Citation Nr: A21008419 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 200824-104434 DATE: April 27, 2021 ORDER Entitlement to service connection for Parkinson’s disease to include as due to exposure to herbicide agents is denied. FINDING OF FACT The appellant’s Parkinson’s disease was not caused by exposure to chemicals, including herbicide agents and trichloroethylene (TCE), during her service at Fort McClellan, and is not otherwise etiologically related to her active service. CONCLUSION OF LAW The criteria for service connection for Parkinson’s disease are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served on active duty for training (ACDUTRA) from June 24, 1974, to July 3, 1974. This matter comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from a December 2016 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO). By way of background, the appellant was denied entitlement to service connection for Parkinson’s disease in a December 2016 rating decision issued by the RO. The appellant has continuously prosecuted the claim on appeal. See e.g.: notice of disagreement (NOD), January 24, 2017; VA Form 9, March 9, 2017. The appellant testified at a video conference hearing before a Veterans Law Judge (VLJ) of the Board in April 2017. A transcript of the hearing has been associated with the claims file. In August 2020, the appellant elected to withdraw her legacy appeal and participate in RAMP. On her RAMP opt-in election form, the appellant selected the evidence-submission docket lane. See VA Form 10182. Unfortunately, the appellant’s election form was not uploaded into VA’s claim processing system until after the Board had issued a legacy decision in the appellant’s appeal. See Board decision, September 21, 2020. Therefore, the Board vacated the September 2020 Board decision in November 2020. See Board decision, November 16, 2020. The appellant’s appeal has now been withdrawn from the legacy appeals system and placed in Appeals Modernization (AMA), and is now ready for adjudication. In the August 2020 VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the July 2020 supplemental statement of the case, as well as any evidence submitted by the appellant or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. Service Connection – Parkinson’s Disease The appellant seeks entitlement to service connection for Parkinson’s disease, to include as due to exposure to herbicide agents and/or the components of herbicide agents, and to include as due to other toxin exposures. Specifically, the appellant and her attorney assert that when she served on ACDUTRA at Fort McClellan, which is a known superfund site, she sustained significant exposure to toxins, to include herbicide agents and the components used to create a blend of toxins known as Agent Orange. See e.g. Correspondence, November 13, 2020. Essentially, the appellant and her attorney argue that her ACDUTRA service at Fort McClellan exposed the appellant to herbicides because of her physical proximity to toxins, locations of herbicide agent storage, and others who came in contact with herbicide agents and other toxins, and therefore should be granted entitlement to service connection for Parkinson’s disease on a presumptive service connection basis. Id. In this regard, the appellant asserts that Anniston, Alabama, and Fort McClellan had significant amounts of polychlorinated biphenyls (PBC), which is a principal component used in Agent Orange. See e.g. Email correspondence, November 3, 2016. Additionally, the appellant asserts that Agent Orange was stored at Fort McClellan near the barracks, and the company Monsanto also exposed PCB to the area near the post. Id. Moreover, the appellant’s attorney argues that even if a particular herbicide product was not used in the Republic of Vietnam that herbicide may still contain an herbicide agent if it contains one of the chemicals enumerated by 38 C.F.R. § 3.307(a)(6)(i). See Third party correspondence, October 4, 2019. 38 C.F.R. § 3.307 was authorized by 38 U.S.C. § 1116(a)(3) and mostly follows the Code verbatim; however, the regulation added the language starting with “specifically”. VA’s addition of these chemicals represents a finding by VA that the enumerated chemicals were the chemicals the Code describes as in an herbicide used in the Republic of Vietnam. Id. There are no modifiers on these chemicals, such as the need to use them in a particular product or in specific proportions with other chemicals. Id. Accordingly, the regulations require VA to accept the enumerated chemicals as “herbicide agents” even if not mixed with the other ingredients that made up an agent used in Vietnam, such as Agent Orange. Id. