Citation Nr: 21022622 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 19-30 435 DATE: April 16, 2021 ORDER Service connection for a disability manifested by Parkinsonian or Parkinson-like features, due to in-service exposure to contaminated water at Camp Lejeune, is granted. FINDING OF FACT Resolving the benefit of the doubt in favor of the Veteran, his disability manifested by Parkinsonian or Parkinson-like features is related to his in-service exposure to contaminated water at Camp Lejeune. CONCLUSION OF LAW The criteria for entitlement to service connection for a disability manifested by Parkinsonian or Parkinson-like features, due to in-service exposure to contaminated water at Camp Lejeune, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from July 1956 to July 1959. In August 2020, he testified at a hearing before the undersigned Veterans Law Judge (VLJ) of the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board). A transcript of that hearing is of record. In November 2020, the Board remanded this issue to the VA Regional Office (RO) for additional development. The claims file has been returned to the Board for adjudication. Entitlement to service connection for a disability manifested by Parkinsonian or Parkinson-like features, due to in-service exposure to contaminated water at Camp Lejeune. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent medical or lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). It has been established that Veterans who served at United States Marine Corps Bases Camp Lejeune were potentially exposed to contaminants present in the base water supply prior to 1987, including trichloroethylene, perchloroethylene, vinyl chloride, and benzene. The chemical compounds involved have been associated by various scientific organizations with the possible development of certain chronic diseases. As the Veteran’s service records show he was stationed at Camp Lejeune from June 1958 to December 1958, it will be assumed that he was potentially exposed to chemicals known to have contaminated the water at Camp Lejeune. For Veterans who had such service at Camp Lejeune, VA has defined a legal presumption to the effect that certain chronic diseases, including Parkinson’s disease, shall be service connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of 38 C.F.R. § 3.307(d). 38 C.F.R. § 3.309(f)(8). This rule will apply to this claim, as it was pending before VA on March 14, 2017, the effective date of the final rule. Under 38 C.F.R. § 3.160 (c), a claim that has not been finally adjudicated (which includes claims where a final and binding decision has been issued but the appeal period has not expired) is still considered a pending claim. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a claimant is competent to report on that of which he or she has personal knowledge). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The issue of whether the Veteran has been diagnosed with Parkinson’s disease, the chronic disease presumed related to exposure to contaminated water at Camp Lejeune, has been challenging. The Veteran, in his March 2019 statement, asserted that after a number of instances of private and VA treatment and testing over the years, he was diagnosed by Dr. Cox, a VA treatment provider, with Parkinson’s disease, and has been treated with medication specifically prescribed for Parkinson’s disease since. The Veteran’s VA treatment records dated in December 2017 include a list of his prescribed medications, including one for Parkinson’s disease. During VA treatment in April 2018, Dr. Cox reported that the Veteran presented for seizure follow-up with new complaints concerning for neurodegenerative process; his examination included some Parkinsonian features although he did not meet the criteria for a Parkinson’s disease diagnosis or atypical Parkinsonian syndromes. Dr. Cox reported that the suspect diagnosis was Parkinson’s disease which will declare itself over time. VA treatment records dated in November 2018 indicate that the Veteran reported left hip and lower back pain; his prior history included Parkinson-like features. He was diagnosed with questionable Parkinsonian features. VA treatment records dated in February 2019 indicate that his examination included some Parkinsonian features, although he did not meet the criteria for Parkinson’s disease or atypical Parkinsonian features at that time. During VA treatment in April 2019, his examination included some mild Parkinsonian features, stable, with medication. In October 2019, during VA treatment, the Veteran complained of left hip and low back pain and the treatment provider noted a history of status-post Parkinson’s diagnosis two years prior. During VA treatment in February 2020, the Veteran complained of left hip pain; the treatment provider noted a history of Parkinson’s epilepsy. During the Veteran’s August 2020 Board hearing, he described the history leading to his diagnosis of Parkinson’s disease by Dr. Cox at VA and asserted that since his medications were effective, such impacted his ability to get the diagnosis VA sought in support of his claim of entitlement to service connection for Parkinson’s disease on a presumptive basis. In a December 2020 Disability Benefits Questionnaire (DBQ), conducted specifically to determine if the Veteran had a diagnosis of Parkinson’s disease, the Veteran presented with motor manifestations including mild stooped posture, balance impairment, bradykinesia or slowed motion, loss of automatic movements, and speech changes, mild tremors of the bilateral upper extremities, mild muscle rigidity and stiffness of the bilateral upper extremities and the right lower extremity, mental manifestations including mild depression, cognitive impairment, and dementia, and additional manifestations including a complete loss of smell. The examiner reported that the Veteran’s symptoms impacted his ability to work, that he would lose one week of in twelve months due to unsteadiness and slowness. In a December 2020 opinion, the VA examiner stated that based on the clinical evidence, she was unable to offer a diagnosis of Parkinson’s disease. To the extent that the Veteran asserts that he has indeed been diagnosed with Parkinson’s disease and his claim should thus be granted on the basis that he has a chronic disease presumed related to in-service exposure to contaminated water at Camp Lejeune, the Board finds that such assertion is not competent, as the diagnosis of his disability is a complex medical question. The Board can understand that the Veteran has been prescribed medication usually prescribed for patients with Parkinson’s disease, has completed testing and treatment for symptoms described using terms similar to Parkinson’s disease, has reported a history of Parkinson’s disease during treatment for unrelated complaints, and contends that his use of medication to successfully treat his symptoms has managed his symptoms so well that he has not been able to obtain a diagnosis of Parkinson’s disease yet. However, there is no evidence that he has the requisite medical expertise or training to opine as to his appropriate current clinical diagnosis. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). His assertion thus lacks probative value, as it is not competent. In this regard, the Board places greater probative weight on the December 2020 opinion of the VA examiner, given her medical training. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (affirming the Court’s conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert’s opinion more probative on the issue of medical causation). To the extent that the Veteran’s symptoms diagnosed as Parkinsonian or Parkinson-like features have not been diagnosed as Parkinson’s disease, the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability.” Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Board finds that, considering Saunders and the functional impairment described in detail in the December 2020 DBQ, the Veteran’s symptoms of Parkinsonian or Parkinson-like features are indeed a disability for VA purposes. Although VA cannot presume under law that the Veteran’s disability manifested by Parkinsonian or Parkinson-like features is related to in-service exposure to contaminated water at Camp Lejeune, this does not prevent the Veteran from presenting evidence showing a direct causation in this particular case. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In a December 2020 opinion, the VA examiner offered a positive etiological opinion. She opined that it was at least as likely as not that the Veteran’s disability manifested by Parkinsonian or Parkinson-like features was related to service. The examiner reasoned that he was exposed to contaminated water during service at Camp Lejeune and his neurologist had clearly shown Parkinson-like features and prescribed treatment with the medication Carbidopa Levodopa, shown by the medical literature as a combination medication to treat symptoms of Parkinson’s disease or Parkinson-like features. She discussed that Parkinson’s disease is thought to be caused by too little of a naturally occurring substance in the brain and the medication changes in that substance and prevents breakdown. She discussed that the Veteran’s records clearly showed his improvement in symptoms and tolerant of the medication. The December 2020 VA opinion was based on a review of the claims file and the examiner offered a reasonable medical basis for her conclusion. Absent probative evidence to the contrary, the Board is not in a position to further question the opinion. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Accordingly, and resolving all doubt in favor of the Veteran, the Board finds that service connection is warranted for a disability manifested by Parkinsonian or Parkinson-like features; the claim is granted. See 38 U.S.C. 5107; Gilbert, 1 Vet. App. 49 (1990). P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.