Citation Nr: 20032746 Decision Date: 05/11/20 Archive Date: 05/11/20 DOCKET NO. 19-08 711A DATE: May 11, 2020 REMANDED Entitlement to service connection for essential tremors as a result of exposure to herbicides is remanded. Entitlement to service connection for neuropathy (nerve damage left leg) as a result of exposure to herbicides is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from August 1966 to August 1968. The records reflect that the Veteran served during the Vietnam Era. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. 1. Entitlement to service connection for essential tremors as a result of exposure to herbicides is remanded. 2. Entitlement to service connection for neuropathy (nerve damage left leg) as a result of exposure to herbicides is remanded. The Veteran contends that he has tremors and nerve damage to his left leg as a result of exposure to herbicides (the dioxin in Agent Orange) while serving during the Vietnam War. The Board notes that the Veteran has not been afforded VA examinations to evaluate the respective etiology of both of his claims. Although the Veteran’s private medical record reflects a current diagnosis of peripheral neuropathy, the record does not include an etiological opinion evaluating whether the Veteran’s nerve disability relates to his military service. The RO cites to the June 2015 VA examiner’s opinion for his separate claim for diabetes mellitus (DM), in which the examiner states that the Veteran’s essential tremors with peripheral neuropathy are not attributed to his DM because his neuropathy pre-dates his DM diagnosis. Further, the RO also cites to a lack of a current diagnosis for the Veteran’s essential tremors as a basis for the denial of the claim. Yet, the Veteran’s September 2011 private treatment record denotes a “history of chronic left foot drop, as well as essential tremors,” including ongoing treatment of Primidone (50 mg) for his tremors. The Veteran’s March 2015 medical treatment record (received March 2016) also reflects that such ongoing treatment for his tremors has been consistent. Therefore, in order for the Board to adjudicate the merits ot the Veteran’s respective claims, a VA examination should be obtained for a medical opinion concerning whether the Veteran’s nerve damage (left leg) and essential tremors were caused or otherwise related to or aggravated by his presumed exposure to Agent Orange while serving in Vietnam. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination by an appropriate clinician to determine the current nature and etiology of any diagnosed neurological disorder, including neuropathy (left leg) and tremors. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination(s). The most up-to-date Disability Benefits Questionnaire(s) should be utilized. The claims file should be made available to and be reviewed by the examiner in conjunction with the examination, and the examiner should note that such review was conducted. The examiner should then address the following: a) State whether the Veteran has a current diagnosis of his claimed essential tremors. b) State whether the Veteran has a current diagnosis of neuropathy of his left leg. c) State whether the Veteran has any other diagnosed neurological disorder. The examiner is requested to offer an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or more) that any diagnosed neurological disorder, including neuropathy of the Veteran’s left leg and tremors are due to or otherwise related to the Veteran’s military service, including to his presumed exposure to herbicide agents, specifically, Agent Orange. The examiner should further address whether it is at least as likely as not that any such diagnosed disability was caused or aggravated by the Veteran’s service-connected diabetes mellitus. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the Veteran’s service treatment records (STRs) to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, 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.