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 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; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the e-file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81(Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30(2000). Additionally, under 38 C.F.R. § 3.309(e), if a veteran was “exposed to an herbicide agent” during service then certain diseases, including Parkinson’s disease, will be service connected if the requirements of § 3.307(a)(6) are met subject to the rebuttable presumption provisions of § 3.307(d). The provisions of § 3.307(a)(6) require that the disease manifest to a degree of 10 percent or more at any time after service. The provisions of § 3.307(d) provide that the presumption may be rebutted by affirmative evidence to the contrary, which in turn requires such a showing as would, in sound medical reasoning and in the consideration of all evidence of record, support a conclusion that the disease was not incurred in service. The questions for the Board are was the appellant “exposed to an herbicide agent” as required to trigger the presumption of service connection, and if so, is there enough affirmative evidence to the contrary to rebut the presumption of service connection. An “herbicide agent” is defined in 38 C.F.R. § 3.307(a)(6) to mean a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. I. Presumptive Service Connection The appellant provided an expert opinion by Dr. H.M. that “it is more likely than not; in fact, it is to a reasonable degree of certainty that those serving and/or living at FMTC between 1974-1976 were exposed to the herbicide agents discussed herein.” See Correspondence, October 7, 2019 (including an October 2018 report by Dr. H.M.) In particular, Dr. H.M. opined that the Directorate of Engineering and Housing at Fort McClellan had used picloram; 2,4,5-T contaminated with TCDD; Tordon; Silvex; 2,4-D; and DMA. In a chart in her report, she identified 8,000 gallons of Silvex; 1,800 gallons of 2,4,5-T; 0 gallons of Picloram; 7,200 gallons of 2,4-D; and 12,000 gallons of DMA as used at the base in 1974. According to the doctor, it would take 11,375 gallons of Silvex, 2,4-D, or DMA to cover the base once and 22,750 gallons of 2,4,5-T to cover the base once. The weakness in Dr. H.M.’s report is that it did not consider the appellant’s individual circumstances. By a significant amount, most of the pesticide use described by Dr. H.M. occurred after the appellant’s two week service at the base in mid-1974. This weakens the persuasive force of her analysis. The opinion also did not try to correlate areas sprayed with the areas in which the appellant was physically present. Although the doctor mentioned the quantities needed to spray the entire base, those quantities were more (sometimes significantly more) than the amounts actually sprayed in 1974. Even for the later periods, Dr. H.M. did not attempt to explain why a base-wide spray pattern should be assumed. This opinion is therefore afforded little, if any, probative weight. The appellant’s attorney prepared a summary entitled “Combined Environmental Exposure Report.” The report is not itself evidence, but a prepared summary of evidence. It too is not tailored to the appellant’s circumstances as it mentions things such as citations from the 1980s and 1990s by the Alabama Department of Environmental Management. These citations happened one to two decades after the appellant’s service period. The report also mentions a Fort McClellan forester’s recollection of Tordon being applied all over the base. The Forester was employed from 1960 to 1987 and the report did not indicate when Tordon was applied. Dr. H.M.’s report and the attorney summary describe Tordon as not being used until 1975, however, the year after the appellant’s time at Fort McClellan. Although the evidence indicates that herbicide agents were used at Fort McClellan, it also indicates that the large majority of the use, including the use remembered by the Forester, was after the appellant’s time. This opinion is therefore afforded little, if any, probative weight. The mere storage or use of herbicide agents somewhere on the base at some point in the base’s history does not make it at least as likely as not that the appellant was exposed to those herbicide agents during her two weeks stationed there in 1974. The appellant, through her attorney, has provided significant evidence regarding herbicide agents at Fort McClellan, but that evidence indicates their use primarily after her time. Nevertheless, the appellant has shown some evidence that thousands of gallons of herbicide agent were used at Fort McClellan around the time of her service and the Forester’s report indicates that the use of herbicide was generally done in a wide-spread manner. Although the appellant’s time at Fort McClellan was limited, the record indicates that she spent time outdoors and in direct contact with the environment. An individual training record indicated that the appellant’s time included 8 hours of physical readiness training, 10 hours of drill and ceremonies, 4 hours of CBR, 10 hours of field training, 7 hours of land navigation, and 1 hour of survival, evasion, and escape training. The appellant testified to riding in the grass and soil at Fort McClellan during her hearing Board testimony in April 2017. The Board finds that the appellant’s activities at the Fort combined with the thousands of gallons of pesticide used makes it at least as likely as not that she was exposed to an herbicide agent. The Regulations do not qualify the amount