Citation Nr: 18152431 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 13-21 195 DATE: November 21, 2018 REMANDED Entitlement to service connection for essential tremors, to include due to herbicide exposure and/or as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1968 to September 1969. Service in the Republic of Vietnam is indicated by the record. He is the recipient of the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. In October 2016, the Veteran presented sworn testimony during a personal hearing in St. Petersburg, Florida, which was chaired by the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the Veteran’s VA claims file. In an August 2017 decision, the Board denied the Veteran’s claim of entitlement to service connection for essential tremors. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In a June 2018 Order, granting a May 2018 Joint Motion for Partial Remand, the Court vacated the Board’s August 2017 decision and remanded the case for further development in compliance with the directives specified in the Joint Motion. 1. Entitlement to service connection for essential tremors, to include due to herbicide exposure and/or as secondary to service-connected PTSD, is remanded. In the August 2017 decision, the Board denied service connection for essential tremors; however, in the May 2018 Joint Motion, the parties agreed that the Board failed to satisfy its duty to assist because it relied upon an inadequate medical opinion. Specifically, the parties stated that the Board failed to recognize that the January 2014 VA examiner failed to address the relationship between the diagnosed essential tremors and the Veteran’s presumed herbicide exposure. The parties also noted that the VA examiner ignored the private treatment records of Dr. K., which suggested a relationship between the Veteran’s essential tremors and his military service. In addition, the parties to the Joint Motion observed that, although the examiner further indicated that the Veteran’s essential tremors were not caused by his service-connected PTSD, the examiner failed to address whether the essential tremors were aggravated by his PTSD. Accordingly, in light of the findings of the May 2018 Joint Motion, the Board finds that this matter must be remanded to provide the Veteran with a new VA medical opinion to determine whether his diagnosed essential tremors are due to his military service, to include presumed herbicide exposure. The examiner should additionally address whether the Veteran’s essential tremors are caused or aggravated by his service-connected PTSD. The matter is REMANDED for the following action: 1. Refer the VA claims file to a medical professional with appropriate expertise to provide an opinion as to the claimed essential tremors. The examiner is requested to review the claims file in its entirety including all service treatment records, VA, and private treatment records. The examiner should then provide an opinion as to: (a). whether it is at least as likely as not that the diagnosed essential tremors were incurred in the Veteran’s active duty service, to include as due to the presumed herbicide exposure. In providing the opinion, the examiner should address the private records of Dr. K., as referenced above; (b). whether it is at least as likely as not that the diagnosed essential tremors were caused by a service-connected disability, to specifically include PTSD; and (c). whether it is at least as likely as not that the Veteran’s diagnosed essential tremors are aggravated (made worse as shown by comparing the current disability to medical evidence created prior to any aggravation) by a service-connected disability, to specifically include PTSD. If the Veteran’s diagnosed essential tremors are aggravated by a service-connected disability, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. Should the examiner decide that a physical examination of the Veteran is required to address these questions, such should be scheduled. All examination findings/testing results (if any), along with complete, clearly-stated rationale for the conclusions reached, must be provided. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. K. Buckley, Counsel