Citation Nr: 21005551 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 13-35 390 DATE: February 1, 2021 REMANDED Entitlement to service connection for a tremor disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from December 1988 to September 1992 including service in Southwest Asia, with additional Reserve service. He also served on active duty in the United States Army from June 1996 to March 1997, with additional service in the National Guard. Among his decorations are the Southwest Asia Service Medal with 3 Bronze Service Stars, the Kuwait Liberation Medal, and the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in February 2015. To that end, the Veteran was erroneously sent a letter in October 2020 regarding a Travel Board hearing. Later that month, the Veteran was sent a letter notifying him of the error, as he had already been afforded a Board hearing, and that the appeal would be adjudicated based on the hearing transcript and other evidence of record. In December 2020, the Veteran was sent a form advising him of his right to an additional Board hearing and to elect an option regarding a hearing within 30 days, noting that if no response was given, the Board would adjudicate the claim based on the record. To this date, the Veteran has not responded to that letter. Accordingly, the Board will proceed with the adjudication of the claim based on the record. In July 2015, August 2018, and November 2019, the Board remanded the issue on appeal for further development. Entitlement to service connection for a tremor disorder is remanded. Although the Board sincerely regrets further delay, a remand is again required, because the February 2020 VA examiner’s opinion is adequate. Specifically, the examiner did not discuss the Veteran’s statement that he experienced tremors after returning from Kuwait, the use of the Veteran’s hypertension medication and its effect on his tremors, and solely based her negative opinion on the lack of documentation in the service treatment records pertaining to tremor complaints or treatment. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (an examination is deemed to be inadequate where the examiner relies on the absence of evidence of disability in the service treatment records, and does not account for competent lay testimony as to onset and continuity of symptoms, to provide a negative opinion). Additionally, the examiner did not provide a clear etiology of the Veteran’s tremors. Finally, the February 2020 opinion was not provided by a physician, as specifically requested by the Board in the prior remand. Stegall v. West, 11 Vet. App. 268 (1998). Accordingly, an addendum opinion is needed on remand. Any outstanding VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Then refer the claims file to a VA physician for preparation of an addendum opinion as to the etiology of the Veteran’s tremor disorder. The entire claims file should be made available to the examiner. No additional examination is necessary, unless the examiner determines otherwise. Following a review of the claims file, the examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s essential tremor: (a.) had its onset in service or is otherwise the result of an injury during service, to include as a result of conceded environmental exposures (e.g., burn pits, oil fires, sandstorms) during service in Southwest Asia; (b.) is proximately due to service-connected hypertension, to include medications used to treat the same (see Board Hearing testimony); or, (c.) has been aggravated (worsened beyond natural progression) by service-connected hypertension, , to include medications used to treat the same (see Board Hearing testimony). In addressing question (a), please (1) discuss and accept as true the Veteran’s testimony that he began first noticing tremors when he returned from Kuwait, and determine whether a nexus to service is “medically plausible” based on the same; (2) address the Veteran’s testimony that his tremors are affected by his blood pressure medications; and (3) note that the lack of contemporaneous medical records or diagnosis within a year of service is not dispositive and may not be used as a basis for a negative opinion. In addressing questions (b) and (c), please note that it is not necessary that hypertension be service-connected, or even diagnosed, at the time his tremor disorder is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. A complete rationale shall be given for all opinions and conclusions expressed. In the event that the VA examiner is unable to provide a medical opinion, he or she must provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.