of exposure that is required. Nor do they indicate a length of service time or something other to indicate that more than slight exposure is required. Accordingly, the presumption of service connection for herbicide agent exposure is applicable. Having found the presumption applicable, the Board must next consider whether the presumption is rebutted. Under 38 C.F.R. § 3.307(d), the presumption may be rebutted with evidence of a nature usually accepted as competent to indicate the time of existence or inception of disease, and medical judgment will be exercised in making determinations relative to the effect of intercurrent injury or disease. A conclusive showing is not necessary, but rather a showing that would in sound medical reasoning and in the consideration of all the evidence of record, support a conclusion that the disease was not incurred in service. The regulations do not include examples of affirmative evidence to the contrary for herbicide agent exposure but do so for tropical diseases. There, the regulations state that a showing that the veteran had no service in a locality having a high incidence of the disease may be considered. 38 C.F.R. § 3.309(d)(1). The language “high incidence” indicates that the regulations do not require that the veteran served only in areas with no exposure to the disease, just that he or she did not serve in areas with high exposure. A parallel can be drawn to the current case because, although the appellant was exposed, she did not have the higher exposure levels that the cited scientific literature used to draw a correlation between exposure and Parkinson’s disease. VA obtained exams and opinion letters stating that the appellant’s time in service was less likely than not the cause of her Parkinson’s disease. In particular, the September 2017 opinion explained that the risk of Parkinson’s disease comes from exposure to high levels of chemicals rather than exposure to any level of chemicals. The opinion explained that the papers finding a link with Parkinson’s were focused on pesticide applications to crops within 100 or 500 meters of the person’s home. The appellant did not report being close to spraying and did not reside for extended periods near such an area. Her training records reported her potential outdoor exposure time in mere hours. VA obtained confirmatory opinions in December 2017 and in February 2020. The December 2017 opinion emphasized the need for high levels of exposure to the pesticides, such as individuals applying pesticide or living for extended periods close to an application site. It referenced relevant medical literature and literature cited by the appellant and the doctor explained the high-level exposures experienced in each. The February 2020 examiner opined that VA’s published information was based on review of the scientific information and consensus by experts in toxicology and that that information reported no adverse health effects of service at Fort McClellan. The VA opinions are based on scientific research and medical experience and are entitled to high probative weight. The appellant submitted a December 2017 self-titled nexus opinion from Dr. C.N.B. Dr. C.N.B. claimed that the September 2017 opinion had logical disconnects because the September doctor stated that he did not know the appellant’s dose but still opined that her Parkinson’s was not caused by exposure in service. These statements are not illogical. The September 2017 opinion stated that high doses of chemicals could cause Parkinson’s. The meaning of a high dose was determined by reference to the scientific studies and the examiner (correctly) determined that the appellant did not have a comparable high dose. Although the doctor could not determine an exact amount of exposure, an exact amount is not needed because he could conclude the dose was not akin to the doses required by the studies. Dr. C.N.B. also made incorrect statements of the law in his opinion. He stated that “in a situation where it is impossible to know (the doses she was exposed to) that the benefit of the doubt goes to the patient.” The benefit of the doubt standard is one where there is equal evidence for and against. It is still the appellant’s responsibility to present and support their claim for benefits, and something being unknown is not the same as something being at least as likely as not. 38 U.S.C. § 5107; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); Skoczen v. Shinseki, 564 F.3d 1319, 1324 (Fed. Cir. 2009). Dr. C.N.B.’s opinion appears based on both a mistaken view of the law and the facts in this case as the Board finds that--based upon the appellant’s descriptions, service records, two week service period, and the expert reports of the time and nature of herbicide applications--the appellant’s exposure is knowable in that it was significantly lower than the amounts required by the studies to find a correlation with Parkinson’s disease. As “an opinion based on an inaccurate factual premise has no probative value,” Reonal v. Brown, 5 Vet. App. 458, 461 (1993). This opinion is therefore afforded little, if any probative weight. The appellant provided other positive nexus opinions. Dr. C.D. opined that her Parkinson’s was more likely due to in-service exposure “per neurology opinion.” This was not a separate opinion, but merely a repeating of the neurology opinion. The neurology opinion was by Dr. A.C.B. and stated that it was more likely than not that the appellant’s Parkinson’s disease was due to her “toxic exposures of PCB’s/herbicides/pesticides and other toxic substances.” No further rationale was given. The Board finds that the lack of a rationale limits the probative value of this opinion because “most of the probative value of a medical opinion comes from its reasoning... [an opinion is not] entitled to any weight in a service-connection... context if it contains only data and conclusions.