VA Disability for Essential Tremor

Essential Tremor Explained

Generally speaking, essential tremor is a neurological disorder that causes involuntary and rhythmic shaking.  Essential tremor can affect almost any part of an individual’s body, but the trembling occurs most often in the hands, particularly when completing tasks that require fine motor skills (e.g., drinking from a glass, tying shoelaces).

While essential tremor is not usually dangerous, it does tend to worsen over time and can become severe in some individuals.  Importantly, essential tremor is not caused by other conditions and can occur at any age; however, it is most common in people ages 40 and older.  Signs and symptoms of include the following:

• Begin gradually, usually more prominently on one side of the body
• Worsen with movement
• Usually occur in the hands first, affecting one hand or both hands
• Can include a “yes-yes” or “no-no” motion of the head
• May be aggravated by emotional stress, fatigue, caffeine, or temperature extremes

Roughly 50 percent of essential tremor cases appear to result from a genetic mutation, referred to as familial tremor.  However, it is not clear what causes essential tremors in those without a known genetic mutation.

To diagnose essential tremors, medical professionals will typically review an individual’s medical history, family history, and symptoms during a physical examination.  Since there are no medical tests used to diagnose essential tremor, medical professionals must rule out other conditions that could be causing the symptomology.  To do so, doctors may perform the following types of tests: neurological examination, laboratory tests, and performance tests.  Medical professionals may rule out thyroid disease, metabolic problems, drug side effects, or Parkinson’s disease (see below).

Finally, essential tremor does not usually require treatment if the symptoms are mild.  On the other hand, if an individual’s essential tremor is interfering with their ability to perform daily activities, medical professionals may suggest medications and/or physical therapy.  Furthermore, surgery might be an option if an individual’s tremors are severely disabling and they do not respond to the above-mentioned interventions.  Medical professionals may also recommend a variety of lifestyle changes to help reduce or relive tremors, including avoiding caffeine, using alcohol sparingly, and utilizing relaxation techniques.

Essential Tremor vs. Parkinson’s Disease

Oftentimes, essential tremor is associated with Parkinson’s disease; however, the two conditions differ in several significant ways:

• Timing of tremors – essential tremor of the hands usually occurs when an individual uses their hands to perform a task whereas Parkinson’s-related tremors typically occur when an individual’s hands are at their sides or resting on their lap.
• Associated conditions – essential tremor does not cause other health problems whereas Parkinson’s disease is associated with stooped posture, slow movement, and shuffling gait.
• Parts of the body affected – essential tremor mainly involves an individual’s hands, head, and voice; however, Parkinson’s disease tremors usually start in the hands, but can also affect the legs and other parts of the body.

Service Connection for Essential Tremor

To establish service connection for essential tremors on a direct basis, veterans must demonstrate the following to VA:

• A current diagnosis of essential tremors:
• An in-service event, injury, or illness; and
• A medical nexus linking the current diagnosis of essential tremor to the in-service event, injury, or illness.

It may be difficult to establish the medical nexus seeing as there are not many known causes of essential tremors.  Nonetheless, it is possible when including the proper research and medical literature relevant to the veteran’s claim.

Additionally, it is possible for a veteran to obtain service connection based on aggravation if they had essential tremors prior to entering service.  In this case, the veteran would have to prove that their pre-existing essential tremor was made worse, beyond the natural progression of the condition, as a result of their time in service.  This type of service connection represents alternative avenue to receiving VA disability benefits for essential tremor.

How VA Rates Essential Tremors

VA rates essential tremors according to 38 CFR § 4.124a, Schedule of Ratings – Neurological Conditions and Convulsive Disorders – Diagnostic Code 8515.  The rating criteria, based on “paralysis of,” are as follows:

• 70/60% – complete; the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances
• 50/40% – incomplete severe
• 30/20% – incomplete moderate
• 10/10% – incomplete mild

Importantly, the higher evaluation is given when the paralysis, or essential tremors, affects the dominant arm, hand, etc.

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