Citation Nr: 18157465 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-49 062 DATE: December 13, 2018 REMANDED Entitlement to service connection for essential tremors claimed as Parkinson’s disease is remanded. REASONS FOR REMAND The Veteran had active duty from May 1966 to June 1969. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing. Entitlement to service connection for essential tremors claimed as Parkinson’s disease is remanded. The Veteran contends that his tremors are a result of exposure to herbicides; and that such tremors are an early manifestation to Parkinson’s disease. The service personnel records show the Veteran served in Vietnam from October 1966 to November 1967 and is therefore presumed to have had herbicide exposure. See 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). Post-service VA treatment records documents essential tremors; however, no specific diagnosis of Parkinson’s disease. The Veteran submitted medical literature that shows essential tremors is a symptom of Parkinson’s. There has been no opinion with regards to the etiology of the Veteran’s tremors. Given this history, the Board finds that a remand is required to afford the Veteran a VA examination to obtain a medical opinion as to the relationship, if any, between the current essential tremors and his military service, to include his presumptive exposure to herbicides due to his service in the Republic of Vietnam. See 38 U.S.C. § 5103A(d). The Board observes that the Veteran’s essential tremors may also be secondary to his service-connected disabilities. He is service-connected for diabetes mellitus, type 2; anxiety; and coronary artery disease. The Board has a duty to consider all theories of entitlement to the benefit sought. See Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004) (when determining service connection, all theories of entitlement, direct and secondary, must be considered); see also Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) (on direct appeals to the Board, theories of substantive entitlement to benefits such as direct and secondary service connection are not independent for res judicata purposes, and can be lost forever if not addressed). The matter is REMANDED for the following action: 1. Associate with the claims file all the Veteran’s treatment records from December 2014 onward from the Shreveport VA Medical Center. 2. After obtaining authorizations from the Veteran, associate with the claims file any outstanding private treatment records including from Dr. Weldon. 3. Please schedule the Veteran for an appropriate VA examination with an appropriate provider that is familiar with Parkinson’s-like tremors, to determine the nature and etiology of his tremors. The electronic claims file, including a complete copy of this remand, must be made available to and reviewed by the examiner, and this fact should be noted in the accompanying medical report. All indicated studies, including x-rays, should be performed. The examiner should address the following: Please identify if the Veteran has a diagnosis for Parkinson’s disease. Please identify the likely cause of the Veteran’s tremors. Indeed, is it at least as likely as not (50 percent or greater probability) that the Veteran’s tremors began in (or is otherwise related to) his military service? In responding, the examiner is asked to consider the Veteran’s exposure to herbicides while in service. A detailed explanation (rationale) is requested for all opinions provided, citing to supporting clinical data and/or medical literature, as appropriate. The Board notes if the examiner determines the Veteran’s essential tremors are not related to his presumptive herbicide exposure, the fact that tremors is not a disability on the presumptive list is not an adequate rationale. Alternatively, the examiner should also address if the Veteran’s tremors are caused or aggravated by any of his service-connected disabilities. As noted above, he is service-connected for diabetes mellitus, type 2; anxiety; and coronary artery disease. Again, a detailed explanation (rationale) is requested for all opinions provided, citing to supporting clinical data and/or medical literature, as appropriate H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel