Citation Nr: 21021817 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 20-05 874 DATE: April 14, 2021 ISSUE Entitlement to service connection for Parkinson's disease. ORDER Entitlement to service connection for Parkinson's disease is granted. FINDING OF FACT Resolving all doubt in his favor, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran's Parkinson’s disease is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for Parkinson's disease have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from December 1955 to August 1957. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2020 the Veteran testified before the undersigned Veterans Law Judge in a video teleconference hearing. A transcript of the testimony offered at the hearing has been associated with the record. This matter was previously remanded in January 2021 for further development. Upon review of the Veteran’s claim file, the Board finds that there has been substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Therefore, the Board will proceed to the merits of the issues on appeal. This matter has been advanced on the docket pursuant to 38 C.F.R. § 20.900. Service Connection Generally, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Entitlement to service connection for Parkinson's disease. The Veteran contends that his Parkinson’s disease is related to his active service through exposure to various paint thinners and chemicals, including Trichloroethylene, while in service. Regarding the first element of service connection, which is a current disability, the record contains a July 2018 private medical opinion from Dr. G.S.B that notes a diagnosis of Parkinson’s disease. Additionally, the Veteran was afforded a VA examination in February 2021, at which time the examiner noted a current diagnosis of Parkinson’s disease. As the Veteran has been shown to have a current disability, the Veteran has met the first criteria for entitlement to service connection. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). As to the second element of service connection, which is an in-service event, in-service incurrence or aggravation of a disease or injury, the Board finds the Veteran to be a reliable historian of his experiences in service. See Jandreau, 492 F.3d at 1377. In his December 2020 Board hearing the Veteran testified that his military occupational specialty (MOS) while in service was a yeoman. He testified that during his time in service he worked on a repair ship, the U.S.S. Ajax, and part of his duties included taking items that needed to be repaired to various locations on the ship. While in different parts of the ship he was exposed to the various cleaners and paint thinners which were being used throughout the ship. The Board finds the Veteran’s report of these in-service incidents to be credible and thus the Veteran has also met the second criteria for entitlement to service connection. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Turning to the final criteria, there must be a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 38 C.F.R. § 3.303(a). At the outset the Board notes that the Veteran’s service treatment records are silent for any complaints, treatment or diagnosis of Parkinson’s disease. The Veteran’s August 1957 separation examination is negative for any neurologic abnormalities. Private treatment records since February 2018 reflect that the Veteran has been receiving ongoing treatment for his Parkinson’s disease. The record contains a July 2018 private medical opinion from Dr. G.S.B, the Veteran’s treating neurologist. As previously mentioned, the examiner noted a diagnosis of Parkinson’s disease. Further, he opined that the Veteran’s current disability is more likely than not related to his exposure to Trichloroethylene during service. In offering this opinion Dr. G.S.B. provided only a conclusionary statement with no rationale. The examination failed to provide not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, in January 2021 the Board found this opinion to be inadequate for adjudication purposes. At that time the matter was remanded for the Veteran to be afforded a VA examination to assess the etiology of his Parkinson’s disease. In January 2021 Dr. G.S.B. submitted another medical opinion on the Veteran’s behalf. At that time the examiner opined that he has personally reviewed the Veteran’s medical history and has noted the circumstances and events of his military service, including the Veteran’s reports of exposure to Trichloroethylene while in service. The examiner explained that the Veteran has been under his care since February 2018 and he has examined him often during that time. Dr. G.S.B. stated that the Veteran does not have any known risk factors that may have precipitated his current condition. The examiner referenced the fact that multiple studies have linked Trichlorethylene exposure and Parkinson’s disease. Dr. G.S.B. further explained that the Veteran has presented with multiple symptoms which have been demonstrated by patients who have been exposed to Trichlorethylene including fall risk, softer voice, bulbar dysfunction, difficulty being verbal with his thoughts, weakness with handwriting, and difficulty with chewing and swallowing. Therefore, the examiner opined that it was more likely than not that the Veteran’s Parkinson’s disease was related to his exposure to Trichlorethylene while in service. The Veteran was afforded the Board-directed VA examination in February 2021. Upon review of the Veteran’s claim file the examiner opined that it was less likely than not that the Veteran’s Parkinson’s disease was related to his service. In providing a rationale the examiner referenced the opinion from the Veteran’s treating physician Dr. G.S.B. but explained that the known etiology of Parkinson’s disease is heavily genetic and is not due to toxin exposure alone. The examiner went on to explain that this means that regardless of the amount or duration of toxin exposure, a genetic predisposition must exist in order for Parkinson’s disease to develop. The examiner stated that she has reviewed medical literature which demonstrates that there is a link between Trichloroethylene and Parkinson’s disease, however the literature does not demonstrate a definitive causal link between the two. The examiner also cited to the fact that the Veteran did not present with symptoms of Parkinson’s disease until late 2017, which is 60 years post his claimed exposure to Trichloroethylene. Therefore, it was the examiner’s opinion that this would be indicative of a degenerative type of Parkinson’s disease rather than that brought on by toxin exposure. In consideration of the above, the Board finds that both the February 2021 VA examiner as well as the Veteran’s treating neurologist, Dr. G.S.B were both competent to opine as to the etiology of the Veteran’s Parkinson’s disease. Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § 3.159 (a)(1). The Board notes that the examiners considered the Veteran's contentions, the claims file, and clinical medical evidence before providing an opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion). Based on the foregoing, the Board finds that the evidence for and against the claim are in relative equipoise. On the one hand, the February 2021 VA examiner opined that it was less likely than not that the Veteran’s Parkinson’s disease was related to his service, and based on his presentation of symptoms it appeared as though he had a degenerative type of Parkinson’s disease rather than a type brought on by toxin exposure. It is interesting to note that in describing a genetic predisposition for Parkinson’s disease, the examiner did not rule in or rule out the possibility of an environmental trigger that activates such predisposition. On the other hand, Dr. G.S.B. has opined that upon review of the records and his ongoing treatment of the Veteran that the Veteran's Parkinson’s disease is more likely than not related to his military service as he has presented with multiple symptoms demonstrated by patients with Trichloroethylene exposure. Both the VA opinion and Dr. G.S.B.’s opinion provide a plausible explanation for the Veteran's Parkinson’s disease. (Continued on next page.) Accordingly, after careful review of the record, including the medical evidence and the lay statements of record, and resolving any reasonable doubt in the Veteran's favor, the Board finds that the evidence is in relative equipoise regarding the question of whether the Veteran’s Parkinson’s disease is related to his period of active duty service. As such, service connection for the Veteran’s Parkinson’s disease is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Nettey, 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.