Citation Nr: 21076378 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-51 421 DATE: December 23, 2021 ORDER Entitlement to service connection for Parkinson's disease is granted. REMANDED Entitlement to an initial rating in excess of 50 percent for a service-connected acquired psychiatric disability is remanded. Entitlement to total disability based on individual unemployability (TDIU) is remanded. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, his Parkinson's disease is etiologically related to his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for Parkinson's disease have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1967 to October 1968 with additional service in the Reserves. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for Parkinson's disease The Veteran contends that he was exposed to both Agent Orange and Tricholorethylene (TCE) during service which caused his Parkinson's disease. Service treatment records are negative for any evidence of complaints, treatment or a diagnosis related to Parkinson's disease. Service military records are also negative for mentions of exposure to TCE. A May 2009 memorandum from the Joint Services Records Research Center (JSRRC) found no evidence that Navy or Coast Guard ships transported tactical herbicides from the U.S. to the Republic of Vietnam or that ships operating off the cost of Vietnam used, stored, tested, or transported tactical herbicides. The memorandum further stated, "Additionally, the JSRRC cannot document or verify that a shipboard Veteran was exposed to tactical herbicides based on contact with aircraft that flew over Vietnam or equipment that was used in Vietnam. The Veteran submitted a January 2014 publication titled Annual Review of Pharmacology and Toxicology which found that contaminants such as solvents had been implicated in clinical and pathological manifestation of movement disorders such as Parkin's disease. VA treatment records regular note that the Veteran was diagnosed with Parkinson's disease in 2015. In March 2016 correspondence, the Veteran argued that he should be granted entitlement to service connection on a presumptive basis due to his exposure to Agent Orange while serving off the cost of Vietnam. The Veteran explained that he served as an aviation machinist mate hydraulics servicing fighter jets that were exposed to Agent Orange while they were Vietnam and carried the residue of Agent Orange on the fuselage when they returned to his ship. Upon the aircrafts return, it was his job to work on the aircraft which he asserted brought him into direct contact with the fuselage and thus the residuals of Agent Orange. A July 2016 VA record made a formal finding that VA lacked information JSRRC required to verify service exposure to Agent Orange. A June 2017 private opinion from Dr. C.B. noted that the Veteran had documented and diagnosed Parkinson's disease and that the Veteran was exposed to solvents containing TCE during service. The private examiner explained solvents were commonly used to degrease and clean mechanical equipment as well as being used as paint thinners and for other purposes. Dr. C.B. further noted that the Veteran was not provided protective equipment during service but was provided protective masks post-service in his occupation as a diesel mechanic. The VA examiner opined that when "attempting to identify where the most direct exposure occurred, reasonable doubt favors the Veteran's statements...regarding not having protection from the high doses while in service." The private examiner further opined that TCE was known to cause Parkinson's disease and cited to medical literature in support of a favorable nexus. Dr. C.B. stated that no other more plausible etiology for the Veteran's Parkinson's disease existed and that the lag time between exposure to TCE in service and current pathology was consistent with known medical principles and that nature history of the disease. In June 2017, Dr. K.D. also submitted a favorable nexus opinion in support of the Veteran's claim for entitlement to service connection for Parkinson's disease. Dr. K.D. cited to medical literature and opined that it was more likely than not that his in-service exposure to solvents represented a nexus to his diagnosed Parkinson's disease. The Veteran submitted another letter in support of his claim in July 2017 detailing his exposure to chemicals during service. The Veteran explained that he was deployed to Vietnam from January 1968 to August 1968 as an aviation machinist's mate hydraulics worker and worked on F4 Phantoms while serving on board the U.S.S. Enterprise. He reported that his daily operations included wiping down struts pre and post flight by hand using a bucket of hydraulic fluid and a rag, repairing and replacing struts, cleaning all hydraulic parts with a chemical solvent, and repacking wheel bearings with grease by hand. The Veteran explained that chemical solvents gave off fumes which caused headaches and dizziness. He stated that no protective gear was available and clothes were thrown away due to saturation. He stated that his eyes, lungs, and skin, particularly his hands, were exposed to chemicals for extended periods of time on a daily basis. Post-service the Veteran worked as a heavy truck and diesel mechanic. He stated that protective gear was available and utilized. Post-service gloves were also worn while cleaning parts or working with chemicals and respirators were worn during sanding, painting, grinding or other such jobs. In October 2017, the Veteran submitted additional studies in support his claim. These studies noted that TCE was used as a powerful degreaser for machinery parts and equipment and that people exposed to TCE had a significant likelihood for developing Parkinson's disease. In October 2017, the Veteran and his representative submitted correspondence detailing the Veteran's duties during active-duty service. The representative explained that the Veteran's duties including repairing and maintaining an F4 Phantom jet. The representative further stated that at the time JP-4 was used universally aboard carriers for wiping down the plane with hydraulic fluid and a rag and for cleaning all hydraulic parts with a chemical solvent. The representative stated that based on historical review of chemicals aboard all carriers during