the facts as to why the conclusion made was reached. If the examiner is unable to provide an opinion without resort to speculation, he or she should state whether the inability is due to the limits of the person’s knowledge, the limits of medical knowledge in general, or there is additional evidence that would permit the needed opinion to be provided. 3. After completing the above actions, the Veteran’s claim should be readjudicated based on the entirety of the evidence. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.