Citation Nr: 21073042 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-56 017 DATE: December 7, 2021 ORDER Entitlement to service connection for neurological disability, including frontotemporal and semantic demential, motor neuron disease, parkinsonism, and primary progressive aphasia, is granted. FINDING OF FACT The Veteran's neurological disability was reasonably shown to be related to his presumed herbicide exposure. CONCLUSION OF LAW Resolving any reasonable doubt in favor of the appellant, the criteria for service connection for neurological disability, to include frontotemporal and semantic dementia, motor neuron disease, parkinsonism, and primary progressive aphasia have been met. 38 U.S.C. §§ 1110, 1113, 1116; 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 from January 1969 to October 1970, including service in Vietnam. He passed away in August 2017. The appellant is his surviving spouse. She was recognized as a valid substitute for this appeal in a December 2017 VA memorandum. This matter is on appeal before the Board of Veterans Appeals (Board) from a February 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2021, a Board hearing was held before the undersigned; a transcript of the hearing is of record. The Board notes that the February 2016 rating decision denied entitlement to service connection for three conditions, frontotemporal and semantic dementia, motor neuron disease and primary progressive aphasia. However, upon review, the Board finds that these conditions, along with Parkinsonism, were all shown to have been manifestations of the Veteran's underlying neurological disability. Consequently, the matter on appeal has been recharacterized as indicated above. The appellant is not prejudiced by this recharacterization as the appeal for service connection for the underlying neurological disability, including all the claimed conditions, is being granted. Neurological disability, to include frontotemporal and semantic dementia, motor neuron disease, parkinsonism, and primary progressive aphasia. The appellant alleges that the Veteran's neurological disability resulted from exposure to herbicides during service. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Establishing entitlement to direct service connection generally requires: (1) competent and credible evidence confirming the Veteran has the claimed disability or, at the very least, showing he has at some point since the filing of his claim; (2) competent and credible evidence of in-service incurrence or aggravation of a relevant disease or an injury; and (3) competent and credible evidence of a relationship or correlation between the disease or injury in service and the currently claimed disability - which is the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Also, veterans who during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, are presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). As the record reflects that the Veteran served in Vietnam during the requisite time period, his exposure to herbicide agents coincident with such service is presumed. Additionally, the law provides a presumption of service connection for certain diseases associated with exposure to herbicide agents even if there is no record of evidence of such disease during service. Under the National Defense Authorization Act for Fiscal Year 2021, Pub. L. No. 116-283, parkinsonism, was added to the list of these diseases. See 38 U.S.C. § 1116(a)(2). The Veteran's DD-214 shows that he served in Vietnam from May 1970 to October 1970. Consequently, he is presumed to have been exposed to herbicides. Also, prior to passing away, he was diagnosed with parkinsonism as part of his progressive neurological disease. See e.g. October 2016 private disability benefits questionnaire from Dr. B, a private neurologist from the Cleveland Clinic. Additionally, in an October 2016 letter, Dr. B opined that the Veteran's progressive neurological syndrome characterized by impairment of language function, parkinsonism, and weakness (thought to be motor neuron disease) was as likely as not due to exposure to herbicides during service. Moreover, in a December 2016 letter, a VA treating physician noted that the Veteran had a primary diagnosis of frontotemporal dementia and primary progressive aphasia and that it was the physician's professional medical opinion that this neurological disability was a direct and proximate result of the Veteran's exposure to herbicides during military service. Notably, in a May 2015 opinion, a VA contract physician who does not specialize in neurology, opined that the Veteran's current neurological condition, including frontotemporal dementia, movement disorder and essential tremor, were less likely than not related to herbicide exposure without there being clinical documentation of this etiology. Also, in an August 2015 opinion, a VA osteopathic physician found that it was less likely than not that the Veteran had a diagnosis of amyotrophic lateral sclerosis (ALS) that was incurred in or caused by service but did not provide any opinion on the likelihood that the Veteran's underlying neurological disability, however diagnosed, was related to herbicide exposure during service. Additionally, in a November 2016 opinion, a VA nurse practitioner found that the Veteran was diagnosed with frontotemporal dementia with parkinsonism features and noted that parkinsonism was a group of characteristics that are similar to Parkinson's disease but did not constitute Parkinson's disease. The nurse practitioner also found that the Veteran's neurological symptoms were attributed to his motor neuron disease, which stemmed from his frontotemporal dementia. However, she also did not provide an opinion concerning the likelihood that this underlying neurological disability was related to herbicide exposure during service. Considering the record as a whole, the evidence is at least in equipoise as to whether the Veteran's underlying neurological disability, including frontotemporal and semantic dementia, motor neuron disease, primary progressive aphasia, and parkinsonism, was related to his presumed herbicide exposure during service. In this regard, the December 2016 VA physician specifically opined that the underlying frontotemporal dementia and primary progressive aphasia was a direct and proximate result of the Veteran's exposure to herbicides during service and Dr. B, a neurologist presumed to have advanced expertise concerning the etiology of the Veteran's neurological disability, specifically opined that the Veteran's progressive neurological syndrome characterized by impairment of language function, parkinsonism and weakness (thought to be motor neuron disease) was as likely as not due to exposure to herbicides during service. Thus, although the VA contract physician reached the opposite conclusion concerning a relationship between current neurological disability and herbicide exposure, weighing this against the noted favorable opinions, the evidence sufficiently establishes that the Veteran's neurological disability, including frontotemporal and semantic demential, motor neuron disease, parkinsonism, and primary progressive aphasia, was directly related to service. Accordingly, resolving any reasonable doubt in favor of the appellant, the necessary requirements have been met for awarding service connection for this neurological disability and the appellant's appeal is granted. C.F.R. §§ 3.102, 3.303, 3.307. 3.309; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dan Brook, 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.