Citation Nr: 20005965 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 19-12 011 DATE: January 23, 2020 REMANDED Entitlement to service connection for tremors in both hands, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from May 1971 to May 1974. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2017 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA). The Veteran has not been scheduled for a VA examination for his claimed tremors of both hands. The Board finds that evidence warrants such examination. In determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in-service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran’s service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The threshold for determining a possibility of a nexus to service is a low one. McLendon v. Nicholson, 20 Vet. App. 79 (2006). VA treatment records from June 2013 and February 2016 suggest that the Veteran has a current diagnosis of essential tremors in both of his hands. The Veteran has contended that the tremors are due to exposure to Agent Orange. The Veteran’s personnel records have confirmed his service in Vietnam, and so exposure to Agent Orange is presumed. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran’s representative has raised the possibility of an association between the Veteran’s service and his current disability. The representative has referenced the “Veterans and Agent Orange,” 2018 update, from the Institute of Medicine of the National Academics of Sciences, Engineering and Medicine, stating that this article indicates that there is “limited or suggestive evidence of an association” between Parkinson’s disease, to include Parkinsonism and Parkinson-like syndromes, and Agent Orange. Parkinson’s disease has been recognized as one of the conditions presumptively related to herbicide exposure under C.F.R. 38 § 3.309(e). Although the Veteran does not currently have a diagnosis for Parkinson’s disease, his representative has provided an article suggesting that tremors are associated with Parkinsonism, and that essential tremor diagnoses may be confused with Parkinsonism. The representative argued broadly that because Parkinson’s Disease is associated with herbicide exposure, this indicates that tactical herbicides can affect the neurological system, to include causing essential tremors. Although essential tremors are not among the listed presumptive conditions entitled to service connection based on herbicide exposure, the possibility of a relationship between the Veteran’s tremors and Parkinsonism has not been ruled out. Alternatively, a determination that essential tremors are related to Agent Orange on a direct basis is also possible. In the June 2013 treatment records, the Veteran reported that he has experienced these tremors since service in Vietnam. Accordingly, there is a possibility of a nexus between a current disability and service, to incldue exposure to Agent Orange. Given the low threshold for determining a possibility of a nexus to service under McLendon, an examination is necessary. Furthermore, the Veteran previously filed a VA 21-4142 in March 2012 seeking private records from BMG. Records were obtained and associated with the claims file in November 2012. However, the records appear to be incomplete. There is reference within the documents that the Veteran received treatment related to tremors at this facility in February 2010, but the only treatment records provided are from 2012. VA is required to assist a claimant by taking all reasonable action in obtaining medical records that are necessary to decide a claim. 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 3.159. On remand, a supplemental attempt to obtain outstanding records should be made. The matters are REMANDED for the following action: 1. Take the necessary steps to obtain and associate with the file the medical records identified in the March 2012 VA 21-4142, from BMG, including securing an updated, valid release. All actions to obtain the records should be documented. If the records cannot be located or do not exist, a memorandum of unavailability should be associated with the claims file, and the Veteran should be notified and given an opportunity to respond. 2. Schedule the Veteran for a VA examination for his claimed hand tremors. The claims folder must be reviewed in conjunction with the examination. The examiner must identify all current conditions manifested as tremors; the presence or absence of Parkinson’s Disease must be discussed. The examiner must opine whether it is at least as likely as not related to an in-service injury or disease, including exposure to herbicides while serving in Vietnam. A full and complete rationale for all opinions expressed is required. 3. Upon completion of the above, and any additional development deemed appropriate, readjudicate the remanded issue. If the benefit sought remains denied, the Veteran should be provided with a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.P. Faris 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.