Citation Nr: 21031675 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 14-25 190A DATE: May 24, 2021 REMAND Entitlement to service connection for a disability manifested by essential tremors is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1967 to August 1971, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board remanded the issues of entitlement to service connection for a skin condition, and entitlement to service connection for tremors, for further evidentiary development. Following the decision, the RO issued a March 2021 rating decision granting service connection for a skin condition. As such, the issue is no longer on appeal. Essential Tremors The Veteran contends that his tremors are related to herbicide exposure he experienced while on active duty in the Republic of Vietnam. He states that his symptoms began in 1970, after returning from Vietnam, and have since continued. The record confirms he had herbicide exposure while on active duty in Vietnam. During the current appeal, the Veteran has been diagnosed with essential tremors. Although he has never been formally diagnosed with Parkinson's disease, the May 2019 VA examiner indicated that the Veteran's symptoms were consistent with essential tremors with only mild equivocal parkinsonism. At a February 2021 VA examination, the examiner diagnosed essential tremors. The examiner explained that, while essential tremors usually go away with rest, tremors associated with Parkinson's are usually seen at rest. Essential tremors in about half of the population are due to a genetic mutation. It is an autosomal dominant disorder, and only one parent is needed to pass the defective gene. The examiner acknowledged that neither of the Veteran parents had tremors and explained that, while the Veteran had exposure to herbicides during service, he (the examiner) was unable to find any clinically relevant or reliable literature supporting that the Veteran's essential tremors were related to his exposure to herbicide agents. The Board notes that effective January 1, 2021, the National Defense Authorization Act for Fiscal Year 2021 added parkinsonism to 38 U.S.C. § 1116 (a)(2) as a condition presumed to be caused by in-service herbicide agent exposure. Parkinsonism is defined as "a group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity." Dorland's Illustrated Medical Dictionary, 1383 (32nd ed. 2012). In this regard, a remand is required for a medical opinion addressing whether the Veteran's essential tremor constitutes parkinsonism for the purposes of applying the presumptive service connection principles under 38 U.S.C. § 1116. While the May 2019 VA examiner diagnosed essential tremors with mild equivocal parkinsonism, a definite diagnosis has yet to be given. If it is determined that the Veteran's disability qualifies as parkinsonism, then the principals of presumptive service connection will apply. If it is determined that the essential tremors do not qualify as parkinsonism, the Veteran may still be awarded service connection if the in-service herbicide agent exposure directly caused the essential tremors. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Accordingly, on remand, a VA medical opinion addressing these theories of entitlement should be obtained. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any non-VA neurologists who provided treatment for his tremors from December 2018 to the present, including the provider who administered a scan in January 2019. Make two requests for the authorized records from the identified providers unless it is clear after the first request that a second request would be futile. 2. After Item (1) has been completed to the extent possible, send the Veteran's claims file to an appropriate VA clinician for a medical opinion regarding the Veteran's claim for service connection for tremors. The examiner should address the following: (a.) Provide an opinion as to whether the Veteran's disability qualifies as parkinsonism, or Parkinson's disease. (b.) If no, provide an opinion as to whether the Veteran's essential tremors had onset during or are otherwise related to service, to include the conceded herbicide agent exposure. For any opinion provided, the examiner should provide a complete rationale. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. J. Smith Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. R. Bobb, 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.