Citation Nr: 21073659 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 18-19 155 DATE: December 9, 2021 ORDER Entitlement to service connection for Parkinson's disease is granted. REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities is remanded. FINDING OF FACT The Veteran's Parkinson's disease is related to his military service. CONCLUSION OF LAW The criteria for service connection for Parkinson's disease are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from February 1985 to February 2005. This matter comes before the Board of Veterans' Appeals (Board) from the February 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at an August 2021 hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Entitlement to service connection for Parkinson's disease is granted The Veteran contends that his Parkinson's disease is related to his military service. Specifically, the Veteran alleges that his disease is caused by his in-service pesticide exposure. At the Veteran's Board hearing, he testified that during his military service he started having pain with slight tremors in his right hand and wrist which he began to self-treat during service. Additionally, the Veteran was a Navy hospital corpsman and while he was abord the USS Kansas City he was asked to be the ship board vector control corpsman. This entailed the Veteran using toxic insecticides for pests and rodent control. The Veteran testified that in 2000 he noted that he began having unexplained right hand and wrist issues. The Board concludes that the Veteran has a current disability that is related to his military service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Additionally, the Board notes that certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of Parkinson's disease as evidenced by VA treatment records. Parkinson's disease, or paralysis agitans, is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. VA treatment records show the Veteran has a current diagnosis of Parkinson's disease. During service, the Veteran was seen for complaints of wrist pressure and pain. Thus, the question becomes whether the current disability is related to service. The Veteran's DD 214 shows that the Veteran had active service from February 1985 to February 2005. Shortly one year after his separation from service, in September 2006, a private physician stated that for the last 2-3 months the Veteran has had a fine tremor affecting his right hand. The physician stated that the Veteran has an essential tremor. Also, July 2006 and February 2007 VA treatment records note a diagnosis of a fine, rapid tremor of the right hand. In August 2021, the Veteran's private physician submitted a medical opinion. The physician stated that given the Veteran's history as a naval corpsman and his involvement with spraying pesticides on the naval ships from 1987 to 1989, it is the physician's opinion that the veteran's symptoms of Parkinson's disease are associated with pesticide exposure. The physician cited medical literature showing a significant association between chemical pesticide exposure and Parkinson's disease. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current Parkinson's disease is related to his military service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for Parkinson's disease is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to service connection for sleep apnea, to include as secondary to service connected disabilities is remanded. The Veteran contends that his sleep apnea is related to his military service. The Veteran has submitted several lay statements stating that he snored during service. Additionally, the Veteran has a current diagnosis of sleep apnea. The Board notes that in April 2016 the Veteran underwent a VA sleep apnea examination. The examiner opined that the Veteran's sleep apnea is not caused by or related to gulf war environmental exposure. Additionally, the examiner stated that the preponderance of the evidence reveals that the proximate cause of sleep apnea is a developmentally narrow oropharyngeal airway, often with superimposed elevation of BMI and/or natural aging. However, the Veteran has submitted several lay statements and medical literature indicating a link between hypertension (which the Veteran is currently service connected for) and sleep apnea. Therefore, the Board finds that an addendum opinion must be obtained to consider the Veteran's contentions that his sleep apnea is caused by his service connected disabilities and to consider the lay statements that he had severe snoring during service. Additionally, on remand, the examiner should consider the Veteran's exposure to pesticides in providing an etiology opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the following: a) whether the Veteran's sleep apnea is at least as likely as not related to his military service, to include statements that indicate that the Veteran snored during service and was exposed to pesticides; and b) whether the Veteran's sleep apnea is proximately due to service-connected hypertension; or c) whether the Veteran's sleep apnea is aggravated beyond its natural progression by service-connected hypertension. All opinions provided must be thoroughly explained and an adequate rationale for any conclusions reached must be provided. The examiner should not rely solely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. If any requested opinion cannot be provided without resort to speculation, the medical professional should state and explain why an opinion cannot be provided without resort to speculation. 2. Following completion of the above, and a review of any additional evidence received, the RO should also undertake any other development it deems to be necessary, to include, if warranted, an addendum medical opinion which considers any newly received evidence. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Mountford, 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.