Citation Nr: 21004276 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 14-13 059 DATE: January 26, 2021 REMANDED Entitlement to service connection for tardive dyskinesia, claimed as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for tardive dystonia, claimed as secondary to service-connected PTSD is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to June 8, 2018, is remanded. REASONS FOR REMAND The Veteran had active duty service from October 1969 to September 1972 and was honorably discharged. He also served for a later period, but was dishonorably discharged. 1. Entitlement to service connection for tardive dyskinesia, claimed as secondary to service connected posttraumatic stress disorder (PTSD) is remanded. 2. Entitlement to service connection for tardive dystonia, claimed as secondary to service-connected PTSD is remanded. The Veteran contends that his tardive dyskinesia and tardive dystonia are secondary to his service-connected PTSD because the conditions are a side effect of medication that the Veteran receives for hallucinations, which are a symptom of his PTSD. The Veteran received a VA examination in September 2010. The examiner provided the following remarks: Tardive dyskinesia, as least as likely as not a result of medication used to treat manic depressive disorder and not his PTSD; it appears [the Veteran] suffered a temporary exacerbation of some of his PTSD symptoms at a time when he was very depressed and hospitalized with suicidal and homicidal ideations in December ‘09. In support of his claim, the Veteran has submitted a report from his private provider, Dr. B.K., dated December 2010. In the report, the doctor stated that the Veteran’s tardive dystonia and tardive dyskinesia are from medications, including Risperidone, which were prescribed to treat hallucinations stemming from his service-connected PTSD. The doctor included several medical treatment reports as well. Dr. B.K. later submitted a follow-up report in August 2014 that contains more detailed, but similar remarks. An additional medical opinion was obtained in February 2014. The examiner determined that the Veteran’s tardive dystonia and tardive dyskinesia are less likely than not proximately due to or the result of the Veteran’s service-connected PTSD. The examiner provided the following rationale: Tardive dyskinesia (TD) is a hyperkinetic movement disorder that appears with a delayed onset after prolonged use of dopamine receptor blocking agents, mainly the antipsychotic drugs (also called neuroleptics) and the antiemetic drug, metoclopramide. Review of private treatment records show a Mayo Clinic physician gave the opinion the veterans tardive dyskinesia/dystonia was due to respiradone used to treat PTSD. Review of recent medical literature shows the incidence of tardive dyskinsia/dystonia in < 3% at the dose of respiradone the veteran was taking. The veteran does not take Respiradone any longer and has not done so since 2010. It is very unlikely the veteran’s symptoms are due to a drug discontinued many years ago. In a January 2021 Informal Hearing Presentation (IHP), the Veteran and his representative challenged the adequacy of the previous VA opinions, reasoning that there is insufficient rationale and conflicting information. It is also alleged that the Veteran’s medications taken to treat hallucinations were a symptom of his PTSD throughout the entirety of the appeal. Given the above, the Board finds that additional clarification in the form of an addendum opinion would be of considerable assistance in determining the claim. 3. Entitlement to a total disability rating based on individual unemployability prior to June 8, 2018. (TDIU) is remanded. Effective June 8, 2018, a 100 percent schedular rating was assigned. Because a decision on the remanded issues addressed above could significantly impact a decision on the issue of entitlement to a TDIU, including from an earlier time, the issues are inextricably intertwined. A remand of the claim for entitlement to a TDIU is thereby required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following action: 1. Arrange for an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s tardive dyskinesia and tardive dystonia, claimed as secondary to service-connected PTSD. The electronic claims files and all pertinent records must be made available to the examiner and the examiner must indicate in the examination report that these records have been reviewed. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (a) The examiner should offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that tardive dyskinesia and/or tardive dystonia is caused by his service-connected PTSD. In particular, the examiner should comment on whether the conditions are a side effect of medication that the Veteran receives for hallucinations, which are a symptom of his PTSD. (b) That examiner should then opine whether the tardive dyskinesia and/or tardive dystonia is aggravated (i.e., permanently worsened beyond the normal progression of that disease) by his service-PTSD and any associated prescription medication. In offering any opinion, the examiner must consider the full record, to include the lay statements in support of the Veteran’s claim. The examiner should also reconcile any prior report (including the reports from Dr. B.K.), if necessary. The rationale for any opinions offered should be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, then the Veteran should be scheduled for such an examination. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Miller, 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.