Citation Nr: 22003403 Decision Date: 01/24/22 Archive Date: 01/24/22 DOCKET NO. 20-07 793 DATE: January 24, 2022 REMANDED Service connection for tremors is remanded. Service connection for a left shoulder disability is remanded. Service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to August 1969. These matters come before the Board of Veterans Appeals (Board) on appeal from May 2018 and December 2018 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Board remanded the claims for additional development and it now returns for further appellate review. Tremors Remand is required to obtain an adequate VA opinion regarding the etiology of the Veteran's diagnosed tremors and service. Pursuant to the November 2020 board remand, an October 2021 VA opinion was obtained. The examiner indicated there is no diagnosis of Parkinson's or Parkinson's-like" tremors and determined that no opinion could be provided. However, the VA treatment records beginning in 2018 show numerous neurological consultations and treatment for essential tremors, with the possibility of early onset of Parkinson's disease. Notably, an April 2019 VA treatment note indicates "essential tremor/mostly action tremor but gradually worsening resting component over the yrs and consideration given to emerging Parkinson's, but tremor may also be worsened by his inhalers." Additionally, a February 2020 VA treatment note indicates "Hyperkinetic syndrome/essential tremor along with resting component suggesting possibility of mixed tremor as well; unable to exclude early PD but this seems less likely." Although the evidence does not contain an actual diagnosis of Parkinson's disease, the evidence clearly shows diagnoses of tremors. As such, a VA opinion regarding the diagnosed tremors and their relationship, if any, to service is required. Left shoulder Right shoulder Regarding the left shoulder disability, remand is required to obtain an adequate VA opinion as the Board finds that the agency of original jurisdiction (AOJ) did not substantially comply with the November 2020 Board directives. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a Board remand confers a right on a claimant to compliance with the remand order). In this regard, noting the history of left shoulder pain on the Veteran's September 1966 entrance examination, the Board directed the RO to obtain a VA opinion that opined whether the Veteran's left shoulder disability pre-existed service and if so, if it was aggravated. The October 2021 VA examiner did not provide such an opinion. Additionally, remand is required because during the October 2021 VA examination, the Veteran noted that he was being treated for left shoulder bursitis by an orthopedic specialist in Corpus Christi. These records should be obtained and associated with the record. Regarding the right shoulder disability, remand is required because the October 2021 VA examiner noted the Veteran's right shoulder was an "unclaimed damaged joint" and did not provide findings or an opinion regarding the right shoulder. Upon remand, an opinion regarding the etiology of the Veteran's right shoulder disability is required. The matters are REMANDED for the following action: 1. Obtain updated VA and private medical records, to include medical treatment records from the identified orthopedic specialist in Corpus Christi, Texas. 2. Upon completion of directive #1, schedule the Veteran for a VA examination with an appropriate clinician to determine the etiology of the diagnosed tremor disability. The entire claims file and a copy of this remand should be made available to the examiner for review, and such review should be noted in the examination report. All necessary tests and studies should be conducted. Thereafter, the examiner should provide an opinion whether it is at least as likely as not (50 percent or greater probability), that the Veteran's current tremor disability was incurred in, caused by or is otherwise related to any in-service disease, event, or injury, to include conceded herbicide exposure. 3. Upon completion of directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the etiologies of his left and right shoulder disabilities and provide responses to the following inquiries: (a) Identify all left and right shoulder conditions present since the date of the claim (i.e., since February 2018). If the Veteran's left and/or right shoulder pain cannot be attributed to an underlying diagnosis (e.g., arthritis), please still address whether any left and/or right shoulder pain confirmed to exist manifests in functional impairment such as limitation of motion, weakness, instability, or the like and causes impairment of his earning capacity to, in turn, be considered the functional equivalent of a ratable disability, even absent an underlying diagnosis. (b) If it is determined the Veteran has a current left shoulder disability (or has at some point since or contemporaneous to the filing of this claim in February 2018), did it clearly and unmistakably (obviously or manifestly) exist prior to his entrance into service? If it did, was it also clearly and unmistakably (obviously or manifestly) NOT aggravated during or by his service (meaning not worsened at all or, if worsened, not beyond the condition's natural progression)? (c) If the VA examiner concludes instead there is no clear and unmistakable evidence that the Veteran's left shoulder condition existed prior to his service and was not aggravated by his service, is it at least as likely as not (a 50 percent or greater probability) that his left shoulder disability alternatively began during his service, or, if involving arthritis, manifested to a compensable degree within a year of his discharge from service, or is otherwise related or attributable to his service? (d) Is it at least as likely as not (a 50 percent or greater probability) that his right shoulder disability alternatively began during his service, or, if involving arthritis, manifested to a compensable degree within a year of his discharge from service, or is otherwise related or attributable to his service? JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hemphill 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.