Citation Nr: 21014297 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-04 218 DATE: March 11, 2021 REMANDED Service connection for Parkinson’s disease due to herbicide agent exposure is remanded. Service connection for progressive supranuclear palsy is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1964 to September 1973 and from January 1975 through August 1985. He died in May 2012; the Appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in October 2018 and May 2019 but was remanded for further development. For the reasons discussed below, the Board finds there has not been substantial compliance with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Service connection for Parkinson's disease due to herbicide agent exposure is remanded. 2. Service connection for progressive supranuclear palsy is remanded. The Appellant seeks service connection for Parkinson’s disease and progressive supranuclear palsy. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding these issues. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In May 2019, the Board found clarification was necessary to determine whether the Veteran was diagnosed with both Parkinson’s disease and progressive supranuclear palsy. The Board noted that at the time of his diagnosis in July 2009, the physician noted the Veteran had “Parkinson’s plus syndrome probably supranuclear palsy.” Follow-up visits noted the Veteran had a diagnosis of progressive supranuclear palsy. See October 2010 medical record. However, other documents note he was diagnosed with Parkinson’s disease. See May 2010 and May 2011 medical records. Additionally, a November 2011 letter from the Veteran’s treating physician noted he was diagnosed with Parkinson’s disease and progressive supranuclear palsy. However, the February 2019 VA medical opinion appears to suggest that the Veteran only had a diagnosis of progressive supranuclear palsy. The Board directed the RO to obtain an advisory opinion from a neurologist or other appropriate phsyician specializing in diagnosis and treatment of neurodegenerative disease. In July 2020, the RO obtained a medical opinion from a physician who indicated they were a general practitioner. There is no indication that the general practitioner specializes in diagnosis and treatment of neurodegenerative disease. Review of the record does not indicate whether a a neurologist or other appropriate phsyician specializing in diagnosis and treatment of neurodegenerative disease was not available to provide the requested opinions. In the absence of such information from the RO, there does not appear to have been substantial compliance with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, remand is necessary. The matters are REMANDED for the following action: Obtain an addendum opinion from a neurologist or other appropriate physician specializing in diagnosis and treatment of neurodegenerative disease. If either such clinician is unavailable at the local VA medical facility, and/or a similar VA-contracted provider is unavailable, then the RO must clearly indicate this in the file (perhaps in a supplemental statement of the case) to reflect that substantial compliance with the prior Board remand was attempted. If a neurologist or other appropriate physician specializing in diagnosis and treatment of neurodegenerative disease is indeed available, then obtain an addendum opinion addressing whether the Veteran was properly diagnosed with both Parkinson’s disease and progressive supranuclear palsy. If the examiner concludes the prior diagnosis of Parkinson’s disease was not accurate, it would be helpful if the examiner could explain why and reconcile any conflicting medical evidence of record. The Board notes that the exact diagnosis is legally significant in this case as Parkinson’s disease is presumptively associated with herbicide agent exposure, while other neurodegenerative diseases, such as progressive supranuclear palsy, are not. The National Academy of Sciences has distinguished Parkinson’s disease from a variety of parkinsonian syndromes and neurodegenerative diseases, noting pathologic findings in other causes of parkinsonism show different patterns of brain injury than with Parkinson’s disease. If the examiner determines the Veteran did not have Parkinson’s disease, but did have progressive supranuclear palsy, the examiner must opine whether it is at least as likely as not the progressive supranuclear palsy is at least as likely as not related to service, including in-service exposure to herbicide agents. A fully explained rationale must be provided. The examiner is advised that a negative opinion cannot be based solely on the fact that the progressive supranuclear palsy is not on the list of diseases that are presumptively associated with exposure to herbicide agents. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.Aoughsten, 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.