Citation Nr: 21074259 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 19-10 537 DATE: December 14, 2021 REMANDED Entitlement to service connection for bronchitis is remanded. Entitlement to service connection for right upper extremity tremors, to include Parkinson's disease, due to herbicide agent exposure is remanded. Entitlement to service connection for left upper extremity tremors, to include Parkinson's disease, due to herbicide agent exposure is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1963 to July 1967. For his meritorious service, the Veteran was awarded (among other decorations) Air Force Medal, Vietnam Service Medal, and Vietnam Campaign Medal. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a December 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. The Veteran initially requested a Travel Board hearing but later requested a virtual hearing. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for bronchitis is remanded. 2. Entitlement to service connection for right upper extremity tremors, to include Parkinson's disease, due to Agent Orange exposure is remanded. 3. Entitlement to service connection for left upper extremity tremors, to include Parkinson's disease, due to Agent Orange exposure is remanded. The Veteran contends he is entitled to service connection for chronic bronchitis and tremors. He alleges that the conditions stem from his in-service exposure to herbicide agents. His VA treatment records document a noted history of chronic bronchitis and tremors of his bilateral hands and chin and noted intention tremors. The Veteran's private medical records noted he has been treated for bronchitis for many years and noted the Veteran's statement he was exposed to herbicide agents in service. The June 2017 private medical records further stated herbicide agents can cause many symptoms, including chronic bronchitis. The Veteran submitted a private opinion from his private primary care physician, Dr. T. dJ in July 2017. Dr. T. dJ stated the Veteran had been her patient since April 1995. Dr. T. dJ reported the Veteran has been treated for respiratory symptoms and chronic bronchitis for several years, as well as a tremor that developed over the past several years. The private physician concluded the Veteran's medical history indicates a strong possibility of a connection to his exposure to herbicide agents. These opinions, on their own, are not a sufficient basis on which service connection may be granted. While the standard of proof in VA compensation cases requires only that a disability be at least as likely as not related to service, the phrasing from the private opinions falls short of that, and are ultimately too equivocal to serve as the required nexus opinions. While the private opinion may not be firm enough to grant service connection for chronic bronchitis and tremors, they do trigger the need for VA examinations. The Veteran testified at his October 2021 hearing that he has had chronic bronchitis since he separated from service. The Veteran testified he believes his tremors may be parkinsonism or Parkinson's Disease, and related to herbicide agent exposure in-service. Although the Veteran's bronchitis is not presumptive disease associated with exposure to herbicide agents, the Board finds that the issue of direct service connection related to exposure to herbicide agents has been raised. As a result, remand for a VA examination is necessary. Additionally, a VA medical opinion was obtained in June 2018 for Parkinson's Disease. The opinion concluded the Veteran's treatment records are not consistent with a diagnosis of Parkinson's Disease and the Veteran's intention tremor does not warrant a diagnosis of Parkinson's Disease. The opinion further stated Parkinson's Disease causes a resting tremor, not an intention or acting tremor. While a VA medical opinion was obtained and concluded the Veteran does not have a diagnosis of Parkinson's Disease, parkinsonism was not discussed, and the Veteran's tremors were not evaluated under the theory of direct service connection. As such, a VA examination is required for chronic bronchitis and tremors, a remand is required. The matters are REMANDED for the following actions: 1. Obtain a VA examination to determine the nature and etiology of the Veteran's chronic bronchitis. The examiner should review the claim file, note such review was conducted, and should provide an opinion to the following: a) Please identify the Veteran's respiratory disabilities present during the appeal period. b) For each respiratory disability diagnosed, is it at least as likely as not (50% or greater probability) that such disability was incurred in or caused by the Veteran's military service, specifically his exposure to herbicide agents while in Vietnam? Please explain why. Merely a statement that the Veteran's respiratory disabilities are not presumptive diseases will not be considered sufficient. The examiner is asked to discuss the June 2017 private medical records that state herbicide agents can cause chronic bronchitis and discuss the July 2017 private opinion. 2. Obtain a VA examination to determine the nature and etiology of the Veteran's tremors. The examiner should review the claim file, note such review was conducted, and should provide an opinion to the following: a) Please identify the Veteran's tremor related diagnoses present during the appeal period, including whether the Veteran has a diagnosis of parkinsonism. b) Is it at least as likely as not that the Veteran's tremors or related diagnosed disabilities had its inception during his period of active service or is otherwise causally related to an in-service disease or injury, to include exposure to herbicide agents in-service? The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jayme Mouzakis 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.