Citation Nr: 22016111 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 17-13 109 DATE: March 21, 2022 ORDER Entitlement to service connection for bilateral hand tremors is granted. FINDING OF FACT The Veteran's hand tremors are etiologically related to active-duty service. CONCLUSION OF LAW The criteria for service connection for bilateral hand tremors have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1990 to September 2009. This appeal comes to the Board of Veterans' Appeals (Board) from a February 2014 rating decision of the Department of Veterans Affairs (VA) regional office. The Veteran testified at a hearing with the undersigned in October 2021. Entitlement to service connection for bilateral hand tremors Generally, direct service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004). Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). The Veteran asserts her bilateral hand tremors are due to her active service. During the hearing with the undersigned the Veteran stated her bilateral hand tremors began during her active service, did not exist prior to service, and have continuously been present since leaving service. The Veteran is diagnosed with essential tremors. The Veteran's service treatment records (STRs) reflect she was treated for seizures and show a history of loss of feeling and tingling of hands. In the hearing with the undersigned the Veteran described how while on a work visit to Korea she suffered from a seizure. The Veteran reported that around two weeks after returning from this trip she went to her primary doctors at the Pentagon and the examiner noted the Veteran had hand tremors. The Veteran has submitted several buddy statements that speak to the nature of the Veteran's hand tremors. One such individual is a retired US Army Colonel who was present with her when she suffered her seizure in Korea. The Colonel recounted the event and stated she has suffered from tremors ever since. Another buddy statement attests he has known the Veteran since August 2005. This individual states he immediately noticed the Veteran's tremors in her hands and that it could be so severe that during formal presentations and briefings, this individual would assist her by holding the laser pointer. Another buddy statement provides evidence of the Veteran's hand tremors while deployed to Iraq. This individual reflects that they first noticed the Veteran's hand shaking before deployment, especially while signing documents. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159(a)(2). The Veteran's fellow service members are competent to report what they witnessed, and the Veteran is competent to report her observable symptoms. The Board finds the Veteran's fellow service members' very specific accounts credible and probative. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds no reason to doubt the credibility of the Veteran's or fellow service members' reports. The record shows that since the Veteran's discharge, the Veteran has made consistent and numerous complaints of her hand tremors and stated on multiple occasions the tremors began in active service. She has credibly and competently made statements regarding her hand tremors. The Veteran and the lay witnesses have competently and credibly described symptoms that later resulted in a diagnosis of essential tremors by a medical professional. Further, medical professionals have noted the Veteran's hand tremors. Lay evidence can be competent and sufficient evidence of a diagnosis or to establish etiology if lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In August 2013 the Veteran was afforded a VA examination. There the Veteran was diagnosed with essential tremors of the bilateral hands. The examiner provided a date of diagnosis of "during service." The Veteran reported the tremor onset was in 2005/2006, and that the tremors come and go. The examiner concluded the Veteran's tremors were less likely than not proximately due to or the result of the Veteran's service-connected conditions of traumatic brain injury (TBI) and/or neuro-cardiogenic syncope. The examiner stated that the Veteran has a positive family history of essential tremors and that tremors are not caused by or related to the service-connected neuro-cardiogenic syncope and or a TBI. However, this examination's rationale is inadequate because did not explain how the Veteran's hand tremors were not caused or aggravated by the Veteran's traumatic brain injury. As such it is not probative. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical opinion obtains probative weight from "factually accurate, fully articulated, sound reasoning for the conclusion"). A December 2016 TBI examination attributes the Veteran's "tremors of hands" to the TBI but provides no rationale for this opinion. No opinion has been provided on direct service connection. However, the Board finds no further development necessary because the evidence clearly shows this disability "was incurred coincident with service." 38 C.F.R. 3.303(a). There is no competent or credible evidence refuting the positive evidence that the tremor began on active duty and has continued to the present day. Thus, the most probative nexus evidence supports the Veteran's claim. Finding the Veteran has established all three elements of service connection, the Board grants entitlement to service connection for bilateral hand tremors. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Brewer, 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.