Citation Nr: 21063398 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 18-32 928 DATE: October 14, 2021 REMANDED Entitlement to service connection for essential tremors is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1955 to January 1957. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in July 2020. A transcript of the hearing is associated with the Veteran's claims folder. This case was previously before the Board in August 2020, January 2021, and June 2021 on which occasions the claim was remanded. Entitlement to service connection for essential tremors is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the June 2021 Board decision, the claim was remanded for an addendum medical opinion regarding whether the Veteran's essential tremors are at least as likely as not related to an in-service concussion. In remanding the claim, the Board directed the VA examiner to assume that the Veteran was in sound condition at the time of his enlistment and to assume that he suffered an in-service concussion as described in his July 2020 Board hearing. The RO complied with the Board's remand directives, and in June 2021 a new medical opinion was proffered. The VA examiner opined that the Veteran's in-service head injury, which the examiner indicated was mild or at a maximum moderate, was "very unlikely the cause of his tremors." In rendering this opinion, the examiner noted that research regarding the relationship between mild to moderate trauma and tremors is inconclusive, and in studies where an association has been found, the tremors were transient in nature. (6/16/2021, C&P Exam, p. 2-3). The Board finds that the June 2021 examiner's opinion is inadequate for evaluation purposes. In this regard, the examiner's opinion relies in part on the finding that research regarding the relationship between mild to moderate trauma and tremors is inconclusive. While there may not be a consensus in the medical community, the Board notes that a medical principle need not reach scientific consensus to adequately support a grant of VA benefits. See Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). Further, the examiner does not address contradictory aspects of medical texts in rendering her opinion. See McCray v. Wilkie, 31 Vet. App. 243 (2019). In concluding that tremors following mild to moderate trauma are transient in nature, the examiner is referencing an article submitted by the Veteran in support of his claim. In the article, Can Head Trauma Cause Essential Tremor?, the writer notes that "[i]n cases of mild to moderate head injury, the incidence of movement disorders is much lower, occurring only transiently [temporarily] in 7.6% of the cases and persistently in 2.6% of the patients." The June 2021 examiner did not acknowledge or address the writer's finding that movement disorders are persistent in 2.6 percent of patients. As the examiner failed to consider this contradictory aspect of the article, the Board finds that the opinion is inadequate. Indeed, while the overall likelihood of causation is low, such finding does not explore the specific facts of this Veteran's case, and thus additional inquiry is warranted. Based on the aforementioned, the claim must be remanded for an addendum opinion. Upon remand, the examiner must acknowledge the aforementioned medical article, and address the finding that movement disorders are persistent in 2.6 percent of patients after suffering a mild to moderate head injury. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran's disabilities from June 2021 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's essential tremors are at least as likely as not related to an in-service concussion. In rendering an opinion, the examiner must assume that: (a.) the Veteran was in sound condition at the time of his enlistment; and (b.) that he suffered an in-service concussion as described in his July 2020 Board hearing. The examiner is reminded that nothing in the regulatory or statutory provisions require both medical and competent lay evidence, and that competent lay evidence can be sufficient in and of itself to substantiate a disability claim. Bearing this in mind, the examiner should consider the Veteran's lay statements regarding when his tremors first manifested. (7/13/2020, Hearing Transcript, p. 9); (11/26/2020, Medical Treatment Record, p. 15). Additionally, the examiner must review the medical article Can Head Trauma Cause Essential Tremor? The examiner should address the finding that "[i]n cases of mild to moderate head injury, the incidence of movement disorders is much lower, occurring only transiently [temporarily] in 7.6% of the cases and persistently in 2.6% of the patients." Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Glenn, 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.