Citation Nr: 21029017 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 18-14 561 DATE: May 12, 2021 ORDER Service connection for bilateral arm myoclonus is granted. REMANDED Service connection for posttraumatic stress disorder (PTSD) is remanded. Service connection for an enhanced physiologic tremor is remanded. FINDING OF FACT The Veteran has experienced continuous symptoms of bilateral arm myoclonus dating from within one year of his discharge from service. CONCLUSION OF LAW The criteria for entitlement to service connection for bilateral arm myoclonus are met. 38 U.S.C. §§ 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Marine Corps from June 1978 to January 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision. Notably, the Veteran originally sought service connection for bilateral arm myoclonus. However, his treatment records also show a diagnosis of a tremor. The Board will include this additional diagnosis as part of the original claim. Clemons v. Shinseki, 23 Vet. App. 1 (2009). However, the two conditions have separate etiologies and, therefore, separate dispositions. Service connection for bilateral arm myoclonus Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of bilateral arm myoclonus as evidenced by VA treatment records dated June 2017. As noted by one of his treating physicians in April 2019, myoclonus is a motor or sensory condition of the central nervous system. "Organic disease of the nervous system" is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The Veteran's service treatment records are not available for review. However, his VA treatment records show that he reported the onset of myoclonus symptoms of arm and hand jerking in 1981 shortly after he left the Marines. Although there is no further specificity regarding the exact date of onset, the Board will resolve any doubts in his favor in finding that his symptoms started within one year of his discharge from service. The Board finds that the Veteran credible in his statements that he continued to experience the same symptoms from 1981 onward. His statements are credible and not in conflict with the other evidence of record. Therefore, the evidence establishes that he experienced continuous symptoms of a chronic disease dating back to the one year period following his discharge from service, and service connection is warranted. In making this determination, the Board acknowledges that the Veteran had service at Camp Lejeune and is presumed to have been exposed to the contaminated water supply there. However, contrary to his assertions contained in the claims file, there is no presumption that "neurobehavioral effects" are associated with such exposure, and the Board is not granting service connection for myoclonus based on his exposure. The disabilities which are presumed to be associated with exposure to contaminated water at Camp Lejeune are listed in 38 C.F.R. § 3.309(f). The list includes Parkinson's disease, but VA treatment records from November 2017 specifically show that the Veteran does not have that disease. REASONS FOR REMAND Service connection for PTSD The Veteran contends that he has PTSD as a result of racial and religious discriminiation he experienced during service. VA treatment records show the Veteran received some treatment for symptoms of PTSD. However, it is unclear whether the Veteran has a current diagnosis of PTSD under the DSM-5, and no examiner has specifically opined whether any current PTSD is at least as likely as not related to the discrimination from service. Therefore, a VA examination is warranted. Service connection for an enhanced physiologic tremor VA treatment records from January 2018 and April 2018 reflect a diagnosis of enhanced physiologic tremor, and both entries note that the condition is related to stress. Therefore, the issue of whether the tremor is secondary to the Veteran's claimed PTSD has been raised by the record. An opinion should be obtained on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD). The claims file must be made available to the examiner for review. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to the Veteran's reports of racial and religious discrimination during service. For the purposes of this opinion, the examiner should presume that the Veteran's statements regarding incidents of discrimination in service are credible. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease, to include discrimination during service. A rationale for all opinions must be provided. (Continued on the next page) 2. Obtain a VA opinion from an appropriate clinician regarding whether the Veteran's enhanced physiologic tremor is at least as likely as not proximately due to, or aggravated beyond its natural progression by, a current psychiatric disability, including PTSD. The claims file must be made available to the examiner for review. A rationale for the opinion must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.