Citation Nr: 22011195 Decision Date: 02/25/22 Archive Date: 02/25/22 DOCKET NO. 13-04 413 DATE: February 25, 2022 ORDER Entitlement to service connection for headaches is denied. Entitlement to service connection for nerve damage is denied. Entitlement to service connection for right arm numbness is denied. Entitlement to service connection for Parkinson's disease is denied. FINDINGS OF FACT 1. Veteran's headaches are not secondary to service-connected thoracolumbar or foot disabilities and are not otherwise related to an in-service injury or disease. 2. The evidence of record persuasively weighs against finding that the Veteran has had a separate nerve damage disability at any time during or approximate to the pendency of the claim. 3. The Veteran's right arm numbness is not secondary to service-connected thoracolumbar or foot disabilities and are not otherwise related to an in-service injury or disease. 4. The Veteran's Parkinson's disease is not secondary to service-connected thoracolumbar or foot disabilities and are not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for nerve damage due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 3. The criteria for service connection for right arm numbness due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for service connection for Parkinson's disease due to service or a service-connected disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from January 1953 to January 1955. During the pendency of the appeal, the Veteran died in January 2013. The Veteran's wife is the substitute appellant. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims were previously remanded by the Board in June 2020, April 2018, May 2017, and April 2014 decisions. The Board finds that the RO has substantially complied with the most recent June 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). This appeal has been advanced on docket pursuant to 38 C.F.R. § 20.900 (c); 38 U.S.C. § 7107 (a)(2). The Board notes that in a June 2014 rating decision, the RO granted the Veteran service connection for loss of use of feet with an evaluation of 100 percent effective November 30, 2010, and entitlement to special monthly compensation based on aid and attendance criteria effective November 30, 2010. Thus, the Veteran's combined rating was 50 percent from August 15, 2003, and 100 percent from November 30, 2010. At the time of the Veteran's death, he was rated at 100 percent disabled. Service Connection 1. Entitlement to service connection for headaches The Veteran contended that his headaches were secondary to his service-connected low back condition. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of or was aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran had a current disability of headaches, the evidence of record persuasively weighs against finding that the Veteran's headaches were proximately due to or the result of or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The most recent December 2021 VA examiner opined that the Veteran's headaches were less likely than not related to his service-connected low back disability. The rationale was two-fold, first, the Veteran's low back disability is anatomically disconnected from any mechanism that would produce headaches. Second, the examiner noted that the Veteran did not report any headache symptoms until decades after his military service. The Board does note that the Veteran contended that his headaches began "20 years" prior to 2011, but also notes that this is still decades after he was separated from service in the 1950s. The Veteran believed his headaches were proximately due to a service-connected disability. The Veteran in this case was not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and pathology. Therefore, it is outside the competence of [the Veteran/other sources] in this case because the record does not show that [he/she/it/they] [has/have] 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). Consequently, the Board gives more probative weight to the December 2021 VA examiner. 2. Entitlement to service connection for nerve damage The appellant contends that the Veteran's complaints of nerve damage (or a nervous condition) were the result of his injury during his active-duty service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran did not have a separate, current diagnosis of nerve damage and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). As discussed below, the symptomatology described by the Veteran was more accurately attributed to Parkinson's disease. The December 2021 VA examiner evaluated the Veteran's medical record including the 2011 VA examination and determined that, while he experienced subjective symptoms of tremors and paresthesias, he did not have a diagnosis of nerve damage or another nerve condition apart from Parkinson's disease. While the Veteran believed he had a current diagnosis of nerve damage, he was not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, knowledge of the interaction between multiple organ systems in the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. 3. Entitlement to service connection for right arm numbness The Veteran contended that his symptoms of right arm numbness were secondary to his service-connected lumbar disability. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran had a current disability that is proximately due to or the result of or was aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran had a current diagnosis of right arm numbness, also claimed as right arm tremors and weakness of the right arm, the evidence of record persuasively weighs against finding that the Veteran's right arm numbness was proximately due to or the result of or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The December 2021 VA examiner opined that the Veteran's right arm numbness is less likely than not proximately due to or the result of the Veteran's service-connected conditions and was unrelated to his lumbar spine and lower extremity disabilities. The rationale was the Veteran did not report any symptoms of right arm numbness until 2010. Further, the examiner noted there was no medical causation possible for a lumbar spine injury to cause upper extremity numbness, weakness, or tremors. The Veteran believed his right arm numbness was proximately due to or the result of a service-connected disability. The Veteran in this case was not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he had 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). Consequently, the Board gives more probative weight to the opinion of the December 2021 VA examiner. 4. Entitlement to service connection for Parkinson's disease The Veteran contended that his Parkinson's disease was secondary to the injury he sustained during service that was the underlying cause of his service-connected lumbar spine disability. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran had a current disability that was proximately due to or the result of or was aggravated beyond its natural progress by service-connected disability. In a November 2010 treatment note, the Veteran was diagnosed with mild Parkinson's disease. The Veteran's condition was noted to be slowly evolving and appeared to be rigidity and instability dominant condition that had responded poorly to treatment. In December 2021, a VA examiner reviewed the Veteran's entire medical record and his lay statements regarding the nature and etiology of his Parkinson's disease. The examiner opined that the Parkinson's disease was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner noted that while the cause of Parkinson's disease is not known, there is no evidence to suggest that physical trauma or spinal compression fractures cause Parkinson's disease. In December 2021, another VA addendum opinion was obtained. The examiner concluded that the Veteran's Parkinson's disease was less likely than not caused or aggravated beyond its natural progression by the Veteran's service-connected disabilities. The examiner explained that Parkinson's disease is a degenerative, progressive disorder that affects neurons in the basal ganglia and the substantia nigra that produce dopamine that is responsible for relaying messages that plan and control body movement. The examiner explained that a feet or lumbar spine disability would have no role in dopamine regulation, and thus, there was not a nexus. The Board concludes that, while the Veteran had a current disability of Parkinson's disease, the evidence of record persuasively weighs against finding that the Veteran's Parkinson's disease is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability, or otherwise related to the Veteran's military service. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran believed his Parkinson's disease was proximately due to or the result of and/or aggravated beyond its natural progression by a service-connected disability. The Veteran in this case was not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, pathology, and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he had 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). Consequently, the Board gives more probative weight to the December 2021 VA examiner's addendum opinion. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Taylor, 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.