Citation Nr: 1304141 Decision Date: 02/06/13 Archive Date: 02/19/13 DOCKET NO. 09-01 966 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for peripheral neuropathy (previously classified as an unspecified neurological disorder). 2. Entitlement to service connection for diabetes mellitus, previously classified as an unspecified endocrine system disorder. 3. Entitlement to service connection for residuals of mouth trauma. 4. Entitlement to a compensable rating for the service-connected left ear hearing loss. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD D. M. Casula, Counsel INTRODUCTION The Veteran had active service from June 1969 to June 1971, including serving in the Republic of Vietnam from November 1969 to October 1970. This matter comes before the Board of Veterans' Appeals (Board), in part, from a November 2006 rating decision by the above Regional Office (RO) of the Department of Veterans Affairs (VA) which denied service connection for a severe nerve condition; found that new and material evidence had not been submitted to reopen the claim for service connection for Agent Orange; and denied a compensable rating for the service-connected left ear hearing loss. This matter further comes before the Board from an April 2010 rating decision in which the RO denied service connection for mouth trauma. In September 2012, the Veteran testified at a hearing at the RO before the undersigned Veterans Law Judge. At the hearing, the claim for service connection for residuals of Agent Orange, was essentially revised to be considered as a claim for service connection for diabetes mellitus, previously classified as an unspecified endocrine system disorder. At the hearing, the claim for service connection for residuals of Agent Orange was basically noted to have been considered by the RO as an endocrine system disorder, which would encompass diabetes mellitus. Based on this finding, and the Veteran's assertion that he had been diagnosed with diabetes mellitus, at the hearing, the issue on appeal was considered to be a claim for service connection for diabetes mellitus. However, even though at the September 2012 hearing the issue on appeal was characterized as entitlement to service connection for diabetes mellitus, the record reflects that this claim was initially denied in a September 2008 rating decision, which became final. Thereafter, the Veteran attempted to reopen the claim, but by an April 2010 rating decision, the RO found that new and material evidence had not been submitted to reopen the claim of entitlement to service connection for diabetes mellitus. The Veteran did not appeal that decision and it became final. As such, the claim on appeal has been recategorized as whether new and material evidence has been received to reopen the claim for service connection for diabetes mellitus. Having reopened the claim below, and having previously considered the claim on the merits, the Board has jurisdiction to review the issue de novo, based on the whole record. The Board also notes that by March 2012, a total rating based on individual unemployability due to service-connected disability (TDIU rating) was granted to the Veteran, effective from May 13, 2010. The issue of entitlement to a compensable rating for left ear hearing loss is addressed in the REMAND portion of the decision below and is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. The competent and probative medical evidence of record preponderates against a finding that the Veteran has peripheral neuropathy that may be related to his active military service; in addition, peripheral neuropathy was not manifested within one year after his active military service 2. The evidence of record shows that the Veteran served in the Republic of Vietnam during the Vietnam War Era; thus, his exposure to Agent Orange is presumed. 3. The competent medical evidence of record reveals that the Veteran has been diagnosed as having diabetes mellitus, type 2, which is controlled by diet and present to a compensable degree. 4. The preponderance of the evidence is against a finding that the Veteran received mouth or dental trauma, to include loss of teeth, during active military service. CONCLUSIONS OF LAW 1. The Veteran's peripheral neuropathy was not incurred in or aggravated by military service, and may not be presumed to have been so incurred. 38 U.S.C.A. § 1110 (West 2002); 38 C.F.R. § 3.303 (2012). 2. Diabetes mellitus is presumed to have been incurred in service. 38 U.S.C.A. §§ 1110 1116 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2012). 3. Service connection for mouth trauma and/or a dental disability for VA compensation purposes is not warranted. 38 U.S.C.A. §§ 1110, 1712 (West 2002); 38 C.F.R. §§ 3.381, 4.150, 17.161 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board has thoroughly reviewed all the evidence in the Veteran's claims folder. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000). I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating a claim for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1), as amended, 73 Fed. Reg. 23,353 (April 30, 2008). This notice must be provided prior to an initial decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The VCAA notice requirements apply to all five elements of a service connection claim: (1) veteran status; (2) existence of disability; (3) connection between service and the disability; (4) degree of disability; and (5) effective date of benefits where a claim is granted. Dingess v. Nicholson, 19 Vet. App. 473, 484 (2006). If complete notice is not provided until after the initial adjudication, such a timing error can be cured by subsequent legally adequate VCAA notice, followed by readjudication of the claim, as in a Statement of the Case (SOC) or Supplemental SOC (SSOC). Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any such defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317, 1323-24 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that any error in VCAA notice should be presumed prejudicial, and that VA bears the burden of proving that such an error did not cause harm. Sanders v. Nicholson, 487 F.3d 881 ( Fed. Cir. 2007). However, the U.S. Supreme Court reversed that decision, finding it unlawful in light of 38 U.S.C.A. § 7261(b)(2). The Supreme Court held that - except for cases in which VA failed to meet the first requirement of 38 C.F.R. § 3.159(b) by not informing the claimant of the information and evidence necessary to substantiate the claim - the burden of proving harmful error rests with the party raising the issue, the Federal Circuit's presumption of prejudicial error imposed an unreasonable evidentiary burden upon VA and encouraged abuse of the judicial process, and determinations on the issue of harmless error should be made on a case-by-case basis. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). In this case, the VCAA duty to notify was satisfied by way of letters sent to the Veteran in July 2005, March 2010, April 2010, and May 2010, that fully addressed the notice elements in this matter. These letters informed the Veteran of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. The Board also notes that in the aforementioned letters dated in March 2010, April 2010, and May 2010, the RO advised the Veteran of how disability ratings and effective dates are assigned. See Dingess v. Nicholson, supra. Moreover, he has not demonstrated any error in VCAA notice, and therefore the presumption of prejudicial error as to such notice does not arise in this case. See Sanders v. Nicholson, supra. Thus, the Board concludes that all required notice has been given to the Veteran. The Board notes that the Veteran was not scheduled for a VA examination to determine whether he has peripheral neuropathy that may be related to service. Pursuant to 38 C.F.R. § 3.159(c)(4), VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service. The third part could be satisfied by competent evidence showing post- service treatment for a condition or other possible association with military service. As delineated in 38 C.F.R. § 3.159(c)(4), a VA examination to address the question of etiology as related to service is required when the Veteran presents a claim for service connection in which there was a pertinent event, injury, or disease in service; there is evidence of current disability; the medical evidence of record does not contain sufficient competent medical evidence to decide the claim; and the Veteran indicates that the claimed disability or symptoms may be associated with service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). With regard to the claim for service connection for peripheral neuropathy, the Board finds that there is arguably competent medical evidence of current disability - at least at some point during the appeal. McClain v. Nicholson, 21 Vet. App. 319 (2007). There is, however, no competent medical evidence of record (other than the Veteran's lay assertions) showing that his peripheral neuropathy, may be related to service. And although the Veteran has basically contended that his peripheral neuropathy is related to service, his lay statements alone are not competent evidence to support a finding on a medical question (such as diagnosis or etiology) requiring special experience or special knowledge. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992). As explained below, the Veteran's own assertions as to his peripheral neuropathy and the relationship to service have been inconsistent and insufficiently specific. Thus, a VA examination on this issue is not necessary or warranted. The Board also finds VA has satisfied its duty to assist the Veteran in the development of the claim. The RO has obtained all identified and available service and post-service treatment records for the Veteran. As noted above, a VA examination for the claim for service connection for peripheral neuropathy was deemed not necessary or warranted. Thus, it appears that all obtainable evidence identified by the Veteran relative to his claim has been obtained and associated with the claims folder, and that neither he nor his representative has identified any other pertinent evidence, not already of record, which would need to be obtained for a fair disposition of this appeal. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, supra. The Board concludes that VA has satisfied its duty to assist the Veteran in apprising him as to the evidence needed, and in obtaining evidence pertinent to his claims under the VCAA. No useful purpose would be served in remanding this matter for yet more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefit flowing to the Veteran. The United States Court of Appeals for Veterans Claims (Court) has held that such remands are to be avoided. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). II. Service Connection Claims Service connection may be granted for disability which is the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, there must be medical evidence of a (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). Additionally, for veteran's who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including diabetes mellitus and organic diseases of the nervous system, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases, to include Type 2 diabetes (i.e., diabetes mellitus) and acute and subacute peripheral neuropathy, shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even if there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset. Id., note 2. Veterans who served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to establish that a Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307. VA has determined that a presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for any condition for which VA has not specifically determined a presumption of service connection is warranted. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that when a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Medical evidence is generally required to establish a medical diagnosis or to address questions of medical causation; lay assertions of medical status do not constitute competent medical evidence for these purposes. Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). However, lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). 1. Peripheral Neuropathy Although the Veteran initially referred to this as a severe nerve condition, and the claim was considered as one for an unspecified neurological problem disorder, at the hearing in September 2012, the issue was clarified as entitlement to service connection for peripheral neuropathy. Thus, the Veteran essentially contends that he has peripheral neuropathy that is related to his active service. A review of the history of this matter shows that in a November 1991 VA treatment record, it was noted that the Veteran was seen for complaints of numbness in his left leg and arm for about a month. He reported he had been seen before for this, but it was not getting better and was mostly in his lower legs and toes. In December 1991, he was again seen for complaints of progressive numbness of the left and left foot, that increased in at night, and occurred three to four times a week, and lasted for hours. The assessment was intermittent neuropraxia. By February 1992 rating decision, the RO denied entitlement to service connection for weakness and numbness in the left side. Received from the Veteran in August 2003 was a claim for compensation for several disabilities, including a "severe nerve condition". Thereafter, in August 2003, received from the Veteran was a notice of disagreement (with a prior RO decision) in which he indicated he was appealing the "decisions made by the board", including a severe nerve condition. In that regard, a prior RO rating decision, dated in August 2000, had denied service connection for posttraumatic stress disorder (PTSD), and an RO rating decision, dated in February 2003, had found that new and material evidence had not been submitted to reopen the claim for service connection for PTSD; however, neither RO decision had addressed the issue of entitlement to service connection for a "severe nerve condition". VA treatment records showed that on October 14, 2003, the Veteran was seen for triage for complaints of pain in his legs, with the left upper thigh being worse. He reported it was as if there was a heating pad on his thigh, and he also had increased pain with standing for periods of time. He reported that the pain/burning in his left thigh was constant and had an onset one year prior. The Veteran was triaged to a primary care provider who indicated that the Veteran was seen for complaints of burning pain along the top of his left thigh. The assessment included peripheral neuropathy in distribution of femoral cutaneous, probably secondary to obesity. Weight loss was recommended, as well as a trial of the medication Elavil. Later in October 2003, the Veteran was seen in the mental health clinic and the assessment included an Axis III diagnosis of peripheral neuropathy. A statement of the case (SOC) was issued in October 2004, and, therein, the RO only addressed the issue of entitlement to service connection for PTSD, and did not specifically consider entitlement to service connection for a severe nerve condition. The Veteran did not file a timely substantive appeal (VA Form 9); thus the RO's prior decision was final. A VA treatment record dated in December 2004 included an assessment of peripheral neuropathy which was to be treated with Elavil, and weight loss was recommended to help the "sup fem cutaneous neuropathy". Received from the Veteran in April 2005 was a letter in which he discussed the issues he was appealing to VA as including psychiatric disabilities (i.e., chronic depression, adjustment disorder, etc.) and various psychiatric manifestations/symptoms (i.e., suicidal ideation, crying spells, etc.). In a subsequent rating decision dated in November 2006, the RO denied service connection for a severe nerve condition, based on a finding that the medical evidence of record failed to show that this disability had been clinically diagnosed. In November 2006, the RO also reopened the claim for service connection for PTSD, and, after considering the claim on the merits, the RO denied entitlement to service connection for PTSD. The Veteran filed a notice of disagreement as to both the PTSD claim and the severe nerve condition claim. In a statement received in November 2007, the Veteran claimed he had been diagnosed with PTSD and a "nerve condition". On a VA treatment record dated in December 2007, the Veteran's active medical problem list included idiopathic peripheral neuropathy, NOS, and this entry was noted to have been last modified on October 14, 2003. A VA treatment record dated in February 2008, showed that the Veteran's extremities were examined and revealed no clubbing, cyanosis, or edema, and normal peripheral pulses. In June 2008, the Veteran's active problem list again included idiopathic peripheral neuropathy, NOS, and the entry was last modified on October 14, 2003. A VA treatment record dated in July 2009 showed that the Veteran was seen for a cardiac rehabilitation consultation, and he was noted to have several medical problems, including peripheral neuropathy. In September 2009, peripheral neuropathy was again listed as an active chronic medical problem for the Veteran. In May 2010, the Veteran was seen for follow up for earlier complaints of pain in his big toes for the past 3 to 4 months. His chronic medical problems were noted to include peripheral neuropathy. Examination of his extremities revealed normal peripheral pulses, and equal bilaterally. His neurological status was noted to be non focal, and deep tendon reflexes were within normal limits. The impressions included peripheral neuropathy, and the examiner noted that the Veteran's vitamin B12 and folate levels would be checked, and that he would be observed for now. In December 2010, he was seen for follow, and reported tingling pain in his left great toe, for which he had been seen by podiatry. Examination of his extremities was negative and his neurological status was also negative. The impressions again included peripheral neuropathy, and the Veteran's vitamin B12 and folate levels would be checked and he would be observed for now. On a VA examination in June 2011, the Veteran reported having leg cramping/pain in the thighs after walking 2 yards on level ground at 2 miles per hour, and that the cramping and pain are relieved by rest. He reported calf pain at rest, and that he felt persistent coldness in the extremities. It was also noted that the Veteran reported the following nerve problems: tingling, numbness, and loss of sensation in the "legs, thigh" and neuralgia in the neck, feet, and toes. For the diagnoses, it was noted that for the Veteran's claimed condition of peripheral vascular disease of the lower extremities, there was no diagnosis because there was no pathology on which to render a diagnosis. It was also noted that there were no findings of secondary complications related to the Veteran's peripheral arteries, peripheral edema, or the neurological system. VA treatment records showed that in June 2011, the Veteran was seen for follow-up, and his neurologic system as grossly intact and he had a normal gait. The impressions included peripheral neuropathy, stable, follow up by podiatry. In September 2012, the Veteran testified that he had been diagnosed with peripheral neuropathy in 2003, and that he took medication for it. He described his symptoms as a bad burning sensation in his thighs and lower legs from prolonged standing, and numbness in his arms and fingers. With regard to the Veteran's claim for service connection for peripheral neuropathy, which had been previously classified as an unspecified neurological disorder), and the need for a current disability to be shown, the Board notes that there is competent medical evidence of record showing that the Veteran was diagnosed with and treated for peripheral neuropathy, including in 2003 and 2010. Thus, the record reflects that the Veteran arguably currently has peripheral neuropathy. The Court has held that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). Service treatment records (STRs) are negative for complaints, findings, or treatment of peripheral neuropathy. What is missing in this case is competent medical evidence linking the Veteran's peripheral neuropathy to service. To that end, the Veteran has submitted no competent medical evidence linking his peripheral neuropathy to service. While VA treatment records do show that the Veteran was treated for peripheral neuropathy, such records show that he was first seen for this in 2003, at which time the diagnosis was peripheral neuropathy in distribution of femoral cutaneous, probably secondary to obesity. Thereafter, he was noted to have a history of idiopathic peripheral neuropathy, and another notation shows that he was again specifically treated for peripheral neuropathy of the lower extremities in 2010. At no time, however, has the Veteran's peripheral neuropathy been medically linked to service. Thus, as noted above, what is missing from the record is competent evidence showing that the Veteran's peripheral neuropathy may be causally related to active service. 38 C.F.R. § 3.303. The Board does not here question the Veteran's assertions that he has subjectively felt numbness and pain in the extremities, and acknowledges that he is competent to report his observations and symptoms. However, with regard to any lay assertions by the Veteran that his peripheral neuropathy may be related to service, there is no competent medical evidence of record which reasonably supports this assertion, and there is no indication that the Veteran has the requisite knowledge of medical principles which would permit the rendering of an opinion regarding matters involving medical diagnosis or etiological cause. Espiritu v. Derwinski, supra. As noted above, lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation, but the diagnostic and nexus aspects as to whether peripheral neuropathy may be related to service clearly requires the expertise of a medical professional, and are not susceptible of lay determination. 38 U.S.C.A. § 1153(a) ; 38 C.F.R. §§3.159 , 3.303(a); Jandreau v. Nicholson, supra; Buchanan v. Nicholson, supra. Without competent medical evidence linking current peripheral neuropathy to service, entitlement to service connection is not warranted. The preponderance of the evidence is therefore against the claim for service connection for peripheral neuropathy, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Diabetes Mellitus The Veteran contends that he has diabetes mellitus which is related to his presumed exposure to herbicides during his service in Vietnam. As noted above, if a veteran was exposed to a herbicide agent during active military, naval, or air service, diabetes mellitus shall be service-connected if there is competent evidence that the diabetes mellitus became manifest to a degree of 10 percent or more any time after service. See 38 C.F.R. § 3.307(a)(6)(ii). Pursuant to 38 C.F.R. § 4.119, Diagnostic Code 7913, a 10 percent evaluation is warranted where the diabetes mellitus is manageable by restricted diet only. A review of the competent evidence of record tends to show that the Veteran has diabetes mellitus that has manifested to a degree of 10 percent or more after service. VA treatment records dated as recent as May 2010, showed that the Veteran was initially diagnosed with pre-diabetes, diet controlled. In a statement dated in November 2010, completed by the Veteran's VA physician, it was noted that he had been diagnosed with diabetes mellitus (Type II, adult onset), which was manageable by a restricted diet only, but which also had caused visual and cardiovascular complications. Subsequent VA treatment records dated in 2011 showed that the Veteran continued to receive treatment for his diabetes mellitus, and that he was referred to as being diabetic. Thus, because the competent evidence of record reveals that the Veteran has been diagnosed as having diabetes mellitus, type 2, and has been advised of the importance of following a diabetic diet and regular exercise, the Board finds that the Veteran's diabetes mellitus has clearly become manifest to a degree of 10 percent or more since military service. As the Veteran has been diagnosed as having diabetes mellitus, which has manifested to a degree of 10 percent or more, and he was exposed to herbicides in the Vietnam, service connection for this disability is granted on a presumptive basis. 38 U.S.C.A. §§ 1110, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309(e). 3. Residuals of Mouth Trauma The Veteran essentially claims that he sustained trauma to his mouth during service. Based upon his pleadings and testimony, and the fact that he Veteran is eligible for VA outpatient dental treatment, due to his entitlement to a 100 percent rating by reason of the TDIU rating, the Board finds that his claim is for service connection for mouth trauma for compensation purposes only. a. Factual Background STRs show that on a dental examination conducted in conjunction with his separation examination in May 1971, it was noted that the Veteran had several missing teeth. By way of history, the Board notes that in September 1971, the Veteran filed an application for medical benefits (VA Form 10-10) for outpatient dental treatment. Therein, he responded "yes" to the question of whether the dental condition was caused by an injury in service, and "no" to the question of whether any teeth were extracted during service. He also indicated that in April 1969, in Vietnam, he was hit in the mouth with the butt of a machine gun. In a deferred rating decision, dated in February 1972, the RO noted that there were incomplete health records, that the Veteran was just back from Vietnam, and that his records had not caught up with him. Another effort was to be made to secure his records, to include all dental treatment records, including the treatment in April 1969 when the Veteran was hit in the mouth with the butt of a machine gun. Thereafter, a Request for Information (VA Form 07-3101) was made for the Veteran's dental enlistment examination and records of all treatment, including treatment in April 1969 when the Veteran was hit in the mouth with the butt of a machine gun. In a response dated in June 1972, the Adjutant General indicated that there were no additional dental records found on file. In a dental rating sheet (VA Form 21-564d), dated in July 1972, the Veteran's claim was denied, for outpatient treatment only, based on a finding that there was "no dental trauma" Received from the Veteran in February 1991, was a statement (VA Form 21-4138) in which he, in pertinent part, indicated he would like to amend his service-connected claim to include a dental injury/trauma which was reportedly sustained in Vietnam. He indicated that in the latter part of 1970 or early 1971, he was stationed at Ben Luc, Vietnam, and his unit came under mortar fire and while they were seeking shelter he was hit in the mouth with the butt of a machine gun. He claimed that the gun knocked out his front teeth and that he also lost a couple of jaw teeth. He claimed he lost a total of four