Citation Nr: 21009066 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 18-53 631 DATE: February 18, 2021 ORDER Service connection for Parkinson’s Disease is granted. Special monthly compensation (SMC) based on the need for aid and attendance of another person is granted. FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, his currently diagnosed Parkinson’s Disease is related to his military service. 2. Resolving all doubt in the Veteran’s favor, he requires the regular aid and attendance of another person as a result of his service-connected Parkinson’s Disease. CONCLUSIONS OF LAW 1. The criteria for service connection for Parkinson’s Disease have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for SMC based on the need for aid and attendance of another person have been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1956 to September 1960. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in April 2018 by a Department of Veterans Affairs (VA) Regional Office. In a June 2020 decision, the Board denied the instant claims and, in July 2020, the Veteran’s representative filed a motion to vacate such decision on the basis that there was an outstanding hearing request. Thereafter, in August 2020, the Board vacated the June 2020 decision. In February 2021, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. As this appeal is being processed under the “One Touch” program, a transcript of the hearing will be associated with the record at a later date. 1. Entitlement to service connection for Parkinson’s Disease. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)]. The Veteran claims that his currently diagnosed Parkinson’s Disease is related to his exposure to various chemicals, to include trichloroethylene (TCE), coincident with his in-service duties as an aircraft mechanic. In this regard, the Board notes that his complete service treatment records (STRs) are unavailable as they were destroyed in a 1973 fire at the National Personnel Records Center. However, he is competent to report the duties he performed while in service, to include the supplies utilized, and his DD Form 214 confirms that his military occupational specialty was aircraft maintenance specialist. Further, the Veteran was diagnosed with Parkinson’s Disease in June 2010 as documented in VA treatment records and at an April 2018 VA examination. Consequently, the remaining inquiry is whether such currently diagnosed disorder is related to his military service, to include his exposure to various chemicals while performing his duties. In this regard, at the April 2018 VA examination, the examiner opined that the Veteran’s Parkinson’s Disease was less likely than not related to his exposure to TCE during his military service. In support thereof, he noted that the Veteran’s Parkinson’s Disease onset was sudden, which was atypical, and had been associated with microvascular disease of the brain as documented by his treating neurologist in June 2010 VA treatment records. Additionally, the examiner indicated that medical literature provided inconclusive evidence demonstrating a link between TCE and Parkinson’s Disease. In contrast, in July 2020, Dr. R.G., the Veteran’s former treating VA neurologist who diagnosed Parkinson’s Disease in June 2010 and treated him through 2014, opined that his development of such disease was more likely than not caused by or the result of his prolonged exposure of TCE. In this regard, Dr. R.G. indicated that, while performing his in-service duties as an aircraft mechanic, the Veteran was never provided any PPE, and the hydrocarbon solvents used for cleaning and servicing his aircrafts included TCE. Here, according to cited medical literature, Dr. R.G. explained that TCE had been shown to specifically injure dopaminergic cells in the brain, which resulted in the clinical manifestations of Parkinson’s Disease. He noted that the Veteran had a documented 3 ½ years of intense exposure to olfactory and skin exposure to soluble hydrocarbons, including but not limited to, TCE without any PPE while performing his assigned job in the U.S. Air Force. He further noted that the Veteran developed anosmia and constipation in his 40s, symptoms which are now known to be the earliest features of Parkinson’s Disease, and began to experience impairment of dexterity in his 50s. Dr. R.G. highlighted the current understanding of the role of soluble hydrocarbons as contributory to the onset of Parkinson’s Disease; the Veteran’s consistent multi-year unprotected exposure to soluble hydrocarbons, most specifically TCE (which has been scientifically proven to be toxic to dopaminergic neurons in both animal and human studies); and the fact that TCE had been recognized as having “strong evidence of a causal relationship and evidence that the condition may be caused by exposure to contaminants” to the development of Parkinson’s Disease by the VA in connection with cases involving exposure to contaminated water at Camp Lejeune. Thus, Dr. R.G. concluded that that the Veteran’s development of Parkinson’s Disease was more likely than not caused by or the result of his prolonged exposure of TCE. After a careful review of the record, the Board finds that the evidence of record is at least in equipoise as to whether the Veteran’s Parkinson’s Disease is related to his military service, In this regard, the April 2018 VA examiner and Dr. R.G. are both competent medical professionals, considered the totality of the evidence and applicable medical principles, and provided a rationale for their opinions. Thus, such opinions are entitled to equal probative weight. Therefore, the Board resolves all doubt in the Veteran’s favor and finds that his currently diagnosed Parkinson’s Disease is related to his military service. Thus, service connection for such disorder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.103; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to SMC based on the need for aid and attendance of another person. SMC is a special statutory award in addition to awards based on the schedular evaluations provided in VA’s rating schedule. SMC at the aid and attendance rate is payable when the veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes with visual acuity of 5/200 or less, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350(b). Determinations as to the need for aid and attendance must be based on actual requirements of personal assistance from others. In making such determinations, consideration is given to such conditions as: inability of the claimant to dress or undress himself or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which, by reason of the particular disability, cannot be done without aid; inability of the claimant to feed himself through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from