Citation Nr: 22051174 Decision Date: 09/08/22 Archive Date: 09/08/22 DOCKET NO. 15-06 609A DATE: September 8, 2022 ORDER Entitlement to service connection for a disorder manifested by shakiness, twitches, tics, and other seizure-type symptoms, claimed as secondary to medications taken for service-connected posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT The Veteran has provided competent and credible evidence that he has a current disorder manifested by shakiness, twitches, tics, and other seizure-type symptoms, and a VA expert has opined that these symptoms are likely to be related to the Veteran's psychiatric medications. CONCLUSION OF LAW The criteria for service connection for a disorder manifested by shakiness, twitches, tics, and other seizure-type symptoms, as secondary to service-connected PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.310 (2021). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from October 1984 to February 1985 and from November 1990 to September 1991. In January 2018, the Veteran testified before the undersigned at a Board of Veterans' Appeals (Board) videoconference hearing. A transcript of the hearing is of record. The Board remanded this matter for evidentiary development in June 2018, October 2019, and August 2020. Entitlement to service connection for a disorder manifested by shakiness, twitches, tics, and other seizure-type symptoms, to include as secondary to service-connected PTSD The Veteran contends that he has a current disorder manifested by shakiness, twitches, tics, and other seizure-type symptoms, which are side effects of psychiatric medications prescribed for his service-connected PTSD. For the following reasons, the Board agrees that service connection is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). At the outset, the Board acknowledges that the relevant evidence of record includes several VA medical opinions, all of which reflect negative nexus opinions as to whether the Veteran's has a current diagnosis related to his claimed symptoms. In prior remands, the Board determined these opinions were inadequate, largely because they did not take into account the Veteran's descriptions of his symptoms nor VA medical records documenting his history of seizure disorder. In its most recent remand, from August 2020, the Board requested that a VA physician opine as to whether the Veteran suffers from a "neurological disorder that is related to service or is due to medication for service-connected PTSD," to include a discussion of the Veteran's competent lay descriptions of his symptoms. A VA medical opinion was obtained in February 2022, with an addendum provided in April 2022. The addendum reflects that the examiner reviewed the record and, in line with prior opinions on the subject, was unable to find that the Veteran had a diagnosis of nerve damage. The examiner noted that while a seizure disorder was listed as an active issue and the Veteran had described symptoms of shakiness, twitches, tics, and seizures, there was no evidence of treatment for or diagnosis of a seizure disorder. The examiner went on, however, acknowledging that certain medications that had been prescribed for the Veteran's psychiatric disorder (specifically Risperdal and Loxapine) were known to have potential side effects, although rare, of dyskinesia, characterized by abnormal muscle movements; unusual, slowed, or uncontrollable movements of any part of the body; and uncontrollable, rhythmic face, mouth, or jaw movementssymptoms that basically mirror what the Veteran is claiming in his appeal. The examiner noted, however, that the Veteran had been tested for dyskinesia multiple times and was found to be negative for the condition. On the other hand, the Veteran had reported during a mental health examination that his symptoms occurred more often at night. The examiner acknowledged that symptoms associated with tardive dyskinesia were usually mild but "intensify during periods of stress" and often went away during sleep. Based on the above, the examiner stated that she could not opine that the medications the Veteran takes for his PTSD caused his claimed disorder. This case presents a conundrum in that the Veteran has not formally been diagnosed for the symptoms he consistently claims to experience. At the same time, he has competently and credibly described symptoms that seem to mirror those of tardive dyskinesia, which, as the April 2022 VA opinion discussed above notes, is a known side effect of the Veteran's psychiatric medications. Furthermore, the April 2022 opinion states that tardive dyskinesia is characterized by generally mild symptoms that intensify during periods of stress. It therefore appears to be plausible to conclude that the Veteran's symptoms were latent during testing and that they tend to flare up or intensify during periods when he is not under the supervision of VA medical personnel. The Veteran is competent to report symptoms that he has observed. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). There is no reason to doubt that he experiences symptoms of shakiness, twitches, tics, and other seizure-type symptoms, despite the lack of a formal diagnosis. See, e.g., Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (2018) (symptoms such as pain may qualify as a disability for VA compensation purposes even without an underlying diagnosis provided they cause functional impairment). These symptoms have been medically linked to psychiatric medications which he has been prescribed. In light of this evidence, the Board will apply the "benefit of the doubt" doctrine in finding that the Veteran's claimed symptoms (1) exist, and (2) are reasonably likely to be a side effect of medications taken for his service-connected PTSD. See 38 U.S.C. § 5107(b). Accordingly, his claim is granted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Minot, 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.