Citation Nr: 0601915 Decision Date: 01/23/06 Archive Date: 01/31/06 DOCKET NO. 03-05 252 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for Parkinson's disease. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert A. Leaf, Counsel INTRODUCTION The veteran had active military service from June 1962 to February 1963. This appeal to the Board of Veterans' Appeals (Board) arises from decisions of the New Orleans, Louisiana, Regional Office (RO) of the Department of Veterans Affairs (VA). In a decision issued in January 2002, the RO denied service connection for Parkinson's disease. Thereafter, the RO issued a decision in July 2002 confirming and continuing a 30 percent rating for service-connected major depressive disorder. A hearing was held in January 2004 at the RO before the undersigned Veterans Law Judge. A transcript of the proceeding is of record. In July 2004, the Board remanded the case to the RO via the Appeals Management Center (AMC), in Washington, DC, for additional development. While the case was on remand, the RO issued a decision in November 2005, that increased the veteran's rating for major depressive disorder to 100 percent disabling. This constitutes a full grant of the benefit sought on appeal, and accordingly, the issue of an increased rating for service-connected major depressive disorder is no longer before the Board on appeal. FINDING OF FACT Parkinson's disease was not shown to be present in military service or during the first postservice year, and Parkinson's disease is not shown to be attributable to service or to a service-connected depressive disorder. CONCLUSION OF LAW Parkinson's disease was not incurred in or aggravated by service nor may it be presumed to have been incurred in service, and it is not proximately due to, the result of, or aggravated by a service-connected disability. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2005). REASONS AND BASES FOR FINDING AND CONCLUSION Procedural Due Process, Preliminary Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2005). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2005); 38 C.F.R. § 3.159(b) (2005); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable RO decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). VA satisfied its duty to notify by means of a May 2001 letter, and subsequent letters dated through June 2005, from the RO to the appellant that were issued in connection with the RO's initial decision from which this appeal arose. The letters informed the appellant of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. The appellant was also asked to submit evidence and/or information in his possession to the RO. Note also that the May 2001 VCAA letter from the RO advising the claimant of his rights and responsibilities in VA's claims process predated the RO's January 2002 decision initially adjudicating his claim. So the VCAA letter complied with the sequence of events (i.e., VCAA letter before initial adjudication) stipulated in decisions promulgated by the United States Court of Appeals for Veterans Claims. As for assisting him with his claim, the claimant's service medical records are on file, as are his VA medical records. The RO also obtained a copy of the veteran's disability determination by the Social Security Administration, with accompanying medical records. There is no indication that other Federal department or agency records exist that should be requested. Records from private treatment providers have also been obtained. There is no indication that any pertinent evidence was not received, which is obtainable. Therefore, the duty to notify of inability to obtain records does not arise in this case. The Board finds that VA has secured all available evidence and conducted all appropriate development. Hence, the Board finds that VA has fulfilled its duties under the VCAA. Legal Criteria In order to establish service connection for a claimed disability, the facts must demonstrate that a disease or injury resulting in current disability was incurred in the active military service or, if pre-existing active service, was aggravated therein beyond its natural progression. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and an organic disease of the nervous system is manifest to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted for a disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted, as well, for disability that is proximately due to or the result of a service- connected disease or injury. 38 C.F.R. § 3.310(a). This includes situations when there has been aggravation of a veteran's nonservice-connected condition that is proximately due to or the result of a service-connected disability, but the veteran shall be compensated only for the degree of disability over and above the degree of disability existing prior to the aggravation. See, Allen v. Brown, 7 Vet. App. 439 (1995). Analysis The veteran claims direct service connection for Parkinson's disease, stating that the condition stems from medications he was prescribed during service for mental illness; specifically, Tofranil, Thorazine and Amitril. Alternatively, he claims secondary service connection for Parkinson's disease as resulting from his service-connected depressive disorder, including medications prescribed for that condition. No neurological defects were noted in service medical records, including on clinical evaluation in October 1962 when the veteran was admitted to hospitalization for treatment of psychotic depressive