Challenge your clinical expertise with “What’s Your TCVM Diagnosis” for an 18-year-old Quarter Horse gelding presented with progressive behavioral changes characterized by easily startled responses (i.e. spooky) over a two-month period? The current owner would like to use the horse as a school mount but finds the behavior of the horse is making the horse progressively unrideable. Read through the clinical history, conventional and TCVM physical findings and answer the questions posed to the reader at the end of these findings. The TCVM pattern diagnoses are then presented along with TCVM treatment strategy, the horse’s constitution and clinical outcome of this equine case.