Citation Nr: 21012186 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 14-05 550 DATE: March 3, 2021 ORDER Entitlement to service connection for the cause of the Veteran’s death is granted. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam and is therefore presumed to have been exposed to herbicides during his active duty service. 2. The evidence shows that it is at least as likely as not that the Veteran’s multi-syndrome atrophy/Parkinsonism was of service origin. 3. Because the Veteran’s multi-symptom atrophy (Parkinsonism) caused his death, the appellant is entitled to service connection for the Veteran’s cause of death. CONCLUSION OF LAW The criteria for entitlement to service connection for the Veteran’s cause of death have been met. 38 U.S.C. §§ 1110, 1310; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Marine Corps from April 28, 1966 to March 1969, with service in the Republic of Vietnam, and passed away in October 2002. In December 2020, the appellant and her sister testified before the undersigned Veterans Law Judge (VLJ) during a virtual videoconference hearing. A transcript of the hearing is of record. 1. Entitlement to service connection for the cause of the Veteran's death For service connection to be granted for the Veteran’s cause of death, the probative evidence must show that a disease or disability incurred in or aggravated by service either caused or contributed substantially or materially to cause death, such that either: (1) a cause of the Veteran’s death is or should be service connected; or (2) a service-connected disability caused the Veteran’s death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. Direct service connection generally requires evidence showing: (a) the existence of a present disability; (b) in-service incurrence or aggravation of a disease or injury; and (c) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). If a veteran was exposed to herbicide agents during service, then presumptive service connection may be established for certain conditions, including Parkinson’s disease. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). As an initial matter, the Board notes that the Veteran’s service records reflect that he had foreign service in Vietnam (see DD-214) during the applicable period; thus, it is presumed that he was exposed to the herbicide agent of Agent Orange. See 38 C.F.R. § 3.307(a)(6)(iii); see also Hearing Transcript, December 2020. Unfortunately, the Veteran passed away in October 2002. His death certificate lists his immediate cause of death as aspiration. Multi-symptom atrophy (MSA) is listed as the underlying cause leading to the immediate cause of death. During the December 2020 hearing, the appellant and her sister testified as to the onset and progression of the disorder that eventually lead to the Veteran’s death. The appellant described how the Veteran was diagnosed with Parkinson’s disease and that following additional testing, he was given a diagnosis of MSA, which she asserted is a “variant” of Parkinson’s. The appellant’s sister, a nurse, testified that the Veteran was taking medication typically prescribed for Parkinson’s disease at the time of his death and described her review of medical literature regarding MSA and Parkinson’s disease. The medical evidence of record reflects varying assessments regarding the nature of the Veteran’s disorder prior to his death. An October 1999 private treatment record reflects a diagnosis of possible early Parkinson’s disease, which was later diagnosed as Parkinson’s disease in January 2000. The Veteran underwent further assessments and his disorder was identified as Parkinson’s and/or MSA in October 2000. A July 2001 private treatment record reflects a diagnosis of “Parkinson’s/MSA” and a June 2002 private treatment record similarly shows a diagnosis of “MSA/Parkinson’s.” In a June 2012 letter, the Veteran’s treating physician relayed that the Veteran was given a diagnosis of Parkinsonism secondary to MSA, that he was referred to a specialist for a second opinion on his Parkinsonism symptoms, and that he was prescribed medications typically used to treat Parkinson’s disease. The Board acknowledges that in January 2013, a VA examiner who reviewed the evidence of record highlighted that the cause of the Veteran’s death was due to MSA, not Parkinson’s disease, and that MSA is not recognized as a disorder presumed to be due to Agent Orange (an herbicide agent) exposure. The examiner stated that MSA has Parkinsonism features but is not synonymous with Parkinson’s disease. In providing this opinion, however, the examiner did not address the private medical evidence indicating a diagnosis and treatment for Parkinson’s and/or MSA with Parkinsonism symptoms at the time of his death. Thus, the January 2013 VA opinion is of little probative value and does not outweigh the other medical evidence of record. The Board concludes that the foregoing evidence supports a grant of service connection. The Board finds that the June 2002 diagnosis of MSA/Parkinson’s disease and the June 2012 letter from the Veteran’s treating physician indicating that the Veteran had Parkinsonism secondary to MSA satisfy the requirement for diagnosis of Parkinson’s disease at the time of the Veteran’s death. Even though the medical evidence is not unequivocal, the evidence is, at the very least, in equipoise as to whether the Veteran’s death due to MSA also involved Parkinson’s disease or Parkinsonian features. Accordingly, because the VA has conceded the Veteran’s exposure to herbicide agents during his Vietnam service, it is presumed that the Veteran’s Parkinson’s disease (identified in the medical evidence as MSA/Parkinson’s disease) was a condition of service origin and the condition is found to have ultimately led to the Veteran’s death. 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.312. Resolving all doubt in the favor of the appellant, service connection for the Veteran’s cause of death is granted. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.