Citation Nr: 21015514 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 15-20 304 DATE: March 17, 2021 ORDER Entitlement to service connection for Parkinson's disease, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is denied. FINDING OF FACT The evidence is insufficient to establish that the Veteran’s was proximately due to or aggravated beyond the natural progression by the Veteran’s medication for treatment of service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for Parkinson's disease, to include as secondary to service-connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States Navy from February 1973 to May 1974. In February 2019, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. A copy of the transcript has been associated with the claims file. In July 2019, the Board remanded the appeal for further development. 1. Service connection for Parkinson's disease, to include as secondary to service-connected PTSD The Veteran contends that his Parkinson’s disease is secondary to medication taken as treatment for his service-connected PTSD. Specifically, the Veteran asserted that his Parkinson’s disease is secondary to his treatment of psychiatric disorder symptoms with Olanzapine. The Board finds that the evidence is insufficient to establish that the Veteran’s medication for service-connected PTSD resulted in the Veteran’s Parkinson’s disease or aggravated it beyond natural progression. At the outset, the Board notes that the service treatment records do not show, nor does the Veteran assert, that his Parkinson’s disease began during his period of service. Therefore, analysis will turn to service connection on a secondary basis. Service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310(a). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or aggravated by, a service-connected disease or injury. The Board notes that secondary service connection on the basis of aggravation may be granted only when there is an increase in severity of the nonservice-connected disability beyond a medically established baseline due to the service-connected disability. The regulation specifically states that VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established. 38 C.F.R. § 3.310(b). This baseline is to be established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. Id. Turning to the evidence, at a February 2019 Board hearing, the Veteran asserted that his medication, Olanzapine, caused side-effects, including tremors and tardive dyskinesia. The Veteran reported that he had been on the medication for about thirty years. The Veteran stated that his tremors began approximately in 2006, about fifteen years after he started taking the medication. In a December 2019 VA examination, the examiner reported that the Veteran has a diagnosis of Parkinson’s disease. The examiner stated that the Veteran’s Parkinson’s disease was less likely than not due to the Veteran’s PTSD, to include medication for treatment. The examiner explained that although extrapyramidal symptoms (muscle spasms, jerky movements, slow movements) and tremors are a side effect of the medication, Olanzapine, it is uncommon that Olanzapine, especially at such a low dose, would cause the degree of the Veteran’s current Parkinsonian symptoms. The examiner noted that, per the Veteran’s medical record, his medical doctors also agree that the “severity of parkinsonian symptoms is uncharacteristically severe for what might typically occur as a side effect of a modest dose of olanzapine.” Citing Veteran’s October 2018 VA medical record. The examiner stated, therefore, that a nexus had not been established. The examiner went on to state that, although the severity of Parkinsonian symptoms is uncharacteristically severe for what might typically occur as a side effect of a modest dose of Olanzapine, it is likely that side effects of Olanzapine (extrapyramidal symptoms - muscle spasms, jerky movements, slow movements and tremors) have aggravated Veteran's Parkinson's disease beyond its natural progression. The examiner noted, however, that a baseline level of severity of the Veteran’s Parkinson’s disease based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation by the Veteran’s PTSD medication could not be determined. In a December 2020 VA addendum opinion, an examiner stated that she was unable to determine when the symptoms described by the examiner in the December 2019 medical opinion were first aggravated beyond natural progression. The examiner explained that the previous statement of side effects of Olanzapine (extrapyramidal symptoms - muscle spasms, jerky movements, slow movements) were only notable possible side effects. The examiner remarked that the Veteran does have tremors of all four extremities; however, there is no current evidence in the Veteran’s records supporting current symptoms of muscle spasm, jerky movements, or slow movements. The examiner also remarked that there is no current evidence of aggravation to other areas of the body by the medication. After review of the record, the Board finds that the evidence is insufficient to warrant service connection for Parkinson’s disease. The December 2019 examiner noted that a baseline for the Veteran’s symptoms could not be determined. Moreover, the December 2020 VA addendum opinion indicates that there is no evidence of symptoms other than tremors of the extremities. The medical evidence does not establish the baseline level of severity of the Veteran’s Parkinson’s disease to show aggravation. Both opinions bolstered these opinions with medical literature and the Veteran’s medical history. Thus, the Board finds the December 2019 and December 2020 VA opinions to be highly probative for the purpose of adjudicating the claim. Furthermore, there is no medical evidence of record, as required by regulation, that establishes baseline severity for the Veteran’s disability. Therefore, service connection for Parkinson’s disease, secondary to medication for treatment of service-connected PTSD, is not warranted. The Board acknowledges that the Veteran believes that his Parkinson’s disease is secondary to his medication for treatment of his service-connected PTSD. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires specialized knowledge to make such opinion. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Ford 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.