Citation Nr: 25002986 Decision Date: 02/28/25 Archive Date: 02/28/25 DOCKET NO. 19-01 230 DATE: February 28, 2025 REMANDED Entitlement to service connection for a condition manifested as facial and neck tics is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1967 to June 1970, to include service in the Republic of Vietnam from May 1968 to May 1969. These matters are before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision. In August 2022 a video conference hearing was held before the undersigned. This matter was remanded in March 2023, November 2023 and June 2024 for additional development. Entitlement to service connection for a condition manifested as facial and neck tics is remanded. Additional development of the record is necessary for the proper adjudication of this claim as there has not been substantial compliance with previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In June 2024, the Board remanded this matter for a medical opinion that identified a diagnosis for the condition manifested by neurologic tics and provided an etiology for the diagnosed medical condition manifested by neurologic tics. Additional develop has indicated that the etiology of the Veteran's observed tics may not be neurologic in nature. Accordingly, the issue has been amended to be a condition manifested as facial and neck tics. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In a July 2024 medical opinion, the clinician opined that it was less likely than not that neurological tics were related to service because the Veteran did not have a diagnosis of neurological tics. In a December 2024 central nervous system examination, it was noted that the Veteran did not have a diagnosed central nervous system condition. In a December 2024 medical opinion, the clinician noted there was insufficient evidence to establish a chronic central nervous system disorder. The clinician noted that on examination the Veteran exhibited involuntary jaw and neck movements and sniffing, which appeared worse when movements were being directly discussed and diminished during periods of concentration on other tasks. The clinician noted that the Veteran "does exhibit both motor and vocal repetitive, involuntary, sudden movements, sniffing, and throat clearing consistent with tics" and went on to state "further evaluation would be needed to determine cause and appropriate treatment." The Veteran has undergone multiple examinations where clinicians have observed the Veteran experiencing tics. However, clinicians have not provided a diagnosis for these present symptoms or conducted adequate testing to evaluate these symptoms. Therefore, unfortunately a remand is necessary in order to obtain adequate diagnostic testing and an adequate opinion in this matter. The matter is REMANDED for the following action: 1. The AOJ should make copies of all pertinent records available to the examiner to conduct an examination and obtain a medical opinion from an appropriate clinician or clinicians regarding the etiology of the Veteran's visible tic condition. Upon examination (TO INCLUDE NECESSARY DIAGNOSTIC STUDIES NECESSARY TO DIAGNOSE THE CAUSE OF THE VETERAN'S FACIAL AND SHOULDER TICS), and review of the record (to include this remand and prior remands, and the Veteran's August 2022 video conference testimony), the clinician must respond to the following: (a.) Identify (by diagnosis) each condition manifested by motor and vocal repetitive, involuntary, sudden movements, sniffing, and throat clearing consistent with tics shown. If a diagnosis cannot be provided, but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner shall consider them a "disability" for the purpose of providing the requested opinion below. (b.) Whether it is as least as likely as not (i.e., is the evidence of record so evenly divided that it is as medically sound to find in favor of the proposition as it is to find against) that the Veteran's various observed tics are caused by service? THE CLINICIAN MUST SPECIFICALLY ADDRESS THE ALLEGATION THAT THE VETERAN'S SYMPTOMS BEGAN JUST AFTER (THE SAME MONTH) THE VETERAN SEPARATED FROM SERVICE. (c.) The clinician must provide a CLEAR, UNDERSTANDABLE, AND COMPLETE RATIONALE for all conclusions reached and any opinion rendered. Medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If the examiner cannot provide an opinion without resort to speculation, he or she must explain why an opinion cannot be provided (e.g., lack of sufficient information or evidence, the limits of medical knowledge, etc.). PAULA B. McCARRON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Staskowski, Nichole 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.