reaction. Postservice medical records include a November 1995 private neurologist's impression of rule out early Parkinsonism involving the left upper extremity. Another private neurologist, in July 1997, reported that the veteran obviously had Parkinson's disease. So even the earliest medical indication of Parkinson's disease was more than three decades after the veteran completed military service and long beyond the one year presumptive period for service connection for organic diseases of the nervous system. A VA neurologic examination was performed in October 2001. The examiner stated that the claims file had been reviewed. The veteran's history was obtained and clinical findings were recorded. The examiner noted that the veteran was treated during service with Thorazine and Tofranil. He stated that the veteran's Parkinson's disease was less likely than not related to his military service or to medications prescribed in service for depression. He added that the onset of Parkinson's disease was more than two decades after service. Another VA neurologic examination was performed in August 2004. The examiner stated that the claims file had been reviewed. The veteran's history was obtained and clinical findings were recorded. The examiner noted the veteran had depression and had been treated, intermittently for many years, with Tofranil, Thorazine, and Amitril. According to the examiner, being on dopamine-depleting medications such as Tofranil, Thorazine, and Amitril caused pseudoparkinsonism, which is a temporary phenomenon that usually resolves after the discontinuation of the medication. He concluded that the veteran had Parkinson's disease, which had no correlation with his being in military service, nor any correlation with his being on Thorazine, Amitril, or Tofranil. The veteran provided numerous articles from medical websites, as well as selections from a newsletter for persons with Parkinson's disease. Cumulatively, they relate that prolonged use of certain medications can lead to Parkinson's disease by interfering with the brain's metabolism of dopamine. They describe properties of the medications Imipramine (Tofranil) and Chlorpromazine (Thorazine) and note that adverse effects of tricyclic antidepressants include tremors and Parkinson-like disorders, known as secondary parkinsonism. They indicate that depression is often one of the first signs of Parkinson's disease and point out that people diagnosed with depression are three times more likely to develop Parkinson's disease later on in life. The Board does not dispute the validity of the treatise evidence in the form of documents from medical websites and from a newsletter for people with Parkinson's disease. But this evidence does not indicate that, in the veteran's particular case, Parkinson's disease is attributable to any psychotropic medications he was prescribed during military service or that is attributable to his service-connected depressive disorder. Rather, the treatise evidence merely raises the possibility that his Parkinson's disease had its onset during service or developed secondary to a service- connected depressive disorder. And this will not suffice. Instead, the treatise evidence must discuss generic relationships with a degree of certainty such that under the facts of this particular case there is at least a plausible causality based on objective facts rather than on unsubstantiated lay medical opinion. See, e.g., Wallin v. West, 11 Vet. App. 509, 514 (1998). See also Timberlake v. Gober, 14 Vet. App. 122, 130 (2000) (citing Hensley v. West, 212 F.3d 1255, 1265 (Fed. Cir. 2000)). In this case, two VA neurologists specifically determined that the veteran's Parkinson's disease is not related to his military service or to his service-connected psychiatric condition. In reaching that assessment, the examiners specifically commented on and rejected the contended relationship between psychotropic medications prescribed for the veteran's depression and his current Parkinson's disease. The assessment of each examiner was supported by claims file review. Their assessments are entitled to much greater probative weight than is the treatise evidence provided by the veteran. The veteran's assertion that Parkinson's disease had its onset in service or developed secondary to his service- connected depressive disorder, including medications prescribed to treat depression, amounts to an opinion about a matter of medical causation. There is no indication from the record that the veteran has medical training or expertise. As a lay person, he is not competent to offer a medical opinion regarding the diagnosis or etiology of a disorder. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The veteran asserts that he has never been on Amitril but that he was on Amytal. Amytal is not shown to be a dopamine-depleting medication and there is nothing in the record to indicate that it causes or is in any way related to the development of Parkinson's disease. For the reasons discussed above, the claim for service connection for Parkinson's disease must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the appellant's claim, that doctrine is not applicable in the current appeal. 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 38 U.S.C.A. 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1991). ORDER Service connection for Parkinson's disease is denied. ____________________________________________ Gary L. Gick Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs