Citation Nr: 21069485 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 20-30 272 DATE: November 18, 2021 ORDER Service connection for Parkinson's disease is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's Parkinson's disease began during active service or is otherwise related to an in-service injury or disease, to include the in-service MVA. CONCLUSION OF LAW The criteria for entitlement to service connection for Parkinson's disease have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from August 1954 to August 1957. This appeal comes before the Board of Veterans' Appeals (Board) from a July 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for Parkinson's Disease and reopened and denied the issue of service connection for non-epileptic seizure disorder. The Veteran's notice of disagreement (NOD) was received in August 2017. The RO issued the statement of the case (SOC) in February 2020, and the Veteran's VA Form 9, substantive appeal was received in September 2020. Although not received within the 60-day window following the February 2020 SOC, the Veteran provided good cause for the delay in VA's receipt of his substantive appeal. See Percy v. Shinseki, 23 Vet. App. 37 (2009)(the timeliness of a substantive appeal may be waived for good cause because the 60-day period for filing a substantive appeal is not a jurisdictional bar to the Board's adjudication of a matter). In March 2021, the Veteran testified at a Board virtual hearing before the undersigned Veterans Law Judge. A transcript of the testimony is associated with the claims file. In May 2021 the Board remanded the case to the RO for further development and adjudicative action. During the pendency of the appeal, the RO issued a rating decision in September 2021 granting service connection for conversion disorder with attacks or seizures, persistent, without psychological stressor effective March 29, 2017. The disorder was combined with the Veteran's service-connected insomnia disorder and assigned a 10 percent rating from March 29, 2017 to August 16, 2021, and a 30 percent rating thereafter. SERVICE CONNECTION Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a Veteran must show: "(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." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for certain chronic diseases may also be established based upon a legal "presumption" by showing that the disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. 1. Entitlement to service connection for Parkinson's disease. The Veteran seeks service connection for Parkinson's disease. He contends that he first developed a seizure disorder following a documented MVA during service and that he has experienced seizures approximately every six weeks since. See generally March 2021 Hearing Transcript. The Veteran has a current diagnosis of Parkinson's disease. See e.g. April 2017 VA examination, VA treatment records dated in December 2016, September 2020, May 2021, and July 2021. Service treatment records (STRs) reflect that the Veteran fell out of a jeep during a motor vehicle accident (MVA) in April 1956. STRs indicate that the Veteran began experiencing "shaking chills" immediately following the MVA in service and denied experiencing any such symptoms prior. See October 1956 hospital discharge note. The Veteran was treated for these symptoms throughout the rest of his service. STRs reflect that, in December 1956, the Veteran was sent for a psychological evaluation "because of a year long history of periodic chills for which no organic basis has been forthcoming." The Veteran's symptoms were determined to be the result of an emotional instability reaction and nervous chills. See STRs dated in February 1957 and July 1957. Post-service, a June 1961 emergency room note indicates that the Veteran was seen for "chills (hands and feet shook) and low back ache." A January 1962 VA examination and June 1962 VA treatment note also indicate that the Veteran had chills characterized as mild shaking of the body with stiffening of the body and arching of the back which were described as a conversion reaction. A July 1962 VA treatment note reflects a diagnosis of convulsive disorder, centrocephalic epilepsy and psychomotor seizures, etiology undetermined. However, a follow-up September 1962 neuropsychology examination determined that the Veteran's "tonic tremors of extremities" and headaches were the result of a conversion reaction. VA treatment records dated in 2004 indicate that the Veteran was treated for meralgia paresthetica and restless leg syndrome. An August 2004 VA treatment note cast doubt on the diagnosis of restless leg syndrome, noting that the movements described by the Veteran appear to be more related to pain in his legs related to meralgia paresthetica as the Veteran stated that his movements were driven by finding a more comfortable place to put his legs. VA treatment records dated in September 2016 reflect that the Veteran presented to the neurology clinic in March 2016 with symptoms of tremor and gait changes concerning for Parkinson's disease. It was noted that the Veteran had some mild suggestion of Parkinson's disease with intermittent asymmetric rest tremor, reports of shuffling gait and some slowed fine finger movements on testing. No clear diagnosis of Parkinson's disease was made but it was noted that the Veteran's medications may be masking his symptoms. VA treatment records dated from December 2016 onward reflect a diagnosis of Parkinson's disease. In April 2017, the Veteran underwent a VA examination