Entitlement to service connection for hydrocephalus as secondary to service-connected Parkinson's disease is granted.

Citation Nr: 26001466 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 19-02 507 DATE: January 30, 2026 ORDER Entitlement to service connection for hydrocephalus as secondary to service-connected Parkinson's disease is granted. FINDING OF FACT Resolving all reasonable doubt in the appellant's favor, the Veterans' hydrocephalus was aggravated by his service-connected Parkinson's disease. CONCLUSION OF LAW The criteria for service connection for hydrocephalus as secondary to Parkinson's disease have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1960 to August 1982. He passed away in 2022. The appellant is his surviving spouse, who has been substituted for the Veteran as the claimant. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2018 by a Department of Veterans Affairs (VA) Regional Office. The appellant testified at a Board hearing before the undersigned Veterans Law Judge in November 2020, a transcript of which is of record. This matter was before the Board in January 2024 when it was denied. The appellant appealed the Board's January 2024 denial to the United States Court of Appeals for Veterans Claims (the Court). The parties agreed to a Joint Motion for Remand (JMR) requesting the January 2024 Board decision be vacated. In July 2025 the Court granted the JMR and remanded the matter to the Board. It now returns to the Board for further appellate review. Significantly, the Board notes the instant claim is for secondary service connection, for a separate and distinct disability. It is not a claim for an initial increased rating for Parkinson's disease. The Board has not addressed the initial rating to be assigned for the newly secondary service-connected disability. The Board shall not assign initial ratings in the first instance. The Board notes that the rating decisions assigning such initial ratings for the newly service-connected disability will be issued under the Appeals Modernization Act. Therefore, no Supplemental Statement of the Case (SSOC) should be issued regarding the initial rating assigned by the agency of original jurisdiction (AOJ) for the newly service-connected hydrocephalus. Entitlement to service connection for hydrocephalus as secondary to Parkinson's disease. The Veteran contended entitlement to service connection for hydrocephalus separate and distinct from service-connected Parkinson's disease, both as directly service connected or as secondary to Parkinson's. The JMR requires the Board to consider a secondary theory of service connection for hydrocephalus based on Parkinson's causing falls which caused his hydrocephalus. Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury. 38?C.F.R. §?3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc); Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). The Veteran is generally competent to report his own lay symptomatology but not to provide a medical diagnosis. 38 C.F.R. § 3.159(a)(2). Barr v. Nicholson, 21 Vet. App. 303 (2007); Layno v. Brown, 6 Vet. App. 465, 471 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature," and is capable of lay observation. Barr, supra. While the Veteran is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, he is not competent to provide evidence as to more complex medical questions. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Although medical evidence is generally necessary for a nexus to service, lay evidence can be sufficient to show continuity of symptoms after service, as a foundation for a nexus opinion, or to link chronic in-service symptoms to the same diagnosed current disability, or as a substitute for a nexus. Jandreau, supra. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The benefit-of-the-doubt rule applies when the evidence is in approximate balance or nearly equal. Lynch v. McDonough, 21 F.4th 776 (2021). The Veteran had a current hydrocephalus disability, separate and distinct from Parkinson's during the pendency of the claim as confirmed by VA medical professionals and medical treatment records. Medical treatment records show that upon reporting symptoms of imbalance and cognitive impairment, medical professionals in 2017 investigated both Parkinsonism and hydrocephalus diagnoses and ultimately ended up diagnosing both hydrocephalus and Parkinsonism, based in part on MRI findings and the Veteran's response to treatments. Both disabilities can cause imbalance and cognitive impairment. Medical records do not indicate which disability onset first, making a theory that falls caused by Parkinson's caused hydrocephalus implausible. However, such may have aggravated the Veteran's hydrocephalus. There is no negative medical opinion of record regarding whether Parkinson's aggravated hydrocephalus. Upon review and resolving all reasonable doubt in the appellant's favor, the Board finds the Veteran's hydrocephalus was aggravated by his service-connected Parkinson's. Consequently, service connection for hydrocephalus as secondary to service-connected Parkinson's disease is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th 776. Nathaniel Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sasha Larie Boersma 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.