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The minimalist nexus opinion does not provide a rationale as to why the appellant’s specific facts support service connection, whereas the three VA opinions provide detailed rationale based on scientific literature. This opinion is therefore afforded little, if any probative weight. As there is significant affirmative evidence contrary to a finding that the appellant’s Parkinson’s disease was caused by exposure to herbicide agents, the presumption of service connection is rebutted. The Board recognizes that its March 2018 decision, which was vacated by the Court, denied the appellant’s claim based on the finding that exposure to herbicide agents had been established. Such was by no means an implied finding that service connection on a presumptive basis would be warranted if exposure had been established. Rather, in entering its analysis of the appellant’s claim, the Board stopped after determining that exposure to herbicide agents had been established. No useful purpose would be served the rebut the presumption of service connection from exposure when exposure was not found. Had exposure been shown, an analysis similar to the above would have followed. The Board acknowledges the arguments of the appellant and her attorney that she had exposure to toxins and herbicide agents during her service at Fort McClellan, to include as due to her physical proximity to the toxins, exposure to others who had direct contact with herbicide agents, PCB dumping by Monsanto in nearby areas, and the fact that Fort McClellan is a recognized superfund site. In support of her claim, the appellant and her attorney have submitted several email correspondence with other servicemembers, articles showing the presence of toxins at Fort McClellan and nearby towns, and the connection of toxin exposure to Parkinson’s disease. However, as noted above, the appellant and her attorney’s assertions are supported by articles and opinions that do not adequately address the appellant’s individual exposure to such toxins. Specifically, as discussed above, the appellant’s articles show storage, use, transport, and the existence of the toxins and herbicide agents at Fort McClellan that is primarily after her service there. Additionally, as noted above, the VA opinions of record emphasized the need for high levels of exposure, considered the appellant’s testimony and reports that she was not in near proximity of spraying, did not reside for extended periods near such areas, and referenced relevant medical literature, and determined the appellant’s individual exposure was not to the comparable high dose needed as akin to studies showing a nexus between the exposure and Parkinson’s disease. This argument is therefore without merit. II. Direct Service Connection  In addition to herbicide exposure, the appellant has claimed that one of the other toxic chemicals she was exposed to could have caused her Parkinson’s disease. Direct service connection is possible for non-presumptive exposure to chemicals or other substances. The Board finds, however, that direct service connection has not been established. Initially, the Board notes that post-service treatment records contain diagnoses of Parkinson’s disease. See e.g. Private medical opinion By Dr. A.C.B., May 5, 2017. Therefore, the first element, current disability is met. Service treatment records are negative for complaints, treatments or diagnoses related to Parkinson’s disease. The appellant submitted an opinion from Dr. C.N.B. that describes Fort McClellan as a superfund site with over 100 toxic chemicals found at the site. To be clear, the record now contains a complete copy of the superfund record for Anniston Army Depot in Alabama. The Army Depot is a large land parcel adjacent to, but separate from, Fort McClellan. The appellant’s testimony and service records do not indicate that the appellant served or traveled to the Army Depot. Moreover, the superfund report speaks specifically to a small portion of the Army Depot referred to as the Southeast Industrial Area. This area, which is remote from the border with Fort McClellan is the section was the “focus of [the] Record of Decision” for the superfund report. The distance of the site from the area the appellant was known to be limits the weight of the report. In addition, the superfund report was compiled in 1991. The