Citation Nr: 21021321 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 12-16 260 DATE: April 12, 2021 REMANDED The claim for service connection for neurological conditions, to include tremors in hands and restless legs, is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Army from October 1968 to May 1970. He served in Vietnam from April 1969 to May 1970 as an ammunition handler. The Veteran is seeking service connection for neurological conditions in his four extremities, to include tremors in his hands and restless legs, which he believes may have resulted either from injuries during service or as a result of this service connected PTSD. In October 2012, the Veteran underwent a private neuropsychological assessment, at which he reported tremors in his hand, restless legs, along with his psychiatric disorders. Doctor Stern diagnosed him with PTSD, sleep apnea, and traumatic brain injury (TBI). A July 2019 Board decision remanded the issue to the Agency of Original Jurisdiction (AOJ) to schedule the Veteran with a VA examination to diagnose any neurological conditions, to include tremors in hands and restless legs, and to obtain medical opinions on direct nexus and secondary nexus. A July 2020 VA examination diagnosed the Veteran with movement disorder, essential tremor, and restless leg syndrome. The examiner concluded that the Veteran’s neurological conditions, to include symptoms of tremors in hands and restless legs are less likely (less than 50 percent probability) caused by his service or service connected PTSD, but more likely caused by a TBI. However, a November 2020 VA examination conducted by a different examiner found that the Veteran does not have, nor had he ever had a diagnosis of TBI or residuals of TBI. In light of the contradictory medical diagnosis and opinions, further development is warranted. Therefore, the matter is REMANDED for the following action: Obtain a medical opinion to clarify the diagnoses of the Veteran’s neurological conditions and their etiologies. The examiner should answer the following questions: a) Does the Veteran have or ever had a TBI or any residuals of TBI? Why or why not? In doing so, the examiner should discuss (i) Dr. Stern’s neuropsychological assessment in October 2012 which diagnosed the Veteran with TBI (see a 4/15/2013 document entitled “Medical Treatment Record–Non-Government Facility”), and (ii) The July 2020 VA examiner’s opinion that he agreed with Dr. Stern’s assessment of TBI and opined that the Veteran’s neurological conditions (to include tremor and restless legs) were more likely attributable to his history of TBI, (see a 8/21/2020 document entitled “C&P exam”). b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s neurological conditions, to include symptoms of tremors in hands and restless legs, either began during or was otherwise caused by his military service, to include any injuries occurred during service? Why or why not? c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s neurological conditions were caused by his service connected PTSD? Why or why not? d) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s neurological conditions were aggravated (made worse) by his service connected PTSD? Why or why not? Please note that, “aggravation” means any increase in the severity of the disability (ie made worse), and not aggravation beyond the natural progression. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Q. Wang, 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.