Citation Nr: 21067984 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 15-35 404A DATE: November 8, 2021 REMANDED Entitlement to service connection for Parkinson's disease is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder, depression, anxiety, dementia, and insomnia, claimed as secondary to Parkinson's disease and/or service-connected tinnitus, is remanded. Entitlement to service connection for migraine headaches, claimed as secondary to Parkinson's disease and/or service-connected tinnitus, is remanded. Entitlement to service connection for kidney stones, claimed as secondary to medications taken for Parkinson's disease, is remanded. Entitlement to service connection for a liver disorder, claimed as secondary to medications taken for Parkinson's disease, is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance of another person or on account of being housebound is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1962 to September 1966.This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2015 and March 2017, the Veteran and his spouse testified at hearings before Decision Review Officers (DROs) at the RO. Transcripts of both hearings are associated with the record. In November 2018, the Board remanded the case for additional development and it now returns for further appellate review. The Board notes that, in a September 2021 statement, the Veteran's spouse requested that, if the RO could not award a 100 percent rating for the Veteran's service-connected disabilities, a virtual hearing before a Veterans Law Judge be scheduled. However, while the Veteran is not in receipt of a 100 percent rating for his service-connected disabilities, VA regulations require that a Board hearing request be made by either the Veteran or his representative. 38 C.F.R. § 20.602. to date, neither have done so. Furthermore, while the Veteran's spouse reported that she had durable power of attorney for the Veteran, no such record is on file and she is not recognized as his custodian for VA compensation purposes. Thus, she cannot request a Board hearing on his behalf. Nonetheless, the Veteran is advised that, if his appeal is not granted in full, he, or his representative, may request a hearing before a Veterans Law Judge upon the case's return to the Board. The Board further observes that, in the Veteran's representative's September 2021 Appellate Brief Presentation, he indicated that the claim for service connection for kidney stones had been withdrawn in a June 2012 Report of General Information; however, such document only memorializes a conversation with the Veteran. Thus, as such was not in writing, it is not an effective withdrawal and the claim for service connection for kidney stones remains on appeal. 38 C.F.R. § 19.55; Hembree v. Wilkie, 33 Vet. App. 1 (2020). 1. Entitlement to service connection for Parkinson's disease. As noted in the November 2018 remand, the Veteran contends that his current diagnosed Parkinson's disease is related to exposure to herbicide agents as a result of cleaning and repairing parachutes and other equipment returning stateside after use in Vietnam while stationed at North Island Naval Air Station (NAS), San Diego, California, as well as hazardous materials while fighting a fire in April 1963 and trichloroethylene (TCE) in the soil and groundwater while stationed at Lakehurst NAS, New Jersey, and as a result of participation in a classified medical research study that he alleges was neurologic in nature. While the Agency of Original Jurisdiction (AOJ) has already determined that the Veteran was not exposed to herbicide agents during service, the Veteran's service personnel records (SPRs) reflect that he was stationed at Lakehurst NAS from January 1963 to November 1963. Further, an Environmental Protection Agency (EPA) report, which was associated with the record in April 2015, reflects that the groundwater and soil sampling during the late 1980s from Lakehurst NAS revealed the presence of volatile organic compounds (VOCs), including benzene and trichloroethylene (TCE), and petroleum hydrocarbons. Additionally, the Veteran's service treatment records (STRs) reflect that he voluntarily participated in a medical research project, MR 005.09-1203.5 and MR 005.09-1206.1. Furthermore, at the January 2015 and March 2017 DRO hearings, the Veteran and his spouse reported that he began having symptoms of Parkinson's disease in the late 1970's as evidenced by the fact that he was dropping things, tripping, and was imbalanced. However, VA treatment records reflect that he was not diagnosed with such disease until 1994, and began taking medication in 1999. In light of the foregoing, in November 2018, the Board remanded the claim in order to obtain an opinion addressing the etiology of the Veteran's Parkinson's disease. Thereafter, in October 2019, a VA examiner opined that such disease is at least as likely as not incurred in or caused by in-service injury, event, or illness. In support thereof, she noted the Veteran was stationed at Lakehurst NAS, cited a July 2003 Agency for Toxic Substances and Disease Registry Public Health Assessment that confirmed TCE contamination in the soil and groundwater, and indicated that medical literature supports that exposure to TCE is a risk factor for developing Parkinson's disease. The examiner further noted that the Veteran was exposed to herbicide agents as a result of cleaning and repairing parachutes and other equipment returning stateside after use in Vietnam and observed that Parkinson's disease is presumptively related to exposure to herbicide agents. Therefore, the examiner opined the Veteran's Parkinson's disease is more likely than not a result of exposures that occurred during military service. However, as noted previously, the Veteran's alleged exposure to herbicide agents has not been shown by the evidence of record and, as the VA examiner considered such exposure in addition to his acknowledged exposure to TCE, it is unclear whether she believes that his Parkinson's disease is due solely to the latter