appellant served in 1974. The report does not support a finding as to the state of ground water at the remote Fort McClellan several decades earlier. Although Dr. C.N.B. based his opinion that the appellant was exposed to TCE solely on the superfund report (“She was exposed to TCE as per the superfund report”), he does not explain how the superfund report supports this conclusion for the appellant specifically in 1974 at Fort McClellan, and the report on its face does not contain any findings about the water at Fort McClellan in 1974. Dr. C.N.B. ultimately opined that the appellant’s Parkinson’s disease was caused by her exposure to TCE in service. As his report is based upon an incorrect factual premise regarding the contents of the superfund report, it cannot be given significant weight. This opinion is therefore afforded little, if any, probative weight. In addition, Dr. C.N.B.’s conclusion that TCE causes Parkinson’s is also undermined by the February 2020 examiner’s report. The February 2020 examiner reviewed Dr. C.N.B.’s sources and found that a link between Parkinson’s and TCE (trichloroethylene) existed based on 3 of 30 workers that had been exposed to TCE over the course of 8 to 33 years. This is significantly different from the appellant--who was at Fort McClellan for two weeks and was not working directly with TCE, and the February 2020 examiner opined that this difference in dosage was critical in determining the likely cause of the appellant’s Parkinson’s disease. Although numeric precision may not be available, the appellant’s dose is knowable based upon her time and routes of potential exposure. In this context, her exposure is considerably smaller than that of the workers that had been exposed for years while working. Dr. C.N.B. erroneously assumed that it was “impossible to know” the exposure dose and his opinion cannot be weighed heavily as he assumed it was a more significant dose based upon “the benefit of the doubt.” As discussed in the previous section, the appellant provided other positive nexus opinions. Dr. C.D. opined that her Parkinson’s was more likely due to in-service exposure “per neurology opinion.” This was not a separate opinion, but merely a repeating of the neurology opinion. The neurology opinion was by Dr. A.C.B. and stated that it was more likely than not that her Parkinson’s was due to her “toxic exposures of PCB’s/herbicides/pesticides and other toxic substances.” No further rationale was given. The Board finds that the lack of a rationale limits the probative value of this opinion because “most of the probative value of a medical opinion comes from its reasoning... [an opinion is not] entitled to any weight in a service-connection... context if it contains only data and conclusions.” Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The minimalist nexus opinion does not provide a clue as to what “toxins” to which it is attributing the Parkinson’s disease or why. This opinion is therefore afforded little, if any, probative weight. The September 2017 VA opinion opined that the personnel at Fort McClellan had not be subject to agents with long term health effects. It cited the Agency for Toxic Substances and Disease Registry assessment of airborne PCBs in Anniston that found that there were no expected harmful health effects to people living outside the perimeter of the former PCB manufacturing facility. The December 2017 addendum opinion added that some members of the Women’s Army Corps (among others) may have been exposed to hazardous materials likely at low levels, but that the levels of potential exposure at Fort McClellan were not of the level to have likely adverse health effects. In particular, the levels of exposure to have a correlation to Parkinson’s disease were high relative to the potential exposure at Fort McClellan. The opinion explained that the level of exposure necessary was for people that had directly worked with the chemicals or who lived within 500 meters of a direct application. The appellant did not apply the chemicals or toxins herself and was not near the chemicals at the time of their application and accordingly did not have the level of exposure necessary to increase her risk for Parkinson’s disease. The Board notes that the report’s conclusion that the Fort did not subject personnel to agents with long term health effects is not contrary to the Board’s earlier finding that the appellant had been exposed to toxins and other chemicals. The key difference is that the report focused on long term health consequences, which required consideration of not just the agents, but their doses. For example, the report did not suggest that people outside of the PCB manufacturing facility were not exposed to any PCBs, but rather that the concentration and dose of PCB outside of the facility were not high enough to result in long term health effects or concerns. The Board affords high probative weight to the VA opinions because they provide a detailed rationale including numerous citations to the literature with explanations as to the appellant’s specific circumstances. Finally, the February 2020 examiner opined that Parkinson’s