Citation Nr: 22018115
Decision Date: 03/28/22	Archive Date: 03/28/22

DOCKET NO. 17-33 257
DATE: March 28, 2022

REMANDED

Entitlement to service connection for dementia is remanded.

Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded.

REASONS FOR REMAND

The Veteran had active service from December 1965 to October 1969, including service in the Republic of Vietnam.  He died in July 2019; the Appellant is his surviving spouse.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in February 2016.

These matters were previously before the Board in May 2020 and September 2021.

1. Entitlement to service connection for dementia is remanded.

The Veteran was diagnosed with Lewy body dementia, and while the Veteran's treatment records do not contain a clear diagnosis of Parkinson's disease, at least some statements made by the Veteran and his wife recorded in those treatment records appear to indicate that the Veteran and his wife were under the impression that that diagnosis had been made.  In the previous remand, one of the remand directives was to provide an explanation as to the relationship (if any) between Lewy body dementia and Parkinson's disease.  The October 2021 addendum opinion indicates that Lewy body dementia is an umbrella term that applies to dementia with Lewy bodies and to Parkinson's disease dementia, and that these conditions present with similar symptoms only in different orders.  Given the similarity of these two conditions, and that the Veteran's condition appears to have only been discussed using the umbrella term that could apply to Parkinson's dementia or not, the Board finds that a remand is required to clarify the Veteran's diagnosis, specifically whether or not the Veteran had Parkinson's disease dementia.  Finally, an addendum opinion is also required to address the relationship between the Veteran's Lewy body dementia and his conceded exposure to herbicide agents.

2. Entitlement to TDIU is remanded.

The matter of entitlement to TDIU was determined to be inextricably intertwined with the matter of entitlement to service connection for dementia during in the last remand.  Consequently, these matters remain intertwined, and this matter must be remanded pending the outcome of the development discussed in the previous section.

The matters are REMANDED for the following actions:

1. Obtain an addendum opinion from an appropriate clinician clarifying whether the Veteran's Lewy body dementia was Parkinson's disease dementia.

Additionally, the VA examiner is asked to provide an opinion as to whether the Veteran's dementia, to include Lewy body dementia, is at least as likely as not (50 percent or greater probability) related to service, to include the Veteran's conceded in-service herbicide agent exposure.

A rationale must be provided for these opinions.

2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to TDIU.  If the benefit sought is not granted to the Veteran's satisfaction, send the appellant and her representative a Supplemental Statement of the Case and provide an opportunity to respond.  If necessary, return the case to the Board for further appellate review. 

 

R.R. WATKINS

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Steven H. Johnston, 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.