Citation Nr: 22017294 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 19-28 565 DATE: March 24, 2022 ORDER Service connection for Parkinson's disease is granted. REMANDED The issue of entitlement to service connection for glaucoma is remanded. FINDING OF FACT The evidence of record indicates that the Veteran's current Parkinson's disease is etiologically related to his exposure to zinc-cadmium-sulfide during a period of active duty for training (ACDUTRA). CONCLUSION OF LAW The criteria for service connection for Parkinson's disease are met. 38 U.S.C. §§ 101(24), 1110, 5107(b); 38 C.F.R. §§ 3.6(a), 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1971 to October 1971, with additional service in the Army Reserve. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of the Veteran's claims file currently resides with the Phoenix, Arizona RO. In May 2019, the Veteran had an informal conference with a Decision Review Officer (DRO) at a VA RO. A report summarizing the conference has been associated with the claims file. In addition, in October 2021, the Veteran and his spouse testified at a Board hearing before the undersigned. A transcript of the hearing is of record. Service Connection for Parkinson's Disease As indicated above in the Conclusions of Law section, the Board finds that entitlement to service connection for Parkinson's disease is warranted. Accordingly, the Board grants the Veteran's claim. In support of this determination, the Board first notes that establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. 38 C.F.R. § 3.303(a); Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). Service connection may also be established for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Applying these principles to the instant case, the Board finds that the Veteran has a current diagnosis of Parkinson's disease. See, e.g., September 2020 VA Neurology Note; December 2015 Private Treatment Record, Dr. Grainger. Accordingly, the Board finds that the first service connection requirement of a current disability has been satisfied in the instant case. 38 C.F.R. § 3.303. Turning to the next requirement of an in-service event, injury, or incurrence, the Board notes that the Veteran has consistently contended during the claim period that he was exposed to multiple toxic and carcinogenic compounds during a period of annual training at Dugway Proving Ground, Utah. See, e.g., February 2019 Correspondence. The Board acknowledges that service connection may be granted for disability from disease or injury incurred in line of duty while performing ACDUTRA, or for disability resulting from an injury incurred or aggravated in line of duty while performing inactive duty for training (INACDUTRA). 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). A review of the Veteran's service personnel records (SPRs) demonstrates that he performed annual training for a period of two weeks in July 1972 at Dugway Proving Ground, Utah with the 1st Battalion, 143rd Field Artillery Regiment. Additionally, in February 2019, the Veteran referenced Government Accountability Office (GAO) Report 04-410 (May 14, 2004), "Chemical and Biological Defense: DOD Needs to Continue to Collect and Provide Information on Tests and on Potentially Exposed Personnel" regarding his exposure to zinc-cadmium-sulfide during this period of annual training in July 1972. A review of GAO-04-410 indicates that zinc-cadmium-sulfide was dispersed at Dugway Proving Ground during Test 70-11, Phase I, Subtest 3 while the Veteran participated in annual training in July 1972. Accordingly, the Board concludes that the second service connection requirement of an in-service eventi.e., exposure to zinc-cadmium-sulfidehas been satisfied in the instant case. 38 C.F.R. § 3.303. Lastly, regarding the outstanding service connection requirement of nexus, the Board acknowledges that the Veteran was not provided a VA examination or medical opinion during the claim period regarding the etiology of his current Parkinson's disease. However, in November 2021, private neurologist Dr. Shah opined that it was as least as likely as not that the Veteran's in-service exposure to zinc-cadmium-sulfide caused his current Parkinson's disease. In support of this conclusion, Dr. Shah referenced GAO-04-410, a 1995 report concerning Dugway Proving Ground submitted to the U.S. Environmental Protection Agency, and a toxicology assessment of the Army's zinc-cadmium-sulfide dispersion tests from the National Center for Biotechnology Information. The Board finds Dr. Shah's November 2021 opinion to be adequate for adjudicative purposes as it was based upon a consideration of the Veteran's medical history, clearly identified and described the Veteran's current condition, and supported its conclusion with an explanatory rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As there are no other competent, adequate medical opinions of record, the Board concludes that all requirements have been satisfied and, thusly, service connection for Parkinson's disease is warranted. 38 C.F.R. § 3.303. The Veteran's claim is granted. REASONS FOR REMAND Service Connection for Glaucoma Although the Board regrets the additional delay, it finds that remand of the issue of entitlement to service connection for glaucoma is necessary for further development. Specifically, the Board cannot make a fully-informed decision on this issue at this time as the Veteran has yet to be provided a VA medical opinion concerning the etiology of his current glaucoma. In making this determination, the Board acknowledges that, in October 2021, private ophthalmologist Dr. Kian opined that it was at least as likely as not that the Veteran's in-service exposure to zinc-cadmium-sulfide caused his current glaucoma. However, the Board finds Dr. Kian's opinion to be of limited probative value as it was conclusory and did not contain an explanatory rationale. See Stefl, supra. Accordingly, the Board remands service connection for glaucoma so that VA may provide the Veteran a competent, adequate VA medical opinion. The matter is REMANDED for the following action: Forward the Veteran's claims file to an appropriate VA clinician for a medical opinion regarding the nature and etiology of his current glaucoma. After reviewing the entire claims file, the clinician should address whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's glaucoma was caused by or related to his in-service exposure to zinc-cadmium-sulfide and/or other substances during a period of ACDUTRA in July 1972 at Dugway Proving Ground, Utah. In providing a response to the above prompt, the clinician should directly address: (a.) Dr. Kian's October 2021 opinion; and (b.) Materials the Veteran submitted in February 2019, including: (i.) GAO-04-410, (ii.) a 1995 report concerning Dugway Proving Ground submitted to the U.S. Environmental Protection Agency, and (iii.) a toxicology assessment of the Army's zinc-cadmium-sulfide dispersion tests from the National Center for Biotechnology Information. The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim (September 2016). The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.S. Pettine, 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.