the hazards or dangers incident to his daily environment. “Bedridden” will be a proper basis for the determination, and is defined as that condition which, through its essential character, actually requires that the claimant remain in bed. It is not required that all of the disabling conditions enumerated above be found to exist before a favorable rating may be made. The particular personal functions that the claimant is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the claimant is so helpless as to need regular aid and attendance, not that there be a constant need. 38 C.F.R. § 3.352(a). For the entire appeal period stemming from his December 2017 claim, the Veteran is service-connected for tinnitus and Parkinson’s Disease. However, he has not argued, and the evidence does not suggest, that he is blind, suffered the loss of use of a hand or foot, or is bedridden due to service-connected disabilities. Furthermore, he does not contend, and the evidence does not suggest, that his tinnitus requires the aid and attendance of another person. Rather, the Veteran’s sole allegation is that, due to his Parkinson’s Disease, he requires the aid and attendance of another person. In this regard, the Board notes that, as service connection for Parkinson’s Disease has been established by virtue of this decision, the Agency of Original Jurisdiction (AOJ) has not yet assigned a disability rating for such disorder. However, there is no statutory or regulatory requirement that the service-connected disability or disabilities resulting in the need for aid and attendance be rated a certain percentage. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.352; compare with § 1114(s) (requiring that a single service-connected disability be rated as total in order to award SMC based upon being permanently housebound). Thus, the Board may proceed with the adjudication of the Veteran’s SMC claim in the first instance. Prior to the receipt of the Veteran’s claim in December 2017, an April 2015 VA treatment record reveals his spouse’s inquiry regarding VA’s assistance with home modifications, a ramp, wheelchair, and aide. VA treatment records dated in 2017 reflect that non-VA home health aide visits for personal care and assistance with activities of daily living were authorized due to the Veteran’s diagnosis of Parkinson’s Disease. In a December 2017 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, the Veteran’s VA treatment provider found that, due to the Veteran’s Parkinson’s Disease and spinal stenosis, he was unable to prepare his own meals or manage his medication and financial affairs, and needed assistance in bathing. However, he was not confined to his bed, was able to feed himself, and did not require nursing home care. In this regard, the provider noted that the Veteran had diminished strength in his upper extremities, numbness and weakness in his legs, and problems with balance and memory, which resulted in the need for assistance with locomotion. However, he was able to leave home with attendance. In a September 2018 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, the Veteran’s VA treatment provider indicated that, due to Parkinson’s Disease, the Veteran was unable to feed himself, prepare his own meals or manage his medication and financial affairs (dementia), and needed assistance in bathing. However, he was not confined to his bed and did not require nursing home care. IN this regard, the provider noted the Veteran had tremors and used a walker, was unable to do fine movements, and he had a loss of memory and poor balance. In a June 2020 Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, the Veteran’s VA treatment provider indicated that, due to Parkinson’s Disease, the Veteran was unable to prepare his own meals or manage his medication and financial affairs (due to cognitive disorder caused by his Parkinson’s Disease), and needed assistance in bathing. However, he was not confined to his bed and was able to feed himself. She indicated that, if the Veteran’s spouse was unable to provide the care he received in the home, he would have to live in a long-term care facility for 24-hour care. The provider further noted that the Veteran had frequent freezing spells (which led to an inability to move) and tremors, as well as a neurocognitive disorder and psychosis due to his Parkinson’s Disease that required supervision. Thus, she found that he was homebound due to severe mobility concerns as a result of his freezing episodes and only left the home for emergency/critical medical care, with assistance for locomotion. The Board notes the December 2017 examination included consideration of the Veteran’s non-service-connected spinal stenosis; however, the September 2018 and June 2020 examinations clearly reflect that the Veteran’s limitations were due solely to his service-connected Parkinson’s Disease. Further, in a June 2020 written statement, the Veteran’s spouse reported that, following the Veteran’s diagnosis of Parkinson’s Disease in 2007, he lost his sense of smell (which led to their home being filled with gas from the stove being left on) and developed difficulty in moving his legs. Here, she indicated that the Veteran shuffled his feet when he walked, and they were told that such was a symptom related to Parkinson’s Disease. The Veteran’s spouse further indicated that the Veteran’s physicians advised him to start using a cane, which led to him using a walker and eventually a scooter. Additionally, she reported that the Veteran has had several trips to the hospital, and the medication he was taking for his Parkinson’s Disease caused constipation (which required her to give him enemas), required her to help him with urination, and caused hallucinations. Here, she noted that, following a hallucination incident, she realized that she could not leave the Veteran at home by himself while she was at work. She further noted that she took the Veteran’s driving privileges away, was fully responsible for their finances, and assumed his power of attorney due to his handwriting issues. Therefore, the Board resolves all doubt in favor of the Veteran and finds that his service-connected Parkinson’s Diseases results in the need for assistance with ambulation and leaving his home, finances and medication, homemaking activities, and personal hygiene. In addition, such physical incapacity requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. For these reasons, the Board concludes the Veteran requires the regular aid and attendance of another person as a result of his service-connected Parkinson’s Disease. Consequently, the criteria for SMC based on the need for regular aid and attendance have been met. 38 C.F.R. § 3.350. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.