Citation Nr: 21001447 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 17-21 222 DATE: January 8, 2021 ORDER Entitlement to service connection for residuals of heat exhaustion, to include uncontrolled tremors, heat intolerance, and gait disturbance is granted. FINDING OF FACT The Veteran’s uncontrolled tremors, heat intolerance, and gait disturbance are residuals of in-service heat exhaustion. CONCLUSION OF LAW The criteria for service connection for residuals of heat exhaustion, to include uncontrolled tremors, heat intolerance, and gait disturbance have been met. 38 U.S.C. §§ 1110, 1112, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the Army from September 1981 to September 1984, August 2005 to December 2006, August 2009 to December 2009, and from May 2011 to January 2015. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran and her spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is of record. The Veteran asserts that, while deployed to Egypt in 2012, she suffered from heat exhaustion resulting in tremors, gait disturbance, and continued intolerance of heat. See, e.g., July 2020 Board Hearing Transcript. A July 2012 service treatment record (STR) noted that the Veteran exhibited full body tremor/shakiness, uneasy gait, and pronounced rhythmic head bobbing. An August 2012 post-deployment assessment noted that the Veteran reported uncontrollable head movements during and since her deployment to Egypt. At a December 2012 neurological consultation, the Veteran reported an uncontrollable head movement at times. When overheated, her head bobbed up and down. She had the problem since May when she got overheated in Egypt. In normal temperature, she did not have many problems. Following a physical examination, the examiner assessed a mild essential tremor. A May 2013 neurology clinic note indicated that the Veteran continued to have intermittent and heat-related difficulties with ataxia. She described her ataxia as her head bobbing back and forth. She also stumbled to either side. The examiner observed that the Veteran’s head moved slightly back and forth while walking, and her steps were hesitant. The examiner’s impression was intermittent ataxia related to the heat stroke suffered in Egypt and exposure to heat. A May 2013 Department of the Army memorandum noted that the Veteran had limiting diagnoses of familiar tremor and heat intolerance and would be placed on a temporary profile until a follow-up appointment was completed. A June 2013 STR noted that the Veteran was admitted to the WTU (Warrior Transition Unit) due to issues of uncontrolled movements of her body, confusion, and a lack of concentration. The examiner observed slight head tremors, and the Veteran reported that they were worse the previous day. A July 2013 Army Physical Profile noted that the Veteran should not be expected to do any physical training or participate in outdoor activities when the temperature was above 75 degrees. A January 2014 Department of the Army memorandum noted that the Physical Evaluation Board (PEB) found the Veteran physically unfit to continue military service due to migraine headaches. The PEB also found that the Veteran’s uncontrolled tremors, heat intolerance, and gait disturbance were medically unacceptable. An April 2014 WTU note indicated that the Veteran had experienced problems with the heat at the place where she was working with a large number of new recruits coming into the Army. She reported that she became somewhat faint and her tremor was markedly exacerbated. A May 2014 Department of the Army memorandum authorized the Veteran to wear civilian attire during warmer months, noting that, “due to her current medical diagnosis, [the Veteran’s] symptoms will exacerbate in warmer temperatures.” Following the Veteran’s discharge from service, a June 2015 VA nursing note indicated that the Veteran reported she was stumbling more with “the heat coming on.” She further stated that if she was out in the heat for more than 5 minutes, she became confused and disoriented. In April 2017, the Veteran submitted statements from fellow Army veterans that witnessed the Veteran’s tremors and unbalanced stance. Based on the foregoing, the Board finds that service connection for residuals of heat exhaustion is warranted. The medical and lay evidence of record reflects that the Veteran first suffered from tremors and gait disturbance after she suffered heat exhaustion in Egypt. The evidence further reflects that the Veteran continued to suffer from tremors and gait disturbance when exposed to heat, both during and since service. The Board acknowledges an August 2013 VA Contract examination that noted no diagnosis of gait disturbance, uncontrolled tremors, or heat intolerance. That report is inadequate because several medical examiners have observed the Veteran’s tremors and gait disturbances during the appeal period. Moreover, the Veteran has consistently reported to her treatment providers that her tremors and gait disturbances are exacerbated by exposure to heat. Consequently, the August 2013 report carries little, if any, probative weight. In sum, the Board finds that the preponderance of the evidence is for the claim of entitlement to service connection for residuals of heat exhaustion. Accordingly, the Veteran’s claim is granted. 38 U.S.C. § 5107 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Roya Bahrami, 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.