Citation Nr: 22019985 Decision Date: 04/03/22 Archive Date: 04/03/22 DOCKET NO. 18-04 600 DATE: April 3, 2022 REMANDED Entitlement to service connection for an essential tremor is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to July 1970. This case is before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision by the VARO. In September 2020, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In May 2021, the Board remanded this issue and the issues of entitlement to service connection for diabetic peripheral neuropathy of right and left upper extremities for additional development. In a November 2021 rating decision, the RO, in part, granted service connection diabetic peripheral neuropathy of right and left upper extremities. As a result, these issues are no longer before the Board. The Board finds that more development is necessary prior to final adjudication of the claim on appeal. The Board notes that VA is obligated to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A (d) (2012). The threshold for finding a link between current disability and disease or injury in service is low. McLendon v. Nicholson, 20 Vet. App. 79 (2006). As noted in the May 2021 Board remand, the Veteran testified during the September 2020 hearing that his treating physician thought that his essential tremor is related to his diabetes mellitus type II. The Veteran notably underwent a VA examination in June 2016 where the examiner opined that it was less likely than not that the Veteran's claimed essential tremor disability was related to his type II diabetes mellitus disability as essential tremors was a distinct condition and not a sequelae of diabetes. However, the examiner did not address whether the Veteran's service-connected type II diabetes mellitus disability has aggravated his essential tremor disability. As such the Board finds that the evidence currently of record is insufficient to resolve the claim for an essential tremor disability and that further medical clarification in connection with this claim is warranted to determine whether the Veteran's current essential tremors disability was caused or aggravated by a service-connected type II diabetes mellitus disability. The Board additionally notes that the Veteran also underwent a VA examination in October 2017 where the examiner opined that it was less likely than not that the Veteran's essential tremors were incurred in or caused by the claimed in-service event, injury or illness. However, the examiner also noted that 50 percent of essential tremors are familiar and this appeared to be the case with the Veteran has a 2005 private physician indicated that the Veteran reported that these tremors were present prior to service (in childhood) when he was excited. While the examiner found that such excitement related triggering of symptoms did not alter the longer term course of the condition, she did not specifically opine as to whether the Veteran's essential tremors preexisted service and if so, were they not aggravated beyond their natural progression during service. A pre-existing injury or disease will be considered to have been aggravated by active military, naval or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). As a result, the Board finds that further development is warranted so an examiner can provide an opinion to determine whether the Veteran has a current essential tremor disability, that is related to his service and as to whether any essential tremor disability that preexisted his service was not aggravated beyond its natural progression during service. See 38 U.S.C. § 1153 (2012) (providing that a pre-existing disease or injury will be considered to have been aggravated by active service where there is an increase in disability during service absent a finding that the increase was due to the natural progress of the disease). The matters are REMANDED for the following action: 1. The Veteran should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated her for the disability on appeal. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. 2. Schedule the Veteran for a VA examination to determine the etiology of the claimed essential tremor disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. After the record review and examination of the Veteran, the VA examiner should determine: (i) Does the Veteran have a current essential tremor disability? (ii) If so, is it at least as likely as not (50 percent greater probability) that the Veteran currently has a essential tremor disability that is etiologically related to his active service? (iii) Is it clear and unmistakable (undebatable) that the essential tremor disability preexisted the Veteran's enlistment into service? (iv) If so, is it clear and unmistakable (undebatable) that any preexisting essential tremor disability was not permanently aggravated beyond its natural progress during the Veteran's active service? (v) The examiner should also provide an opinion as to whether if it is at least as likely as not (at least a 50 percent probability) that the Veteran has a current essential tremor disability that is caused or aggravated by a service-connected disability (to include type II diabetes mellitus). If the examiner finds that the Veteran has a essential tremor disability that has been permanently aggravated/worsened by a service-connected disability, to the extent feasible, the degree of worsening should be identified. Adequate reasons and bases for any opinion must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination. 3. After completion of the above and any additional development deemed necessary, the issue on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.