Citation Nr: 21012762 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 16-59 696 DATE: March 5, 2021 REMANDED Entitlement to total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1952 to May 1955. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified before a Veterans Law Judge other than the undersigned Veteran Law Judge. A transcript of that hearing is of record. Per August 2020 correspondence, the Board notified the Veteran that the Veterans Law Judge who presided over that hearing is now in a different role with the Board and no longer providing decisions on issues on appeal. The Veteran was afforded the option of having the Board adjudicate his claim without a second hearing or to have a hearing before another Veterans Law Judge. In September 2020, the Veteran indicated that he wished that his appeal be adjudicated without testifying before another Veterans Law Judge. This matter was previously remanded by the Board in August 2019, January 2020 and November 2020 for further development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. §20.900(c). 38 U.S.C. § 7107(a)(2). Entitlement to total disability rating based upon individual unemployability (TDIU) due to service-connected disabilities is remanded. Per the November 2020 Board remand, the Board determined that an April 2020 VA opinion did not comport with the Board’s January 2020 remand directives pursuant to Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding veterans are entitled to compliance with Board remand instructions). Specifically, the Board determined that the opinion did not apply the correct analytical framework for aggravation as stated in the Board’s January 2020 remand directive. In that regard, in articulating its January 2020 request for a new VA examination and opinion, the Board’s framing of the issue drew on the elements of secondary service connection within the context of the holding in Ward v. Wilke, 31 Vet. App. 223 (2019). In that context, the U.S. Court of Appeals for Veterans Claims (Court) has held that any amount of aggravation is sufficient to establish secondary service connection and that permanent aggravation/worsening of a nonservice-connected disability is not required. Id. The November 2020 Board remand further noted that the requirements for aggravation, as stated in Ward, were not expressly stated in the Board’s January 2020 request for the medical opinion and, while the April 2020 opinion stated that the medical record did not indicate any medical evidence that the Veteran’s use of alcohol had aggravated the Veteran’s Parkinson’s disease in any way, it was not clear, however, whether the examiner considered any amount of aggravation, to include non-permanent or temporary aggravation and worsening of Parkinson’s disease. Hence, the Board determined remand was necessary in light of the Court’s holding in Ward, to ensure compliance with the Board’s January 2020 remand directive. Accordingly, in its November 2020 remand, the Board directed an addendum opinion be obtained to determine whether the Veteran’s Parkinson’s disease was at least as likely as not proximately due to the Veteran’s service-connected PTSD with alcohol dependence, or underwent any incremental increase in disability, regardless of its permanence, due to the service-connected PTSD with alcohol dependence. Pursuant to the November 2020 Board remand, an addendum opinion was obtained on November 9, 2020. The examiner provided an opinion regarding whether the Veteran’s Parkinson’s disease was at least as likely as not proximately due to the Veteran’s service-connected PTSD with alcohol dependence; however, she stated that comments as to any worsening of the PTSD with symptoms or other conditions secondary to PTSD would need to be addressed through psychiatry. To date, an opinion addressing the question of aggravation has not be obtained as directed in the November 2020 Board remand. Further, the Board notes that in December 2020, the Veteran submitted two studies from American Neurological Association and the American Association for geriatric Psychiatry regarding the association of PTSD and Parkinson’s Disease. Accordingly, remand is required for an addendum medical opinion to fully comply with the Board’s November 2020 remand directives pursuant to Stegall and to consider the findings of the medical research studies submitted by the Veteran in December 2020. Stegall, 11 Vet. App. 268, 271 (1998). Updated treatment records should also be obtained upon remand. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After records development is completed, send the Veteran’s claims file to an appropriate psychiatric and/or neurologic examiner, to obtain an addendum opinion regarding the etiology of the Veteran’s Parkinson’s disease. If an examination is required in order to respond to the request, such should be scheduled. If an examiner in unable to respond to one or both of the requested opinion due to a lack of expertise in the subject matter, the claims file should be sent to an appropriate examiner who is able to provide an answer to the requested opinion(s). Following review of the claims file, the examiner should provide an opinion as to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s Parkinson’s Disease was caused by the service-connected PTSD with alcohol dependence? Please explain why or why not, to include addressing the research studies submitted by the Veteran in December 2020 regarding the association between PTSD and Parkinson’s Disease. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s Parkinson’s disease is worsened beyond natural progression (aggravated) by his service-connected PTSD with alcohol dependence? Please explain why or why not, to include addressing the research studies submitted by the Veteran in December 2020 regarding the association between PTSD and Parkinson’s Disease. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. The examiner is advised that a finding that the Parkinson’s Disease was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Medina, 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.