for his claim. With respect to Parkinson's disease, the VA examiner found that the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. For rationale, the examiner noted that the Veteran may have experienced transitory loss of consciousness related to a MVA in 1956 but stated that the risk of Parkinson's disease in association with traumatic brain injury increases with multiple concussive events or knock outs. The examiner stated that one isolated traumatic brain injury event would not be causative of Parkinson's disease. The examiner concluded by stating that it is medically unlikely that the Veteran's possible mild traumatic brain injury in 1956 caused the Veteran's recent diagnosis of Parkinson's disease. An addendum opinion was obtained in July 2021. The VA examiner found that the condition claimed was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness. For rationale, the examiner stated that review of the Veteran's available medical records does not provide any documentation indicating that the Veteran complained of, or was treated for, symptoms associated with the development of Parkinson's disease during his military career. The Veteran's Parkinson's disease did not have its onset in service, and did not manifest to a compensable degree within one year of discharge. While the Veteran was treated for seizures and chills during and following active service, these symptoms have consistently been associated with the Veteran's recently service-connected conversion disorder. See STRs dated in February 1957 and July 1957, June 1962 VA discharge note, September 1962 neuropsychological examination and August 2021 VA Mental Disorders examination. Notably, the Veteran reported onset of tremors related to Parkinson's disease in 2006 and onset of gait disturbance in 2015. See April 2017 VA examination. In this case, the only evidence to support the Veteran's claim is his own belief that his Parkinson's disease is related to an inservice injury or disease; however, as a lay person, he is not competent to provide a nexus opinion on this issue because the first diagnosis of Parkinson's disease was well after service discharge, and the Veteran does not possess the requisite medical expertise to opine on medical matters requiring knowledge of internal medical processes. The Veteran is certainly competent to report observable symptoms he experiences and their history (such as the presence of varicose veins or the onset of frequent headaches, for example). Layno v. Brown, 6 Vet. App. 465 (1994); Buchanan v. Nicholson, 454 F.3d 1331 (Fed. Cir. 2006); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In addition, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology (such as the onset of ringing in the ears following acoustic trauma, for example). See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). However, in this case, the question of a causation relationship between the Veteran's Parkinson's disease and any in-service injury or disease falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The disease involves a complex internal process and requires the ability to interpret diagnostic medical testing, as opposed to an external process or something capable of lay observation. The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a competent opinion on medical causation. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). In this case, the Veteran is considered competent to observe symptoms such as seizures and tremors, but determining a diagnosis for, or cause of, the symptoms requires medical training and expertise. As noted above, the Veteran has not been shown to have the requisite medical qualifications and/or training to provide a competent opinion on causation in this case. In the current case, the VA examiners' opinions are the most probative evidence of record and reflect that the Veteran's Parkinson's disease is unrelated to service. The examiners reviewed the claims file and included a complete rationale for the conclusions reached. In the October 2021 Appellate Brief, the Veteran's representative argues that the July 2021 VA addendum opinion is inadequate because it does not provide an etiology for the Veteran's Parkinson's disease and does not reconcile the findings in the Veteran's STRs with the Veteran's testimony regarding in-service onset of Parkinson's disease. However, the July 2021 opinion indicates that the examiner reviewed the Veteran's claims file including STRs and March 2021 hearing testimony but nevertheless concluded that such symptoms were not associated with the development of Parkinson's disease. As a lay person, the Veteran is not competent to determine the etiology of his current Parkinson's disease, or to determine whether the symptoms he experienced during service were manifestations of his current Parkinson's disease, and the VA examiner specifically found that they were not. Moreover, the competent and probative evidence in the record shows that such symptoms are associated with the Veteran's service-connected conversion disorder and not related to his Parkinson's disease. The Veteran has not submitted any competent medical evidence to the contrary. Consequently, service connection is not warranted with regard to the claim for Parkinson's disease. The preponderance of the evidence is against the Veteran's claim and the doctrine of reasonable doubt is not applicable in the instant appeal. 38 U.S.C. § 5107(b); 38C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Modesto, Victor 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.