Citation Nr: 21064314
Decision Date: 10/19/21	Archive Date: 10/19/21

DOCKET NO. 13-02 748
DATE: October 19, 2021

REMANDED

Entitlement to service connection for tremors is remanded.

Entitlement to service connection for hypertension is remanded.

REASONS FOR REMAND

The Veteran served on active duty from January 1973 to May 1975. The Veteran testified at a hearing with the undersigned in January 2018. The matter was most recently remanded in May 2021. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998).

Entitlement to service connection for tremors.

Entitlement to service connection for hypertension.

The claim must be remanded again because the June 2021 VA opinion is inadequate. The rationale for the negative opinion on tremors includes some inaccurate statements. The examiner discounted statements from the Veteran and his wife that the tremors started after the tracheostomy and have continued since then; the examiner concluded the tremors had started within a few years of a 2020 examination. 

Treatment records show the Veteran's tremor is documented as early as 1999. The examiner did not consider the Veteran's 1984 statement that he was told he may have suffered brain damage related to a coma in service. 

The hypertension claim is intertwined with the claim for tremors and must be remanded.

The matters are REMANDED for the following action:

1. Obtain an opinion from an appropriate clinician, preferably a neurologist, on the likely etiology of the Veteran's tremors and hypertension. Copies of all pertinent records must be made available to the examiner for review. The examiner must answer the following:  

(a) Is it at least as likely as not that the current tremors began during service or are otherwise related to an in-service injury, event, or disease, to include the tracheostomy, heart stoppage, coma and/or pneumothorax? 

In offering the opinion, the examiner must specifically discuss (i) whether the in-service pneumothorax could have led to a potential brain injury that may have caused tremors; (ii) May 1975 testimony that the Veteran's heart stopped during the inservice incident involving the tracheotomy; (iii) August 1984 statements made by the Veteran that he was informed of brain damage while in a coma during service; (iv) testimony of the Veteran and his wife that the tremors began after the tracheotomy procedure and have continued; (v) whether the lack of medical literature supporting a connection between tracheostomy and tremors is the same as precluding a connection, and if so, why?  

(b) Is it at least as likely as not that the Veteran's hypertension was incurred in service?

(c) Is it at least as likely as not that the Veteran's hypertension is (i) caused by or (ii) aggravated by the tremors? Aggravation here is defined as any increase in disability. 

In answering these questions, the examiner must discuss the in-service pneumothorax and tracheostomy. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, 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.