Citation Nr: 19145877 Decision Date: 06/12/19 Archive Date: 06/12/19 DOCKET NO. 96-23 563 DATE: June 12, 2019 REMANDED Entitlement to service connection for a disability claimed as "trembling," to include as secondary to a service-connected hyperthyroid condition is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1968 to September 1979 and November 1990 to March 1991, to include service in the Republic of Vietnam, from August 6, 1971, to June 27, 1972, and in Southwest Asia from December 10, 1990, to January 30, 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 1995 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. This case has an extended procedural history. Most recently, in a September 2017 Board decision, the Veteran’s claim was denied. The Veteran appealed the case to the United States Court of Appeals for Veteran’s Claims, resulting in a Joint Motion for Partial Remand (JMPR), which was granted by the Court in December 2018. Entitlement to service connection for a disability manifested as "trembling" is remanded. The purpose of the December 2018 Court Order implementing the JMPR to partially vacate and remand the September 2017 Board decision was to fulfill VA’s duty to assist the Veteran in providing him with an adequate examination. 38 U.S.C. § 5103A; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The JMPR agreed that remand for a new VA examination was required to address the etiology of the Veteran’s claimed tremors. The parties noted that, while the Board relied on an April 1999 VA general examination to show that the Veteran’s trembling was related to his thyroid disorder, the parties agreed that the examination does not clearly attribute tremors to hyperthyroidism, stating only that it “may well have been related to his hyperthyroidism.” In addition, the parties agreed that May 2014 and January 2017 VA thyroid examinations found no current signs or symptoms attributable to a hyperthyroid condition. Hence, because there was no evidence that clearly addressed the etiology of the Veteran’s tremors, to include any relationship between the tremors and his service-connected hyperthyroid condition, the parties agreed that a new examination was required. See Barr, 21 Vet. App. at 312; McLendon 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 current etiology of his disability claimed as trembling. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner should: a) Identify the etiology of the Veteran’s tremors; b) Opine as to whether there is a 50 percent or greater probability that the Veteran’s trembling is related to or had its onset in service to include the Veteran’s competent report of his symptoms. c) Opine as to whether there is a 50 percent or greater probability that the current symptoms claimed as trembling are caused or aggravated by the service-connected hyperthyroidism. Please explain why or why not. In rendering the opinion, the examiner must address the April 1999 medical report in which the examiner opine that the Veteran’s trembling is related to his thyroid and “may well have been related to his hyperthyroidism.” If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. The examiner must provide a clear rationale for the opinion and a discuss the facts and medical principles involved. (Continued on the next page)   2. Then readjudicate the appeal. If any claim is not granted in full, issue a supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Jones Council, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.