Citation Nr: 21071510 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-27 759 DATE: November 30, 2021 ORDER Entitlement to service connection for chronic tremors, to include on a secondary basis, is denied. FINDING OF FACT The Veteran's chronic tremors did not have their onset in service or within a year of separation therefrom, and have not been caused or aggravated by any service-connected disability or treatment therefor. CONCLUSION OF LAW The criteria for entitlement to service connection for chronic tremors, to include on a secondary basis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February to March 1973, from January to April 1978, and from July 1980 to June 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the board in February 2019 and June 2021, on which occasions it was remanded for development. It returns to the Board for appellate review. The claimant has not raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). 1. Entitlement to service connection for chronic tremors, to include on a secondary basis Service connection may be granted for a disability resulting from disease or injury incurred coincident with or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 247, 431 (2006). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including other organic diseases of the nervous system (which includes sensorineural hearing loss and tinnitus), are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (2018). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran carries a current diagnosis of essential tremors, a chronic disorder initially furnished in September 2001. The record indicates the condition has persisted through the appeal period; thus, the first element of service connection is satisfied. There is no evidence that the condition had its onset during a period of active duty service, or that it developed to any degree within a year of separation from active duty service. The Veteran has instead averred that he believes the condition is secondary to service-connected disability and/or its treatment, in particular to his lumbar spondyloarthropathy or to medications prescribed for treatment of service-connected disabilities, which include the low back condition, a bilateral shoulder condition, a bladder condition, left elevated hemidiaphragm, radiculopathy of the left lower extremity secondary to the low back condition, a left elbow condition, and a right wrist condition. A VA examiner with whom the Veteran met in December 2019 confirmed his diagnosis of essential tremors but concluded that because the initial diagnosis occurred approximately five years after separation, with no notation of symptoms arising in service, and with the Veteran acknowledging initial onset of the condition in 2000, the condition was less likely than not directly related to service. Pursuant to the Board's June 2021 remand, a second VA examination was conducted in August 2021. Based on a thorough in person examination and review of the medical record, the examiner concluded that the Veteran's tremors were less likely than not related to service, given the absence of complaint, treatment, or diagnosis for the condition in service or for several years following separation, coupled with the Veteran's acknowledgment of the approximately 5-year gulf between separation and onset. As for secondary service connection, the examiner explained that there was no pathophysiological mechanism that could explain any etiological relationship between any service-connected disability, including lumbar spondyloarthropathy, lumbar radiculopathy, impingement of the shoulders, neurogenic bladder, torn cartilage in the fibula, a wrist disorder, elbow epicondylitis, or left elevated hemi diaphragm, or any medications prescribed in treatment of those conditions, and the Veteran's current tremor disorder. As for aggravation, the examiner explained that tremor conditions such as the Veteran's are understood to progress on their own, but that that is no pathophysiological pathway by which any of the above-listed conditions, or medications prescribed in their treatment, might aggravate or accelerate the condition. The Board accepts the August 2021 VA examiner's statements as the most probative evidence of record on the question of etiology for the Veteran's tremors. The opinions are thorough, reasoned, and fully explained, and are uncontroverted by other objective evidence of record, or by any competent opinion evidence in the record. Thus, while the Board has considered with sympathy the Veteran's lay statements, it cannot afford probative weight to his assertions with respect to the etiology of his chronic tremors in this case. While he is competent to report his experiences and symptoms since service, the Veteran is not competent to provide a nexus opinion regarding the nature and etiology of his condition. Jandreau v. Nicholson, 492 F. 3d 1372 (2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Veteran's reports of his symptoms are relevant, competent, and credible; however, the question of the etiology of his chronic tremors is limited to the purview of someone with medical knowledge and training, such as the VA medical examiner in this case. In sum, the evidence does not show that it is at least as likely as not that the Veteran's diagnosed chronic tremors are related to active service, or that they have been caused or aggravated beyond the normal course of progression by service-connected disability. The probative value of the Veteran's assertions is outweighed by the probative value of the thorough and reasoned opinion of the VA medical expert. As the preponderance of the evidence is against the claim, service connection for chronic tremors must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sahraie, 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.