Citation Nr: 21066407 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 14-25 190A DATE: October 29, 2021 REMANDED Entitlement to service connection for a disability manifested by essential tremors is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1967 to August 1971, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Board remanded this claim to obtain a VA examination as to whether the Veteran's tremors were caused by service, to include herbicide exposure. In May 2020, the Board again remanded this issue for another VA medical opinion as it found the May 2019 VA examination inadequate. In May 2021, the Board again remanded the claim for further development, namely, to obtain another VA examination to determine if his essential tremors qualified as parkinsonism for the purposes of applying presumptive service connection principles under 38 U.S.C. § 1116 pursuant to the National Defense Authorization Act for Fiscal Year 2021. The claim now returns to the Board. Entitlement to service connection for essential tremors Pursuant to the May 2021 remand, an August 2021 VA examination was obtained. Therein, the VA examiner determined that the Veteran's essential tremors did not qualify as parkinsonism as the "physical exam is negative for stiff muscles, difficulty standing, difficulty walking, difficulty with bodily movements, muscle rigidity, problems with coordination and other symptoms of Parkinson's disease." The examiner also stated that there was no medical evidence to establish a link between his essential tremors and herbicide exposure on a direct basis. However, remand is still necessary to obtain an addendum VA medical opinion. In the Veteran's September 2021 written brief presentation, he contended that his essential tremors could be secondarily caused or aggravated by his other service-connected disabilities including intervertebral disc syndrome (IVDS), ischemic heart disease (IHD), and degenerative disc disease. At this point, the Board lacks the medical information necessary to make a fully informed decision on the relationship, if any, between these service-connected disabilities and essential tremors. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). More importantly, the Board notes that the Veteran is additionally service connected for sleep apnea and that the August 2021 VA examiner implied that it may play some role in the Veteran's essential tremors. See August 2021 VA Examination, Section III, 3D. As there is no etiological opinion aside from the above regarding this connection, remand is warranted. Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). For the reasons stated above, remand is necessary to obtain an addendum VA medical opinion on these secondary service connection questions. The matters are REMANDED for the following action: Obtain a VA medical opinion regarding the nature and etiology of the Veteran's essential tremors. An in-person examination or telehealth interview need not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The entire claims file, to include this remand, must be reviewed by the examiner. The examiner must provide separate, thorough, well-reasoned opinions as to whether: (a) It is at least as likely as not that the Veteran's essential tremors were caused by his IVDS; (b) It is at least as likely as not that the Veteran's essential tremors were aggravated by his IVDS; (c) It is at least as likely as not that the Veteran's essential tremors were caused by his IHD; (d) It is at least as likely as not that the Veteran's essential tremors were aggravated by his IHD; (e) It is at least as likely as not that the Veteran's essential tremors were caused by his degenerative disc disease; (f) It is at least as likely as not that the Veteran's essential tremors were aggravated by his degenerative disc disease; (g) It is at least as likely as not that the Veteran's essential tremors were caused by his sleep apnea; and whether (h) It is at least as likely as not that the Veteran's essential tremors were aggravated by his sleep apnea. All opinions should be based on examination findings, historical records, and medical principles. The examiner should fully articulate a sound reasoning for all conclusions made. If any requested opinion cannot be provided without resorting to mere speculation, the examiner should explain why that is so. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.