Vietnam, TCE was part of the chemical solvent. A private opinion was obtained in February 2018 addressing the Veteran's Parkinson's disease. The private physician noted that the Veteran was exposed to multiple chemicals, including TCE on a daily basis in his role as an aviation machinist. In addition, the Veteran was diagnosed with Parkinson's disease and had symptoms including chronic ataxia, bradykinesia debilitating weakness and range of motion, impaired coordination, and impaired balance that resulted in numerous falls. The private physician asserted that evidence linking TCE exposure and Parkinson's disease in medical literature was exceptionally strong. The private physician cited to medical literature in support of this assertion. The private physician explained that it was rare to find such strong causal relationships in medicine and that the link between TCE exposure and Parkinson's disease was incontrovertible. The private physician opined, "[t]he fact that [the Veteran] was exposed to TCE during his military service and now has Parkinson's disease makes it extremely likely, fare more likely than not, that the TCE was the causal agent for his disease." Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection generally requires evidence satisfying three criteria: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). At the outset, the Board acknowledges the Veteran's contention that exposure to Agent Orange caused his Parkinson's disease. However, the Board emphasizes that presumptive service connection due to herbicide exposure is not for application as the Veteran's alleged exposure to Agent Orange was not been confirmed or verified. On the other hand, the Board finds that the Veteran has a diagnosis of Parkinson's disease. Accordingly, the first prong for entitlement to service connection is met. The Board also finds that the Veteran's lay statements describing in-service exposure to TCE are credible and consistent with his position as an aviation machinist. Accordingly, the second prong for entitlement to service connection is met. Lastly, the Board affords great probative value to the June 2017 private opinions submitted by C.B. and K.D in support of a nexus between the Veteran's exposure to TCE and his diagnosed Parkinson's disease. These opinions are also consistent with the numerous medical articles affiliated with and cited to in the Veteran's claims file showing a nexus between TCE and Parkinson's disease in general. Lastly, no negative nexus opinions are of record. The Board finds that the preponderance of the evidence is in support of the Veteran's claim for entitlement to service connection for Parkinson's disease. The claim is granted. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 50 percent for a service-connected acquired psychiatric disability is remanded. The Veteran's most recent VA examination to evaluate the severity of his service-connected acquired psychiatric disability was over 4 years ago in April 2017. The Veteran also submitted a privately completed June 2017 disability benefits questionnaire in support of his claim for an increased initial rating for his service-connected acquired psychiatric disability. The private physician appeared to combine the impact of both the Veteran's service-connected acquired psychiatric disability and his Parkinson's disease when explaining the severity of the Veteran's impairment. For example, the private physician stated, "Combining service-connected Parkinson's disease and impairment from other specified trauma and stressor related disorder, indicates a disability rating of 100 percent (due to unemployability). The Board finds that remand is required for a VA examination addressing the current severity of the Veteran's service-connected acquired psychiatric disability alone without consideration of any impairment caused by the Veteran's Parkinson's disease. 2. Entitlement to TDIU is remanded. An October 2017 VA treatment record noted that the Veteran received disability benefits for his Parkinson's disease. However, no Social Security Administration records have been affiliated with the Veteran's claims file. Remand is required to obtain these records. Moreover, the Veteran contends that he is unable to maintain gainful employment due, at least in part, to his service-connected Parkinson's disease and service-connected acquired psychiatric disability. The Board finds that the Veteran's claim of entitlement to TDIU is inextricably intertwined with the claim of service connection for Parkinson's disease granted herein and will defer consideration of the TDIU matter until the AOJ implements this Board decision and assigns disability ratings and effective dates. In addition, the Veteran's claim for entitlement TDIU is also inextricably intertwined with his claim for an increased rating for his service-connected acquired psychiatric disability. Because adjudication of this claim will potentially affect the entitlement to TDIU, adjudication of TDIU is further deferred. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (stating that two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The matters are REMANDED for the following action: 1. Obtain and associate the Veteran's Social Security Administration records with the claims file. All attempts to obtain records should be documented. 2. Then, schedule a VA examination to determine the current severity of the Veteran's service-connected acquired psychiatric disability. The Veteran's claims file, to include a copy of this remand, must be made available to the examiner in conjunction with the examination along with any other information the medical professional deems pertinent. A note that it was reviewed should be included in the opinion. 3. After the development outlined above has been completed and after the rating for Parkinson's disease has been assigned, and any additionally indicated development has been completed, readjudicate the issue of TDIU. 4. Then, readjudicate the claims. If the determination of the claims remain unfavorable to the Veteran, then issue a Supplemental Statement of the Case and afford him a reasonable period of time to respond before returning the case to the Board. SONJA S. AN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Palombi, 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.