Citation Nr: 23049929
Decision Date: 09/09/23 Archive Date: 09/09/23
DOCKET NO. 18-23 786
DATE: September 9, 2023
REMANDED
Entitlement to service connection for a dental condition (claimed as deterioration of bottom teeth, gums and jawline) is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Air Force from August 1972 to July 1973.
The Veteran presented sworn testimony before the undersigned at a January 2022 videoconference hearing, and a copy of the transcript of this hearing is of record.
In August 2022, the Board remanded the issue of entitlement to a compensable rating for hammer toe of the second toe of the left foot. In a subsequent February 2023 decision, the Board granted a 10 percent rating for left foot hammer toe of the second toe. The Veteran did not appeal that decision. It is no longer before the Board.
Regarding the Veteran's for entitlement to service connection for a dental condition, the Board denied this claim in an August 2022 decision. In November 2022, the United States Court of Appeals for Veterans Claims ("CAVC" or "the Court") issued an Order granting a March 2023 Joint Motion for Partial Remand (JMPR) and remanded the above issue to the Board. The JMPR found the August 2022 Board decision, the Board erred by providing an inadequate statement of reasons or bases for its determinations under the requirements of 38 U.S.C. § 7104(d)(1), by not ensuring that the Department of Veterans Affairs (VA) complied with its duty to assist under the requirements of 38 U.S.C. § 5103A and 38 C.F.R. § 3.159(c) to provide a medical opinion that is adequate for rating purposes, and by not ensuring that VA complied with its duty to assist regarding treatment records.
Entitlement to service connection for a dental condition (claimed as deterioration of bottom teeth, gums and jawline) is remanded.
The Veteran seeks service connection for a dental condition that he states began during service and has continued since that time. Specifically, during the January 2022 Board hearing, the Veteran testified that he has had dental pain and deterioration since his 1972 in-service oral surgery, to include the teeth extraction of teeth number 1, 16, 17 and 27 and the removal of the odontoma associated with tooth number 27.
The Board notes that the Veteran was afforded a VA examination in April 2017. The examiner diagnosed periodontal disease but concluded that "[p]eriodontal disease is not considered a compensable disability for VA adjudication purposes and is not among the non-compensable service-connected dental disabilities for which outpatient dental treatment may be authorized."
The examiner noted that a panoramic x-ray revealed "chronic generalized severe periodontitis." The April 2017 VA examiner opinion is inadequate for rating purposes. The April 2017 examiner opined that the Veteran's oral surgery of removal of odontoma and impacted teeth is not likely to have caused 'deterioration of the bottom of teeth, gums and jaw line.' There is no history of why other teeth were lost and would be mere speculation for me to say cause of loss of teeth." In rendering her opinion, the examiner stated that she could not opine as to the cause of loss of teeth without resorting to mere speculation, the examiner did not explain the basis for her inability to do so. The examiner did not provide an opinion as to whether Veteran's current dental conditions are etiologically related to his in-service diagnosis of gingivitis. The Board notes the Veteran was diagnosed with acute necrotizing ulcerative gingivitis. Therefore, remand is warranted to determine whether the Veteran's current dental conditions are etiologically related to service, to include an in -service diagnosis of gingivitis.
A remand is warranted in order for the RO to undertake the appropriate development and adjudication with respect to the Veteran's claim of entitlement to service connection for a dental disability, both for disability compensation purposes and for purposes of obtaining VA outpatient treatment. 38 C.F.R. § 20.202; see Mays v. Brown, 5 Vet. App. 302 (1993).
The matters are REMANDED for the following action:
1. Obtain any outstanding VA treatment records and any outstanding private medical records identified by the Veteran as pertinent to his dental condition.
2. Obtain an addendum opinion as to the nature and etiology of the Veteran's dental disorder from a VA examiner different than who provided the April 2017 opinion. The Board will leave it to the medical examiner to determine if a new examination and interview of the Veteran is warranted. Make the Veteran's electronic claims file available to each examiner and ensure that each examiner specifies in the report that it was contemporaneously reviewed. All pertinent symptomatology and findings must be reported. Any indicated special diagnostic tests that are deemed necessary for an accurate assessment must be conducted. Based on review of the appropriate records, the examiner should offer opinions on the following questions:
Is it as likely as not that the Veteran's current dental disorder(s) was incurred in or caused by his active service, to include as due to his in-service diagnosis of gingivitis?
Please review and/or address the following:
" March 2017 positive nexus opinion.
" The Veterans oral surgery during service.
" The Veterans in-service diagnosis of gingivitis.
What is the most likely etiology of each current dental disorder?
In so doing, the appropriate examiner must specifically consider and discuss the Veteran's lay statements as to the onset and course of symptoms.
The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached.
David Gratz
Veterans Law Judge
Board of Veterans' Appeals
Attorney for the Board Jordan, Jacquelynn
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.