Citation Nr: 21023726 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 19-37 062 DATE: April 21, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a disorder manifested by tremors, to include Parkinson’s disease, is remanded. REASONS FOR REMAND The Veteran had active military service from January 1962 to March 1990, including duty at Ubon Air Base in Thailand in 1970-1971. The Veteran testified before the undersigned Veterans Law Judge at a virtual hearing in November 2020. A transcript of the hearing has been associated with the file. For the reasons discussed below, the Board finds that a remand is warranted for the issues of entitlement to service connection for bilateral knee disability and a disorder manifested by tremors. Bilateral Knee Disability The Veteran contends that he is entitled to service connection for bilateral knee disability from spending over twenty-five years walking the flight line. See Notice of Disagreement, May 2018. In addition, he testified during his November 2020 virtual hearing to in-service injuries to both knees and continued post-service symptoms. See Hearing Transcript, Page 3-4. The Veteran has not been afforded a VA examination for his asserted bilateral knee disability. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). The Board finds the low threshold requirement has been met for a VA examination. Id.; see also 38 U.S.C. § 5103A. Tremor Disability The Veteran contends that his disorder manifested by tremors is related to service. Specifically, he contends his tremors are from exposure to herbicides while serving in Thailand. Here, the record contains a diagnosis of essential tremors, which suggest the need for further testing. The Board finds that there is evidence of the existence of a disorder manifested by tremors, which is competent. Its etiology; however, is unclear. Therefore, a VA examination is necessary before a decision can be reached. In particular, an examination is warranted in the instant case to clarify 2 issues: (1) does the Veteran currently have a diagnosis of Parkinson’s disease; and (2) if not, are the Veteran’s reported symptoms, including tremors, indicative of another condition that was caused by or related to service. The examination obtained on remand must specifically address the Veteran’s contention of herbicide exposure in Thailand. Given such, the Board finds a remand is warranted to afford the Veteran a VA examination. The matters are REMANDED for the following action: (Please note, this appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). Expedited handling is requested). 1. Obtain any outstanding VA and private treatment records relevant to the claims on appeal. 2. Schedule the Veteran for an appropriate VA examination to determine whether he has a current diagnosis and the etiology of any bilateral knee disability. The entire claims file should be made available to the reviewing examiner and the examiner should indicate in the report that the claims file was reviewed. The VA examiner is asked to answer: Whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s left knee disorder or right knee disorder manifested in service or is otherwise causally or etiologically related to his military service. For purposes of this opinion, the examiner is asked to accept as true the Veteran’s reports of any in-service knee injuries. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his noted tremors, to include as due to herbicide exposure. The examiner is directed to consider the Veteran’s reported history of hand tremors and noted diagnosis of essential tremors. The examiner is asked to determine the nature and etiology of any currently diagnosed nervous system disorders. For each condition identified, please opine: Whether it is at least as likely as not (50 percent probability or greater) that the condition manifested in service or is otherwise causally or etiologically related to his military service. Whether it is at least as likely as not (50 percent probability or greater) that the condition was proximately due to or the result of herbicide exposure. A complete rationale for all opinions should be provided. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Krista Johnson, 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.