Citation Nr: 21002422 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 18-01 507 DATE: January 13, 2021 ORDER Entitlement to service connection for dementia (claimed as brain atrophy with memory problems) is granted. FINDING OF FACT The Veteran’s dementia was caused by his injuries to his head sustained during his period of active service. CONCLUSION OF LAW The criteria for entitlement to service connection for dementia (claimed as brain atrophy with memory problems) are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1977 to September 1982. He died in December 2020. The appellant is his surviving spouse. In January 2021, the appellant was substituted as the claimant in this appeal. 1. Entitlement to service connection for dementia (claimed as brain atrophy with memory problems) In May 2013, the Veteran filed a claim for service connection for brain atrophy. In October 2013, the Veteran was provided a VA examination. The Veteran reported symptoms of short-term memory loss and a history of boxing while serving in the Navy. The VA examiner opined that the Veteran’s current memory loss was at least as likely as not caused by the effect of his current medications for his service-connected injuries, as well as, any possible sports related injuries. In April 2017, a VA examiner noted a diagnosis of major neurocognitive disorder. The examiner stated that Veteran’s speech and language deficits were severe indicating the possibility of progressive aphasia due to frontotemporal dementia, but such a diagnosis would need to be confirmed by neuroimaging. The examiner stated that the Veteran, however, clearly met the criteria for dementia that was likely due to multiple etiologies. In September 2017, a VA physician, P.R.T., M.D. provided a diagnosis of moderate major neurocognitive disorder or dementia. The physician noted the Veteran’s reports of head trauma during his period of service. The physician stated that a 2016 MRI demonstrated volume loss in the left temporal tip with gliosis and encephalomalacia suggesting prior head trauma. Given these findings which placed chronic traumatic encephalopathy high in the differential diagnosis, the physician opined that it is at least as likely as not that the Veteran’s cognitive dysfunction is related to his time in the Navy. The Veteran’s service treatment records are silent for any report of boxing or head injuries during his period of service. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded. After a review of the evidence, the Board finds that service connection for dementia is warranted. The evidence establishes that the Veteran was diagnosed with dementia during the appeal period; as such, the first element of service connection is met. The Veteran has reported that he suffered blows to the head due to boxing during his active service in the Navy. While the Veteran’s service treatment records are silent for reports of boxing, the Board notes that the Veteran was competent to provide reports boxing during service. See Layno. The evidence of record indicates that the Veteran reported having developed vascular symptoms in his legs due to boxing workouts during service in 2003 and 2004 many years before the onset of dementia. The Board finds the Veteran’s consistent reports over the course of many years, including prior to the onset of his memory problems, to be credible. As such, the competent, credible lay evidence establishes an in-service injury or event. Finally, the Board finds that the medical evidence of record is at least in equipoise regarding a finding that the Veteran’s dementia was due to his in-service boxing. The Board finds probative the opinion of the September 2017 VA physician that opined that the Veteran’s cognitive dysfunction was related to his in-service activities. The physician noted that the Veteran’s MRI findings from 2016 were consistent with a history of prior head trauma. There is no evidence that the 2017 VA physician was not competent or credible, and as the report was based on accurate facts and review of the Veteran’s history, the Board finds this opinion is entitled to significant probative weight as to the etiology of the Veteran’s disability. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, the 2017 VA physician’s opinion is also supported by the opinion provided by the October 2013 VA examiner. The 2013 examiner opined that the Veteran’s memory loss symptoms were likely due to his in-service activities (or were secondary to the Veteran’s medications taken for his service-connected psychiatric disorder). The only other competent medical opinion of record was provided by the April 2017 VA examiner, which does not disagree with the positive opinions of record. Rather, the April 2017 examiner merely opines that multiple etiologies by that time could be responsible for the Veteran’s symptoms of dementia. Thus, the Board finds that the evidence is at the very least in equipoise as to whether the Veteran’s dementia was caused by his in-service boxing. As a result, the Board finds that the criteria for entitlement to service connection for dementia (claimed as brain atrophy with memory problems) are met. 38 C.F.R. §§ 3.102, 3.303. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.M. Johnson, 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.