disease is typically idiopathic, and that the appellant’s case was also most likely idiopathic. According to the American Heritage Medical Dictionary, idiopathic designates “a disease having no known cause.” In other words, this is not a disease that only occurs after exposure to certain chemicals and it is not a matter of narrowing down which exposure caused it. The examiner found the appellant’s Parkinson’s disease likely had no connection to chemical exposure and this too weighs against service connection. The Board again acknowledges the arguments of the appellant and her attorney that she had exposure to toxins and herbicide agents during her service at Fort McClellan, to include as due to her physical proximity to the toxins, exposure to others who had direct contact with herbicide agents, PCB dumping by Monsanto in nearby areas, and the fact that Fort McClellan is a recognized superfund site. In support of her claim, the appellant and her attorney have submitted several email correspondence with other servicemembers, articles showing the presence of toxins at Fort McClellan and nearby towns, and the connection of toxin exposure to Parkinson’s disease. However, as noted above, the appellant and her attorney’s assertions are supported by articles and opinions that do not adequately address the appellant’s individual exposure to such toxins. Specifically, as discussed above, the appellant’s articles show storage, use, transport, and the existence of the toxins and herbicide agents at Fort McClellan that is primarily after her service there. Additionally, as noted above, the VA opinions of record emphasized the need for high levels of exposure, considered the appellant’s testimony and reports that she was not in near proximity of spraying, did not reside for extended periods near such areas, and referenced relevant medical literature, and determined the appellant’s individual exposure was not to the comparable high dose needed as akin to studies showing a nexus between the exposure and Parkinson’s disease. This argument is therefore without merit. The appellant has also asserted that she believed that her Parkinson’s was due to her time at Fort McClellan. Here, the appellant is competent to identify the circumstances of her experiences in-service; when she first experienced symptoms of Parkinson’s disease. See 38 U.S.C. § 1154. Furthermore, her statements have been found credible. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board’s categorical statement that ‘a valid medical opinion’ was required to establish nexus, and that a layperson was ‘not competent’ to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, the matter of a medical diagnosis and nexus for a disability not capable of lay observation, such as that of Parkinson’s disease, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). In the instant case, there is no suggestion that the appellant, has developed an expertise in the etiology of Parkinson’s disease. Therefore, as she does not have the appropriate medical training and expertise to competently provide an opinion as to the nature and etiology of Parkinson’s disease, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 (“[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer”); see also 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). Ultimately, the Board finds the VA examiners’ opinions to be more probative than the private opinions submitted by the appellant and her attorney, the articles and email correspondence submitted in support of her claim, and lay assertions by the appellant to the nature and etiology of the appellant’s Parkinson’s disease and her service. Finally, the Board notes that the appellant has submitted copies of Board decisions in other cases in which service connection for Parkinson’s disease was either remanded for additional development or granted. VA benefits decisions are considered to be non-precedential in nature. See, e.g., 38 C.F.R. § 20.1303. Each case is decided on the basis of the individual facts in light of the applicable law and regulations. Apart from the lack of precedential value, as different evidence in the case of another veteran may have resulted in the grant of educational benefits, any prior VA or Board decision does not compel the conclusion that the facts in this case warrant an award of benefits. Moreover, the Board decisions submitted by the appellant either remanded the claim for additional development or were granted based on periods of service at Fort McClellan that were different in time and substance or were for longer periods of time than the appellant’s service at Fort McClellan. Therefore, while the Board has considered the Board decisions submitted by the appellant, such decisions are not binding and do not control the outcome of this appeal; rather, the facts of this particular case must be determinative. (Continued on the next page)   In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the appellant’s claim for service connection for Parkinson’s disease. As such, that doctrine is not applicable in the instant appeal, and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.