Citation Nr: 22015577 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 16-13 027 DATE: March 18, 2022 REMANDED Entitlement to service connection for essential tremors, to include as due to herbicide exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from December 1968 to September 1972 and May 1983 to December 1988. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded for further development in March 2021 and November 2021. The matters return for appellate consideration. Entitlement to service connection for essential tremors is remanded. The Veteran contends that his essential tremor is related to service, to include as due to herbicide exposure. Pursuant to the November 2021 Board remand, a December 2021 VA addendum opinion was obtained. The examiner provided a positive nexus opinion and concluded that the Veteran's essential tremor is a symptom of Parkinson's disease, which is an illness the VA associates with herbicide exposure, and at least as likely as not the Veteran's essential tremor is proximately due to his herbicide exposure. In support, the examiner cited to medical literature explaining the mechanisms of Parkinson's disease as a central nervous system disorder that affects muscle movement and discussed early signs and symptoms to include tremors. The Board finds the December 2021 VA opinion is inadequate and that a clarification of diagnosis is needed. Namely, the December 2021 VA examiner associates the Veteran's essential tremor as a sign/symptom of Parkinson's disease as a basis for presumptive service connection, but the April 2021 VA examiner explicitly states that, while essential tremors can be a trait of Parkinson's disease, the Veteran does not have a diagnosis for Parkinson's disease. Therefore, it is unclear to the Board whether the Veteran ultimately has Parkinson's disease with early onset symptoms of essential tremors, or whether the December 2021 VA examiner simply associates the essential tremor with that of Parkinson's disease and finding a causal connection to herbicide exposure as a basis for presumptive service connection. As noted in the November 2021 Board remand, the NDAA 2021 has added three disorders to the list of diseases presumptively associated with exposure to herbicide agents. Specifically, it amended 38 U.S.C. § 1116 (a)(2) to include parkinsonism, bladder cancer, and hypothyroidism. The Veteran has a diagnosis of essential tremor and verified service in the Republic of Vietnam. Therefore, it is imperative for the Board to determine whether the Veteran actually has a diagnosis for Parkinson's disease or rather a symptom that mimics Parkinson's disease. As such, an addendum opinion is requested to determine the nature and etiology of the Veteran's essential tremor, to include whether he has an actual diagnosis for Parkinson's disease. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from the December 2021 VA examiner, or another qualified clinician, to determine the nature and etiology of the Veteran's essential tremor. The claims folder and a copy of this remand in its entirety must be provided to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay statements; the examiner must indicate on the report that such review was undertaken. The examiner is asked to determine whether the Veteran has a diagnosis of Parkinson's disease based on signs and symptoms of essential tremor, or whether the Veteran's essential tremor is a standalone diagnosis that mimics traits of Parkinson's disease. The examiner should also reconcile the April 2021 VA examiner's findings for symptoms of essential tremors as traits of Parkinson's disease but that a diagnosis for Parkinson's disease was not made. If the examiner determines that a diagnosis for Parkinson's disease is not warranted, the examiner is asked to determine whether it is at least as likely as not (approximately 50 percent probability or greater) that the Veteran's essential tremor is related to service, to include as due herbicide exposure. The examiner should note that a finding of essential tremor as a symptom of Parkinson's disease, without a diagnosis for Parkinson's disease, is not a basis for establishing presumptive service connection pursuant to 38 C.F.R. § 3.309. The examiner must provide a rationale in support of all opinions provided. If any opinion cannot be provided without resorting to speculation, the examiner must explain why this is so. 2. Then, readjudicate the Veteran's claim on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided a supplemental statement of the case. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.