Citation Nr: 21015934 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 13-28 959 DATE: March 18, 2021 REMANDED Entitlement to service connection for tremors, to include as due to herbicide exposure and/or secondary to the service-connected unspecified anxiety disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to May 1968. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in August 2016. In August 2017 and March 2019, the Board of Veterans’ Appeals (Board) remanded the claims of service connection for an acquired psychiatric disorder and service connection for tremors for further development. The agency of original jurisdiction (AOJ) granted entitlement to service connection for an unspecified anxiety disorder in a February 2021 rating decision. The claim was granted in full, and therefore the appeal is no longer before the Board. Regrettably, the Board has determined that the claim of service connection for tremors must be remanded once more. The Board remanded the matter in March 2019 to obtain a new VA opinion if the Veteran’s disorder was found to be related to service. The Veteran was provided with a December 2019 VA examination. The examiner diagnosed the Veteran with tremors, since 1963. The Board notes the Veteran did not enter active duty service until 1966, and the entrance examination was negative for any evidence of a tremor condition. Therefore, the Board needs clarification in the form of new opinions to determine if the tremors pre-existed service and if the tremors may have been aggravated by service. The Board also notes the December 2019 VA examiner provided a contradictory rationale in the negative nexus opinion. The examiner found the tremors were not caused or aggravated by the Veteran’s anxiety; however, the examiner also noted poor sleep is associated with tremors. Yet, the December 2019 VA mental health examiner noted the Veteran’s anxiety manifested in chronic sleep impairment. The Veteran’s primary care physician noted the Veteran’s tremors did appear to be worse at times of increased stress and anxiety in May 2010. The December 2019 VA examiner did not address this evidence even though the mental health examination showed the Veteran’s anxiety manifested in difficulty adapting to stressful circumstances. Therefore, an addendum opinion is also needed to determine if the Veteran’s tremors were caused by or aggravated by the service-connected anxiety disorder based upon an adequate rationale. The matters are REMANDED for the following action: Forward the Veteran’s claims file to a qualified VA medical professional in order to an obtain an addendum opinion as to the current nature and etiology of the diagnosed tremor disorder. The claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner. The examiner is asked to address the following: (a.) Identify and diagnose any current (at any point during appeal period) tremor condition. Please also include a discussion of the validity of past diagnoses; (b.) For any diagnosed tremor condition, provide an opinion as to whether such disorder clearly and unmistakably preexisted the Veteran’s active service; (c.) IF any diagnosed tremor condition clearly and unmistakably preexisted active service, provide an opinion as to whether the diagnosed condition was clearly and unmistakably NOT aggravated beyond its natural progression by the Veteran’s active service; and (d.) IF any diagnosed tremor condition did not clearly and unmistakably preexist active service, provide an opinion as to whether the diagnosed condition at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active service, to include presumed herbicide exposure; and (e.) IF any diagnosed tremor condition did not clearly and unmistakably preexist active service, provide an opinion as to whether the diagnosed condition at least as likely as not was caused or aggravated (increased in severity beyond the natural progress of the disorder) by service-connected unspecified anxiety disorder. A complete rationale for all opinions expressed should be provided. The examiner must explain the relevance or significance of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching his or her conclusions, by detailing how such medical knowledge applies to the Veteran specifically. The examiner must address the May 2010 opinion from Dr. J.d.G. and the date of diagnosis provided in the December 2019 VA central nervous system examination. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.