Citation Nr: 21071944 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-49 533 DATE: December 1, 2021 REMANDED Entitlement to service connection for Parkinson's Disease is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance (A&A) of another person or housebound status is remanded. Entitlement to a total disability based on individual unemployability (TDIU) prior to March 7, 2018, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1953 to October 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2016 and January 2017 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2020, the Board denied the claims listed above. The Veteran timely appealed to the Court of Appeals for Veteran's Claims (Court). In April 2021, the Court issued a Joint Motion for Remand (JMR). The JMR found that the Board failed to address and discuss the notations in the August 1954 service treatment record which recorded "[d]eflection of the nose and nasal septum due to trauma" was incurred in the line of duty. In addition, the Board failed to provide an adequate statement of reasons or bases for finding that the Veteran's Parkinson's disease was not secondary to his service-connected disabilities such as sleep apnea, sinusitis, rhinitis, and deviated septum. The claim for SMC and TDIU could not be determined, because they are inextricably intertwined with the service connection claim for Parkinson's Disease. In a September 2016 Primary Care Note, the physician wrote that she believed the Veteran's Parkinson's like symptoms were due to post concussive trauma due to him getting smashed in the face while serving in the military. His issues worsened due to hypoxia caused by the facial repair. The Veteran submitted a September 2021 private medical opinion written by Dr. Z. She extensively detailed the Veteran's medical history and commented on the correlation between obstructive sleep apnea (OSA) and Parkinson's disease. The physician opined that the Veteran's Parkinson's disease is at least as likely as not the secondary to his service connected OSA. Based on the findings of the JMR and the evidence included in the record, the Board concludes that remand is necessary to obtain a medical opinion to determine if the Veteran's reported in-service injury to the nose could have resulted in his development of Parkinson's disease. In addition, an opinion is necessary to determine if the Veteran's Parkinson's disease is secondary to any of his service-connected disabilities including OSA, to include secondary aggravation. The claims of entitlement to SMC and entitlement to TDIU are also remanded because they are inextricably intertwined with the Parkinson's Disease claim. See Tyrues v. Shinseki, 23 Vet. App. 166, 178 (2009) aff'd 631 F.3d 1380 (Fed. Cir. 2011), vacated, 565 U.S. 802, 132 S. Ct. 75, 181 L. Ed. 2d 2 (2011), reinstated as modified, 26 Vet. App. 31 (2012) (per curiam order), aff'd 732 F.3d 1351 (Fed. Cir. 2013) (holding that two claims are inextricably intertwined where a decision on one issue has a "significant impact" on the other such that it would render "any review by [the] Court of the decision [on the other claim] meaningless and a waste of judicial resources"). The matters are REMANDED for the following action: 1. Obtain any outstanding treatment records related to the claims on appeal and associate them with the claims file. 2. Then obtain a VA medical opinion to address whether the development of Parkinson's disease is related to the Veteran's August 1954 service treatment notation of trauma to the nose and nasal septum. A complete copy of the Veteran's claims file, including a copy of this remand and any newly obtained treatment records, must be provided to the examiner for review. The need for an in-person examination is left to the discretion of the examiner. (a.) The examiner is asked to acknowledge and comment on the August 1954 service treatment notation of the trauma to the Veteran's nose and nasal septum as it relates to the Veteran's Parkinson's disease. The examiner is asked to determine whether the Veteran's Parkinson's disease was at least as likely as not (50 percent probability or greater) incurred in or caused by the claimed in-service August 1954 nose injury. (b.) The examiner is asked to acknowledge and address the findings of the September 2021 private medical opinion. (c.) Then, determine whether the Veteran's Parkinson's disease is at least as likely as not (50 percent or greater probability) proximately due to or the result of any of his service-connected disabilities which include bilateral hearing loss, OSA, chronic maxillary sinusitis, tinnitus, deviated septum, and allergic rhinitis, to include whether the service connected disabilities aggravated the Parkinson's. The examiner should discuss a September 14, 2016 Primary Care Note from Appellant's VA treating physician that "his Parkinsons like issues have been worsened due to hypoxia caused by the [obstructive sleep apnea] p[ost] facial repar [sic]." (Continued on the next page) A clear rationale must be provided for all opinions expressed. The examiner must consider Veteran's lay statements and post-service treatment records. If the examiner is unable to provide such an opinion without resort to speculation, the examiner must provide a rationale for this conclusion 3. Thereafter, readjudicate the claims on appeal. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris, 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.