Citation Nr: 21063736 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-61 106 DATE: October 15, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for service-connected bilateral eyelid myokymia, residual hypokalemia, is denied. FINDING OF FACT Throughout the period on appeal, the Veteran's myokymia is shown to cause no more than moderate eyelid twitching. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for service-connected bilateral eyelid myokymia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124(a), Diagnostic Code 8103. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1981 to May 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In a November 2019 decision, the Board denied the issue on appeal. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a November 2020 Order, the Court remanded the claim to the Board for actions consistent with a November 2020 Joint Motion for Remand (JMR) filed by the parties. The issue of entitlement to an increased rating for service-connected myokymia was most recently before the Board in April 2021 when it was remanded for additional development along with the issue of entitlement to service connection for adrenal adenoma. In a July 2021 rating decision, the RO granted service connection for adrenal adenoma and increased the Veteran's disability rating to 10 percent for his service-connected myokymia. As a partial increase is not a full grant of the benefit sought, the increased rating issue has returned to the Board. The Veteran is notified that he has one year from notification of a RO decision to initiate an appeal. Entitlement to a disability rating in excess of 10 percent for service-connected bilateral eyelid myokymia, residual hypokalemia A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Currently, the Veteran's bilateral eyelid myokymia is rated 10 percent disabling pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8199-8103. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned. See 38 C.F.R. § 4.27. An unlisted disease, injury, or residual condition is rated by analogy with the first two digits selected from that part of the rating schedule that most closely identifies the part or system of the body involved; the last two digits will be 99 for all unlisted conditions. Myokymia is not listed in the rating schedule. In this case, 8199 refers to neurological conditions and convulsive disorders, while 8103 refers to the convulsive tic diagnostic code. The Board finds the use of the hyphenated Diagnostic Code 8199-8103 to be appropriate as the symptoms of the Veteran's myokymia are most analogous to a rating via the criteria for a convulsive tic in Diagnostic Code 8103. The Board finds that there is no other, relevant diagnostic code that would be more appropriate for rating the Veteran's condition, nor has the Veteran so alleged. Pursuant to Diagnostic Code 8103, a mild disability warrants a 0 percent rating, a moderate disability warrants a 10 percent rating, and a severe disability warrants a 30 percent rating. The Note to Diagnostic Code 8103 directs the Board to assign a disability rating depending upon the frequency, severity, and muscle groups involved. 38 C.F.R. § 4.124a. The Board acknowledges that 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. Turning to the evidence of record, in September 2014, the Veteran indicated that he had a medication change related to the increased severity of his hypokalemia and myokymia. The Veteran was afforded a VA examination in April 2015. At that time, the Veteran stated that he developed eye twitching in 2009 that resolved after his adrenal adenoma was removed in 2014. He denied taking medication for his myokymia. In his September 2015 notice of disagreement, the Veteran stated that he had moderate tics caused by his myokymia. The Veteran was afforded an additional VA examination in July 2021. At that time, the Veteran reported intermittent twitching of both eyelids, the left more than the right. He continued to take a daily potassium supplement since his left adrenal adenoma resection. The examiner stated that the left myokymia caused no functional limitation and that the condition was unchanged since August 2015. After a review of the above, the Board finds the Veteran's service-connected myokymia was manifested by no more than moderate convulsive tics of the eyelid at any time during the appeal period. Indeed, neither VA examiner found objective evidence of a convulsive tic and the July 2021 VA examiner even stated that the condition caused "no functional limitation." The Board has carefully considered the Veteran's statements regarding the severity of his disability. The Veteran described his myokymia as causing "intermittent" eye twitching and described the symptoms as "moderate". He is certainly competent to describe the physical manifestations of his disability and the Board finds his statements to be credible and consistent with the VA examination reports. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Indeed, the medical evidence largely contemplates the Veteran's descriptions of his symptoms. The lay testimony has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. Therefore, the Board finds the Veteran's myokymia to be no more than moderate in nature, manifested by subjective reports of intermittent eye twitching which the Veteran himself has described as "moderate" in severity, matching the level of severity compensated by the 10 percent rating as discussed above. These movements have not been shown to affect any other part of the Veteran's body and the overall evidence does not indicate the Veteran's disability has resulted in any significant functional loss. As such, the disability cannot be classified as more than moderate in nature, and a rating in excess of 10 percent is not warranted. The claim must be denied. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Connor, 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.