Citation Nr: 18145687 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 17-06 209 DATE: October 29, 2018 REMANDED Entitlement to service connection for essential tremors, to include as due to service-connected psychiatric disability is remanded. REASONS FOR REMAND The Veteran had active service from March 1960 to December 1963. This matter comes before the Board on appeal from a March 2015 rating decision. The matter was previously before the Board in July 2016 and December 2017. The matter now returns for appellate consideration. The issues of entitlement to an initial rating in excess of 30 percent for gastroesophageal reflux disease with gastric/duodenal ulcer, helicobacter pylori infection, hiatal hernia, and diverticulosis, service connection for gastrointestinal disability (other than gastroesophageal reflux disease with gastric/duodenal ulcer, helicobacter pylori infection, hiatal hernia, and diverticulosis, and including gastroenteritis, rectal polyps, and irritable bowel syndrome), and entitlement to a total disability rating for compensation based on individual unemployability, were the subject of a separate December 2017 Board remand due to requested limitation of representation. 1. Entitlement to service connection for essential tremors, to include as due to service-connected psychiatric disability is remanded. The Veteran attended a VA examination in April 2018 to determine the nature and etiology of his essential tremors. The examiner opined that the Veteran’s essential tremors were less likely incurred in or caused by service, and that the Veteran’s mental health conditions did not cause or permanently aggravate his essential tremors. The Board finds this opinion inadequate for decision making purposes. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The Board notes that the examiner specifically stated that he reviewed the “STR’s, CAPRI, and BVA which made no mention of essential tremor.” The examiner then went on to reference neurology consults from 2013 and 2016. The examiner also indicated that there was no clear link for causation between essential tremors and emotional stress, and that mental health disorders aggravation of essential tremors is temporary in nature. The examiner failed to address the consistent reports in the medical treatment records of tremors that the Veteran attributed to medication taken for his service-connected mental health condition. The Veteran contends these tremors began in service, and have continued since. The record shows that in March 1999, the Veteran reported a decrease in tremors at the time, indicating that they were present before that time. The Veteran frequently requests medication adjustments for his tremor and his tremor is noted on examination in treatment records. An opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). As such, an addendum opinion is necessary on remand. The matter is REMANDED for the following action: 1. Forward the record and a copy of this Remand to the examiner who conducted the April 2018 tremor evaluation, or, if that examiner is unavailable, to another suitably qualified examiner for completion of an addendum opinion. The examiner must review the entire record, and note such review. The examiner must opine as to: a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s current tremor condition was incurred in or caused by service. b) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s current tremor condition is proximately due to, or aggravated by, service-connected disability, specifically service-connected psychiatric disability and the medication taken therefor. Aggravation means the permanent worsening beyond the natural progression of the disease. A complete rationale must accompany the conclusion(s) reached. In rendering the requested rationale, the examiner must address the Veteran’s medical history of complaints as shown in the record for a tremor, to include dated in March 1999 in which the Veteran reported a decrease in tremors at the time, indicating that they were present before that time. The examiner must also opine whether the Veteran’s medication taken for service-connected disability is or was a factor in causing and/or aggravating the tremors. The examiner must consider the Veteran’s lay statements as to onset. 2. After the development requested is completed, readjudicate the claim on appeal. If the benefit sought remains denied, furnish the Veteran and his   representative a supplemental statement of the case and a reasonable period to respond, and then return the case to the Board U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Baker, Associate Counsel