exposure. Furthermore, while Parkinson's disease is acknowledged to be presumptively related to exposure to water contaminated with VOCs, to include TCE, as evidenced by the establishment of presumptive service connection for such disease for any service member exposed to contaminated water at Camp Lejeune if stationed there for more than 30 days, the record suggests alternative non-service-related causes of the Veteran's Parkinson's disease that have not been considered by the VA examiner. Specifically, VA treatment records reflect that, in October 1983, the Veteran fell about 20 feet from a barn roof, hitting a fence and rail post before hitting the ground and a board with protruding nails. Such fall resulted in significant injury and disability, including head trauma resulting in dizziness, confusion, memory problems, and migraine headaches. An August 1984 private treatment note detailing the Veteran's injuries from the October 1983 fall reflects that, at such time, he "has headaches and [has had] three dizzy spells in the last two months, sometimes after coughing with bad taste and touch of nausea." A December 1984 VA examination for non-service-connected pension reflects the Veteran incurred a closed head trauma with resultant dizziness, confusion, loss of memory, and chronic headaches. The Board observes the Veteran began receiving permanent and total disability for a non-service-connected pension purposes as of October 22, 1983, the date after his fall from the barn roof. Further, a July 2006 neurology note records the Veteran's statements that his cognitive difficulties began at age 13 when he fell out of a tree and sustained a loss of consciousness and subarachnoid hemorrhage. Consequently, the Board finds a remand is necessary to obtain an addendum opinion that addresses such matters. As a final matter, the Board observes that no development has been undertaken so as to determine the nature of the medical research project the Veteran participated in during service. Thus, such development should be undertaken on remand and, if the nature of such is determined, the VA examiner should also be requested to comment upon whether the Veteran's Parkinson's disease is related to such research project. 2. Entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder, depression, anxiety, dementia, and insomnia, claimed as secondary to Parkinson's disease and/or service-connected tinnitus. 3. Entitlement to service connection for migraine headaches, claimed as secondary to Parkinson's disease and/or service-connected tinnitus. 4. Entitlement to service connection for kidney stones, claimed as secondary to medications taken for Parkinson's disease. 5. Entitlement to service connection for a liver disorder, claimed as secondary to medications taken for Parkinson's disease. 6. Entitlement to SMC based on the need for aid and attendance of another person or on account of being housebound. The Veteran's claims for service connection for an acquired psychiatric disorder, migraine headaches, kidney stones, and a liver disorder, and entitlement to SMC, which have been claimed, in part, as secondary to Parkinson's disease, are inextricably intertwined with his claim for service connection for Parkinson's disease, which is remanded herein. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009). As such, consideration of the Veteran's claims for service connection for such disorders and entitlement to SMC must be deferred pending the outcome of his claim for service connection for Parkinson's Disease. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Board further finds that, as relevant to the Veteran's claim for service connection for migraine headaches as secondary to his service-connected tinnitus, a remand is necessary in order to obtain an addendum opinion addressing such matter as the October 2019 VA examiner, who was tasked with offering such opinion, indicated that such should be addressed by the audiology department. The matter is REMANDED for the following action: 1. Undertake any necessary development to determine the nature of the medical research project the Veteran participated in during service. In this regard, his STRs reflect his participation in MR 005.09-1203.5 and MR 005.09-1206.1. All efforts to obtain such information should be documented. 2. Thereafter, forward the record to the VA examiner who conducted the October 2019 examination, or an appropriate substitute if she is unavailable, for an addendum opinion addressing the etiology of the Veteran's current Parkinson's disease. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's current Parkinson's disease had its onset in, or is otherwise related to, his military service, to include his acknowledged in-service exposure to VOCs, including benzene and TCE, and petroleum hydrocarbons while stationed at Lakehurst NAS and/or his participation in the medical research project (if so determined)? In offering such opinion, the examiner is advised that the Veteran's reported in-service exposure to herbicide agents has not been shown. He or she should also consider the Veteran's and his spouse's report that he began having symptoms of Parkinson's disease in the late 1970's as evidenced by the fact that he was dropping things, tripping, and was imbalanced, but such was not diagnosed until 1994 and he began taking medication in 1999. The examiner must also discuss what impact, if any, the Veteran's traumatic head injuries at age 13 and in October 1983 had in the development of his Parkinson's disease. A rationale for any opinion offered should be provided. Forward the record, to include a copy of this remand, to an appropriate VA examiner who has the necessary audiological expertise to address the potential relationship between the Veteran's migraine headaches and his service-connected tinnitus. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's current migraine headaches are caused or aggravated by his service-connected tinnitus. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly, 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.