Citation Nr: 21065752 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 18-50 194 DATE: October 27, 2021 ORDER Entitlement to service connection for Parkinson's disease is denied. Entitlement to service connection for a fungal disability is denied. Entitlement to service connection for arthritis of the body, feet and ankles is denied. FINDINGS OF FACT 1. Parkinson's disease was not manifest in service, nor has it been shown to be related to service. 2. A fungal disability was not manifest in service, nor has it been shown to be related to service. 3. The Veteran's arthritis of the body, feet and ankles did not manifest during service, within 1 year of service separation and is not otherwise related to service. CONCLUSIONS OF LAW 1. Parkinson's disease was not incurred in or aggravated by service, and is not attributable to service. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303. 2. A fungal disability was not incurred in or aggravated by service, and is not attributable to service. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303. 3. Arthritis of the body, feet and ankles was not incurred in or aggravated by service, may not be presumed to be related to service and is not attributable to service. 38 U.S.C. §§ 1110, 1112, 1113, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1949 to January 1953. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified at a travel Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran's electronic claims folder. In July 2021, the Board remanded the matters to obtain a medical opinion. The Board finds that there has been substantial compliance with its remand directives. Service Connection Initially, the Board notes that the Veteran's complete service treatment records are unavailable (only his separation examination is available), as they were housed in that section of the National Personnel Records Center's St. Louis storage facility which burned in a 1973 fire. Under such circumstances, there is a heightened obligation to assist the Veteran in the development of the case, a heightened obligation to explain findings and conclusions, and a heightened duty to consider carefully the benefit of the doubt rule. See Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); Cromer v. Nicholson, 19 Vet. App. 215, 217 (2005) (citing O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991)); Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). The RO issued a formal finding of unavailability of the records in February 2018 and advised the Veteran of alternative methods of supporting his claim, including the Veteran's own submission of any service treatment records in his possession. Therefore, the Board finds that VA has satisfied its duties to notify and assist the Veteran. Accordingly, the Board finds that there is no further action to be undertaken to comply with the provisions of 38 U.S.C.A. §§ 5103 (a) and 5103A, or 38 C.F.R. § 3.159, and that the Veteran will not be prejudiced as a result of the Board's adjudication of his claim. In order to obtain service connection under 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 3.303 (a) a Veteran must satisfy a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so- called 'nexus' requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). Service connection on a presumptive basis is also warranted for certain chronic diseases, including arthritis. 38 C.F.R. §§ 3.307, 3.309. 1. Entitlement to service connection for Parkinson's disease The Veteran contends, without specificity, that he is entitled to service connection for Parkinson's disease. For the reasons explained below, the Board finds that entitlement to service connection is not warranted. Service connection may be granted for specific diseases, including Parkinson's disease, that are associated with exposure to herbicide agents. 38 C.F.R. § 3.309 (e). If a Veteran was exposed to an herbicide agent during active military, naval, or air service, Parkinson's disease, shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, despite any lack of evidence of such disease during service provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. The Veteran testified that he was stationed in Okinawa, Japan from 1950 to 1952 and was diagnosed with Parkinson's disease in May 1994. See Board Hearing Transcript, pp. 11-12. VA has not recognized, for presumptive service connection purposes, that herbicide agents were used in Okinawa, Japan. However, a Veteran who is unable to prove entitlement to the presumption under 38 C.F.R. § 3.307 may still be able to establish service connection on a direct basis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994); 38 C.F.R. § 3.303 (d). In an August 2021 medical opinion, the clinician opined that it was less likely than not that the Veteran's Parkinson's disease was related to service. The clinician noted that there was no objective evidence to connect the Veteran's current Parkinson's disease to service. The clinician also noted that the Veteran's lay statements were considered before forming the opinion. The Board finds the August 2021 medical opinion to be probative in value. The clinician reviewed the Veteran's medical records and considered the Veteran's statements prior to rendering an opinion. The examiner concluded that the Veteran's Parkinson's disease was not related to his service. The Board attaches no probative value to the Veteran's general contention regarding the etiology of his Parkinson's disease. There is no evidence that the Veteran has the medical expertise to provide such an opinion and therefore is not competent to offer such an opinion. The Veteran has not asserted why he believes his Parkinson's disease is related to service and the record does not support any nexus between Parkinson's disease and service. Given that the Board has found the unfavorable August 2021 medical opinion to be the most probative evidence of record, the preponderance of the evidence is against the Veteran's claim for service connection, and the claim must be denied. