Citation Nr: 21075221 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-42 828A DATE: December 17, 2021 REMANDED Entitlement to service connection for a tremor disorder to include as due to herbicide agent exposure and exposure to contaminated water at Camp Lejeune or as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1959 until January 1963 and from November 1964 until May 1982. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902 (c). This appeal was previously before the Board in June 2021 when it was remanded. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a tremor disorder to include as due to herbicide agent exposure and exposure to contaminated water at Camp Lejeune or as secondary to service-connected disabilities is remanded. The Veteran's representative argued that the VA opinion obtained in remand is inadequate. See November 2021 written brief. The Board agrees. The claim must be remanded for another opinion. The Board previously remanded the claim to obtain a medical opinion that resolved some inconsistencies; specifically, the nature of the tremors. There were diagnoses of essential tremor and a diagnosis of nonspecific tremor syndrome, with no objective evidence to support a diagnosis of essential tremor. The October 2021 negative VA opinion is inadequate. In the rationale, the examiner details numerous risk factors but comments on the diminished likelihood that Camp Lejeune exposure was a "significant" factor in developing tremors. The question is whether the exposure is a factor at all and if so, the likelihood that it is the cause of the diagnosed disability. The Veteran's representative raised the question of whether the tremors are secondary to the Veteran's service-connected posttraumatic stress disorder (PTSD). The opinion on remand must address that. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician who has not yet opined in this matter regarding the likely etiology of the Veteran's tremors. The clinician should be provided with all pertinent documents. If the clinician determines that a requested opinion cannot be offered without further examination or testing of the Veteran, such examination or testing should be scheduled. After thoroughly reviewing all pertinent documents and further examination of the Veteran, if necessary, the clinician should answer the following: (a) Clarify the appropriate diagnosis for the Veteran's tremors resolving any conflict in the medical evidence. (b) Is it at least as likely as not that the diagnosed tremors are related to the Veteran's exposure to herbicide agents or to contaminated water at Camp Lejeune? (c) Is it at least as likely as not that the diagnosed tremors are (i) proximately due to or (ii) aggravated by (any increase in disability) his service-connected disabilities including PTSD, diabetes mellitus, and impingement syndrome of the bilateral shoulders? In answering this, the examiner must specifically discuss the medical literature cited and discussed by the Veteran's representative in their November 2021 Informal Hearing Presentation. 2. After completion of the above development, and any additionally indicated development, ensure that the obtained medical etiology opinions comport with this remand. Specifically, ensure that the correct legal standard for aggravation (any increase in disability) is used. If not, obtain an addendum that does use the correct legal standard. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.