Citation Nr: 21001169 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 12-19 478 DATE: January 7, 2021 REMANDED Entitlement to service connection for hand tremors is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1970 to December 1971. His decorations and medals include a Purple Heart, a Combat Infantry Badge, and a Bronze Star Medal with “V” Device. The Veteran and his spouse, who is his legal fiduciary, testified at a Travel Board hearing before the undersigned in July 2018. A transcript of this hearing is associated with the Veteran’s claims file. This case was previously remanded by the Board in February 2019. Also remanded at the time was the issue of entitlement to service connection for ischemic heart disease. In an August 2020 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for ischemic heart disease. As this award represents a full grant of the benefits sought with respect to this issue, the matter is resolved and is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Regarding the matter of hand tremors, the Veteran was afforded a VA examination in August 2020 to determine the nature and etiology of that condition. The VA examiner opined that the Veteran’s hand tremor condition was less likely than not caused by his in-service shrapnel injury, as there were no focal neurological deficits caused by a localizable lesion such as would be observed if caused by a shrapnel injury. The VA examiner explained that there was no medical basis for finding that the current hand tremor condition resulted directly from any injury or experience during military service, and noted that the Veteran’s tremor as observed on examination was minor at best and was most consistent with minor age-appropriate essential tremor. However, the August 2020 VA examiner also stated in the examination report that the Veteran’s essential tremor symptoms were not consistent with a focal peripheral nerve lesion, since there was no observable focal deficit, and that the hand tremor symptoms were more likely related to his history of traumatic brain injury (TBI). The VA examiner concluded that the Veteran’s nervous system disorder was more consistent with a central issue or lesion. As the Veteran is service-connected for posttraumatic stress disorder (PTSD) with residuals of TBI, the Board finds that a clarifying addendum opinion is warranted. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician. After reviewing the claims folder, the examiner is instructed to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current hand tremors are caused or aggravated by his history of TBI, to include his service-connected PTSD with residuals of TBI. In doing so, the VA examiner is asked to clarify the August 2020 VA examination note stating that the Veteran’s essential tremor symptoms were not consistent with a focal peripheral nerve lesion, since there was no observable focal deficit, but that the hand tremor symptoms were more likely related to his history of TBI. For the purposes of secondary service connection, the examiner is advised that aggravation is defined as “any increase in disability.” If the examiner determines that the requested opinion may not be provided without a physical examination of the Veteran, then such should be scheduled. A complete rationale must be provided for all opinions presented. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffin, 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.