Citation Nr: 19192565 Decision Date: 12/10/19 Archive Date: 12/10/19 DOCKET NO. 14-24 633A DATE: December 10, 2019 REMANDED Entitlement to an initial rating in excess of 10 percent for blepharospasm is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1973 to February 1975, from December 1997 to September 1998, and from October 2004 to January 2006. The Veteran appeared at a March 2016 hearing before the Board of Veterans’ Appeals (Board) by videoconference. A transcript of that hearing is of record. 1. Entitlement to an initial rating in excess of 10 percent for blepharospasm is remanded. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. § 4.1, 4.2 (2017); Schafrath v. Derwinski, 1 Vet. App. 589 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran’s blepharospasm is rated by analogy as a compulsive tic under. A mild tic is rated 0 percent, a moderate tic is rated 10 percent, and a severe tic is rated the maximum available rating of 30 percent. 38 C.F.R. § 4.124a, Diagnostic Code 8103; Pierce v. Principi, 18 Vet. App. 440 (2004). The Note to Diagnostic Code 8103 directs the Board to assign a rating depending upon the frequency, severity, and muscle groups involved. The words mild, moderate, and severe are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. The Veteran underwent VA examination in May 2014. That report mentions treatment for the blepharospasms at the Hines Veterans Affairs Medical Center (VAMC). Those treatment reports are not of record. The Veteran indicated that his eyelid spasm causes a loss of peripheral vision which affects driving. The examiner noted functional impact of blepharospasms as fatiguability when reading for a length of time. On VA examination of February 2019, the Veteran indicated a long history of left eye twitching and closure which occurred randomly and was caused by stress. Spasms were reported as controlled with BOTOX, with continuous injections required. The examiner indicated that the disorder affected the Veteran’s ability to work because a closed eye, during a spasm, interfered with reading and driving. The examiner did not address the frequency or severity of spasms or any associated loss of peripheral vision. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). Clinical documentation of the Veteran's cardiovascular treatment after May 2017 is not of record. The matters are REMANDED for the following action: 1. Obtain all relevant, outstanding private and VA treatment records, to include records from Hines VA Medical Center. 2. Schedule the Veteran for a VA examination to determine the current severity of his service-connected left blepharospasm. The examiner must review the claims file and should note that review in the report. All pertinent symptomatology and findings must be reported in detail to include frequency of spasms, duration of episodes of spasms, and any effect on peripheral vision. If further testing is needed to determine the effect on peripheral vision, that testing should be conducted. Any other indicated diagnostic tests and studies should be performed. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Duke, 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.