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107. 2. Entitlement to service connection for a fungal disability The Veteran contends that he is entitled to service connection for a fungal disability due to his exposure to "a high moisture environment" while stationed in Okinawa between April 1950 to March 1952. See VA Form. He further testified that he worked in the field and went to sick call several times based on his blisters and fungus. See Board Hearing Transcript, p. 5. He testified that he sought treatment within 5 or 6 years post-service because he had a job which required extensive walking. Id. at 6. For the reasons explained below, the Board finds that entitlement to service connection is not warranted. On a June 2017 VA Form Request for Information Needed to Reconstruct Medical Data, the Veteran indicated that he was treated at the Okinawa Army dispensary for a blister and fungus on his feet. As mentioned above, the Veteran's full service treatment records are unavailable; however, his separation examination is available and did not reflect a fungal disability diagnosis. Private treatment records show that the Veteran was treated post-service several times for fungus of the feet. However, there are no private medical opinions regarding the etiology of the fungal disability. In an August 2021 medical opinion, the clinician opined that it was less likely than not that the Veteran's fungal disability was related to service. The clinician noted that there was no objective evidence to connect the Veteran's current fungal disability to service. The clinician also noted that the Veteran's lay statements were considered before forming the opinion. The Board finds the August 2021 medical opinion to be probative in value. The clinician reviewed the Veteran's medical records and considered the Veteran's statements prior to rendering an opinion. The examiner concluded that the Veteran's fungal disability was not related to his service. The Board attaches no probative value to the Veteran's contention regarding the etiology of his fungal disability. Although he is competent to say that he experienced symptoms of fungus during and post-service, he is not competent to provide an etiological opinion. The Veteran had extensive post-service private treatment and there is no evidence that the post-service specialists who treated him related the extensive fungal problems to service. The August 2021 clinician noted that there was no evidence of any fungal symptoms at separation and there was no evidence for many years post-service. Given that the Board has found the unfavorable August 2021 medical opinion to be the most probative evidence of record, the preponderance of the evidence is against the Veteran's claim for service connection, and the claim must be denied. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107. 3. Entitlement to service connection for arthritis The Veteran contends that he is entitled to service connection for arthritis in his ankle and body because he twisted his ankle during service while walking through coral stones. See Board Hearing Transcript, p. 9. For the reasons explained below, the Board finds that entitlement to service connection is not warranted. On a June 2017 VA Form Request for Information Needed to Reconstruct Medical Data, the Veteran indicated that he was treated at the Okinawa Army dispensary for his left ankle. As mentioned above, the Veteran's full service treatment records are unavailable; however, his separation examination is available and did not reflect any ankle or arthritis diagnosis. There was a notation of 1st degree pes planus asymptomatic. The Veteran reported that his arthritis began in 1993 and has worsened since. In an August 2021 medical opinion, the clinician opined that it was less likely than not that the Veteran's arthritis was related to service. The clinician noted that there was no objective evidence to connect the Veteran's current arthritis disability to service. The clinician also noted that the Veteran's lay statements were considered before forming the opinion. The Board finds the August 2021 medical opinion to be probative in value. The clinician reviewed the Veteran's medical records and considered the Veteran's statements prior to rendering an opinion. The examiner concluded that the Veteran's arthritis disability was not related to his service. The Board has considered the Veteran's statements regarding the etiology arthritis. A Veteran is competent to report symptoms that she experiences at any time because this requires only personal knowledge as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465 (1994). However, the Veteran has not asserted, nor has the evidence shown, that he is qualified and/or competent to give a medical opinion regarding a diagnosis or the etiology of his arthritis. In formulating the opinion, the examiner relied on review of x-ray films and other medical principles neither of which the Veteran has represented he has knowledge. Therefore, the Board has not attached any probative value to the Veteran's statements regarding nexus. The Board observes that service connection may be awarded on a presumptive basis for certain disabilities such as arthritis that become manifested within a proscribed period following active military service. 38 C.F.R. §§ 3.307, 3.309. In this case, however, the Veteran's arthritis was not initially manifested within a year following service. Rather, the first evidence of a diagnosis is around 1993 over 40 years after separation from service. Given that the Board has found the unfavorable August 2021 medical opinion to be the most probative evidence of record, the preponderance of the evidence is against the Veteran's claim for service connection, and the claim must be denied. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Baskerville 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.