Citation Nr: 21022077 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-61 106 DATE: April 14, 2021 REMANDED Entitlement to a compensable rating for lid myokymia is remanded. Entitlement to service connection for adrenal adenoma, to include as secondary to service connected hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1981 to May 2011 and from August 1974 to April 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters previously came before the Board in November 2019, whereupon the claims were denied. The Veteran subsequently appealed these claims to the United States Court of Appeals for Veterans Claims (Court); whereupon the Board’s November 2019 decision was vacated on a Joint Motion for Remand, agreed to by both the Veteran and VA. The matters have now returned before the Board for further appellate action. 1. Entitlement to a compensable rating for lid myokymia is remanded. The Veteran was provided a VA examination in April 2015 to assess the severity of the Veteran’s myokymia. The examiner discussed the onset, progression, and current symptomatology of the Veteran’s myokymia. The examiner noted that the condition had manifested in 2009 as eyelid twitching and had uncontrolled hypokalemia and hypertension. The Veteran was found to have adrenal adenoma which was removed in 2014, and the twitching subsequently resolved. In the November 2020 Joint Motion for Remand, the parties agreed that the April 2015 VA examination was inadequate. Specifically, the April 2015 VA examiner provided only a conclusory statement that the Veteran's myokymia had resolved after the August 2014 surgery, without any further detail, to include how or when it resolved. As such, remand for a new VA examination is necessary in order to determine whether the Veteran’s myokymia has resolved, when it resolved and how it resolved. 2. Entitlement to service connection for adrenal adenoma is remanded. An April 2015 VA examiner opined that it is less likely than not (less than 50 percent probability) that the Veteran’s adrenal adenoma was proximately due to or the result of his service-connected hypertension. The examiner supported his opinion with the rationale that instead of the hypertension causing the adrenal adenoma, rather the adrenal adenoma was causing the hypertension. In the November 2020 Joint Motion for Remand, the parties agreed that the Board did not properly address whether direct service connection had been raised. An April 2015 VA examiner opined that the Veteran’s service-connected hypertension, which was diagnosed in 1997, was caused by adrenal adenoma. As such, direct service connection was raised by the record. On remand, an addendum opinion addressing this theory should be obtained. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, schedule the Veteran for an examination to determine the current severity of his lid myokymia. All pertinent evidence should be made available to and reviewed by the examiner. The need for further in-person examination is left to the discretion of the examiner. The examiner must make all findings relative to rating the Veteran's lid myokymia. Specifically, the examiner should address whether the Veteran’s condition has indeed resolved, and if so, how and when. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion as to the Veteran’s claimed hypertension. The examiner should review the claims file and provide an addendum opinion. The need for further physical examination is left to the discretion of the examiner. The examiner should answer the following question: Is at least as likely as not (50 percent or better probability) that the diagnosed adrenal adenoma had its onset during service or was caused by service? The examiner should specifically address the April 2015 VA examiner's findings that the Veteran's hypertension, which was diagnosed during service in 1997, was caused by an adrenal adenoma. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.