Citation Nr: 18144616 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 15-24 047 DATE: October 25, 2018 REMANDED The claim for entitlement to service connection for hypertension as a result of in-service exposure to herbicides is remanded. The claim for entitlement to service connection for essential tremors disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1966 to May 1968. He served in the Republic of Vietnam from May 1967 to April 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office in Montgomery, AL. In August 2018 the Veteran withdrew a motion for a video conference hearing before a Veterans Law Judge of the Board of Veterans’ Appeals (BVA) scheduled for September 2018. No subsequent motions are of record. 1. Hypertension as a result of in-service exposure herbicides The Veteran filed for a claim for service connection for hypertension (claimed as hypertensive vascular disease) as a result of herbicide exposure in October 2012. Throughout the pertinent appeal the Veteran has been assessed with hypertension. A VA examination has not been afforded to evaluate the nature and etiology of the Veteran’s hypertension disability. Given that the Veteran served in the Republic of Vietnam during the Vietnam War, was diagnosed with hypertension in March 2012, and the record demonstrates treatment for the disability, the Board finds that the Veteran should be afforded a VA examination to determine the nature and etiology of his hypertension disability. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). In order to properly adjudicate this appeal, a fully articulated and soundly reasoned medical opinion that accounts for the Veteran’s lay testimony and accounts for his service in the Republic of Vietnam during the Vietnam War is needed. As such, a VA examination must be afforded to the Veteran. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). 2. Essential tremor (claimed as convulsive tic) is remanded. The Veteran contends that his essential tremor (claimed as a convulsive tic) existed prior to service and was aggravated beyond its natural progression by service. The Veteran’s October 2012 claim indicates that throughout the pertinent time on appeal, the Veteran has been assessed with an essential tremor diagnosis. The Veteran’s 1966 induction physical exam report is devoid of notations or references to any nervous conditions or tic/convulsive disorders. The Veteran was afforded a VA examination in August 2013 to evaluate the nature and etiology of his tic/convulsive disorder. Clinical evaluation revealed findings of essential tremors. The VA examiner explained that the tic/convulsive disorder seen in the June 1966 medical evaluation is now clinically referred to as “essential tremors.” The examiner opined that the essential tremors was less likely as not (less than 50%) aggravated by the Veteran’s time in the service. The examiner opined that the Veteran’s essential tremors condition is a congenital disorder with early onset based on the Veteran’s service treatment records, which show no exposure or events in the service that would affect the pathophysiology of this condition. He further opined that the condition is most likely a genetic condition, as the Veteran’s father was afflicted with the same condition. The examiner also explained that the psychiatric conditions are not found to be linked in terms of etiology or aggravation. The Board has considered the negative medical opinion provided in the August 2013 VA examination report and finds the opinion to be incomplete as the examiner did not determine whether the Veteran suffers from a congenital disease, as opposed to a defect for VA purposes. See generally VAOPGCPREC 82-90 (1990). If the Veteran’s essential tremors disorder is a congenital defect, it is unclear whether a superimposed in-service activity caused additional disability. Specifically, the VA examiner did not reconcile the proffered negative opinion with the evidence on record, showing that on entry into service the Veteran’s essential tremors disorder was noted as asymptomatic, but his service treatment records show complaints for a nervous disorder in June and December 1966. Thereafter, in April 1967, the Veteran reported that his hand shaking worsened after basic training, reported to have a history of shaking hands for decades, and claimed to have received medical treatment for the claimed tic/compulsive disorder two years prior to service. For these reasons, further medical inquiry is required, and a new VA medical opinion should be obtained to determine the nature and etiology of the Veteran’s essential tremor’s disorder. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed hypertension, to include as a result of exposure to herbicides. The claims file should be made available to the examiner for review and the examiner should state in the examination report that the claims file has been reviewed. The examiner must elicit from the record a full history. Based on a review of the record, and with consideration of the Veteran’s statements, the examiner must provide an opinion as to whether it is as likely as not (50 percent or greater likelihood) that the Veteran’s current hypertension had its onset during or is otherwise related to active service, including whether hypertension is caused by exposure to Agent Orange or other herbicide agents. The examiner must consider the National Academy of Sciences findings in Updates 2006 and 2008, which demonstrate “limited or suggestive evidence of association” between hypertension and herbicide exposure. A complete rationale for all proffered opinions must be provided. 2. Schedule the Veteran for a VA examination with the appropriate specialist, a different VA examiner from the one who conducted the August 2013 examination, to obtain medical opinions on the nature and etiology of the Veteran’s essential tremors. The claims file should be made available to the examiner for review and the examiner should state in the report ath the claims file has been reviewed. Based on a review of the record, the examiner should address the following: a. Identify whether the Veteran’s essential tremors disorder is a congenital defect or disease. Note that a “disease” generally refers to a condition is considered capable of improving or deteriorating while a “defect” is generally not considered capable of improving or deteriorating. b. If the essential tremors disorder is a congenital defect, opine as to whether it is at least as likely as not (a probability of 50 percent or greater) that there was superimposed disease or injury during service that resulted in additional disability. c. If the essential tremors disorder is a congenital disease, opine whether it is at least as likely as not (probability of 50 percent or greater) that there was a permanent increase in severity of the pre-existing essential tremors disorder during active service from May 1966 to May 1968. d. If so, was any increase clearly and unmistakably (obviously, manifestly, or undebatably) due to the natural progress of the disease during active duty from May 1966 to May 1968? e. If the examiner determines that the Veteran did not have an essential tremors disorder that existed prior to service, is it at least likely as not that his current essential tremors disorder had its onset during service or is otherwise related to service. (Continued on the next page)   A complete rationale must be provided for all opinions expressed. If the examiner cannot provide a requested opinion without resorting to speculation, it must so be stated, and the examiner must provide the reasons why that opinion would require speculation. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Steele, Associate Counsel