## Facts

- Arnold J. Parks, a Vietnam War veteran, participated in Project 112/SHAD and was intentionally exposed to chemical warfare agents.
- Parks sought VA service connection for type II diabetes with peripheral neuropathy and a heart disability, alleging they were caused by in-service chemical exposure.
- The VA Regional Office denied the claims, and Parks appealed to the Board of Veterans’ Appeals.
- During the appeal, Project 112 details were declassified; DoD reported no known long-term effects, while VA stated health problems could be linked on an individual causal showing.
- After a Board remand, VA provided a medical examination and nexus opinion by an advanced registered nurse practitioner (ARNP), who concluded Parks’s conditions were less likely than not related to the chemical exposures.
- The Board relied on the ARNP opinion and denied service connection.
- Parks did not challenge the ARNP’s professional competence before the Board; he first raised that challenge on appeal to the Court of Appeals for Veterans Claims (CAVC).
- Parks also submitted internet materials to support causation; the Board and CAVC declined to treat them as competent medical nexus evidence.

## Issues

1. Whether an ARNP’s medical opinion may constitute “competent medical evidence” under VA regulations for service-connection adjudications.
2. Whether a claimant forfeits a challenge to an examiner’s competence by failing to raise it before the Board and raising it first at the CAVC.
3. Whether the Board may discount generic internet materials as not competent medical evidence of nexus.

## Decision

- The Federal Circuit affirmed the CAVC’s judgment upholding the Board’s denial of service connection.
- The court held that VA regulations do not limit competent medical evidence to physicians and that a qualified nurse practitioner may provide a competent medical opinion.
- The court upheld the CAVC’s refusal to consider Parks’s examiner-competence challenge because it was not raised before the Board.
- The court upheld the Board’s treatment of Parks’s internet materials as insufficient to establish medical causation in his individual case.

## Legal Principles

- “Competent medical evidence” under VA regulations includes opinions from persons qualified by education, training, or experience; it is not categorically restricted to physicians.
- Examiner-competence objections must be timely presented to the agency factfinder (the Board); raising the issue for the first time on judicial review may result in forfeiture.
- The Board may assign greater probative weight to an individualized clinical evaluation and nexus opinion than to generalized internet information that does not apply medical analysis to the claimant’s specific circumstances.

## Conclusion

The Federal Circuit affirmed the denial of service connection, holding that a nurse practitioner’s nexus opinion can be competent medical evidence under VA regulations, that challenges to an examiner’s competence must be raised before the Board to be preserved, and that generic internet materials may be discounted as non-competent evidence of medical causation.


Parks v. Shinseki, 716 F.3d 581 (Fed. Cir. 2013)