teeth in this mishap, and that VA had already replaced one of his front teeth. In a rating decision dated in March 1991, which was apparently a "deferred" rating decision, the RO indicated, "Please note that dental rating of 7-6-72 found no evidence of dental trauma". In a VA discharge summary, it was noted that the Veteran underwent tooth extraction of tooth #26 on September 24, 1991. Received from the Veteran's representative in October 1991, was a statement (VA Form 21-4138) in which the representative indicated that in February 1991 the Veteran presented to their office and requested that his claim be amended to include dental trauma. The representative noted that the Veteran reportedly lost several teeth while in Vietnam, when he was hit in the mouth with the butt of a machine gun. The representative further indicated that although the Veteran had an audiological examination in April 1991, nothing had been done about his request for evaluation of dental trauma suffered while in service. The representative requested that the Veteran be scheduled for this examination as soon as possible, since he continued to suffer with dental problems as a result of this injury. Received from the Veteran in August 2005 was a stressor statement, in support of another service connection claim, in which he describes an incident in November 1969, while he was in Cam Ranh Bay, and there was a mortar attack at the fuel depot. He reported they were put on "red alert" and he was assigned to a guard tower, watching over the perimeter, when a mortar exploded by the tower (which was 50 to 60 feet tall) and caused it to fall to the ground. The Veteran claimed that he jumped out to the ground and took cover. He described his feelings after that, but made no mention of any mouth or dental injury or trauma. In a statement dated in April 2010, the Veteran claimed that when he was in Vietnam, he had serious trauma to his teeth. He claimed he lost some of his teeth while in service, and that when he came home he was sent to a private dentist but the problem still existed. In a letter dated in April 2010, the Veteran indicated that he had severe trauma to his mouth, resulting in lost teeth. He claimed that when he got out of service, he was sent to a private dentist to fix them, but that he was still having serious teeth problems. He claimed he had tried to get help from VA to have his mouth repaired, but had not received help. By April 2010 rating decision, the RO denied service connection for mouth trauma, essentially based on a finding that STRs, including dental records, were negative for mouth trauma, but did show evidence of missing teeth, and that the Veteran's separation examination in March 1971 showed a normal mouth examination. The RO further noted that service connection for mouth trauma was denied because the medical evidence of record failed to show that this disability had been clinically diagnosed. In a statement dated in May 2010, the Veteran indicated his mouth trauma occurred at Bayloc Pass, Camp Smith, during support for the 572 Engineering battalion, and that it happened at "Bazar" on the other side of "Song Dong, on the Q'Nai River Q'L 20 and Q'L1". The Veteran claimed that this was where he lost his teeth. In September 2012, the Veteran testified that he injured his mouth in Vietnam. He claimed that he was in guard tower in the ammo dump at Cam Ranh Bay, and there were under mortar and sniper attacks, when the tower he was in was hit and tipped over and he fell out and across a piece of wood and "ripped" and "busted" his mouth, causing him to lose some top teeth. He testified that the top teeth were put back in permanent, and that his bottom teeth were very loose and they were rewired. He testified he went to sick call, and then to the infirmary the night the accident happened, and that he received sutures in his mouth. He claimed that his teeth were not repaired by VA, but rather he was sent to a private dentist who repaired his teeth and put in the brace for his bottom dentures to hold those teeth in place. He testified that that came out after many years and started giving him problems. He testified that "after VA had pulled a couple of teeth from abscesses and . . . before [he] received [his] percentage to be able to go get dental care", his mouth looked really bad, so he went ahead and had a plate made. Under questioning, he clarified that his mouth trauma in service was from a board, that he had bleeding from the mouth, that his teeth were broken off, that one particular (front upper) tooth was pulled, and that the bottom teeth were knocked loose and wired, but that he did not need any stitches. He testified that later, after service, his bottom teeth were pulled, but that his bottom teeth were messed up because of the trauma in service. b. Analysis The record reflects that the Veteran initially contended in (in September 1971 and February 1991) that he sustained mouth/dental trauma in service when he was hit in the mouth by the butt of a machine gun. He later contended (in September 2012) that he sustained mouth/dental trauma in service when he fell out of a tower that collapsed and hit his mouth on a piece of word (a board). He contends he was treated in service after this accident, and also received treatment from a private dentist, after service. Service connection for compensation purposes can only be established for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus and loss of a portion of the maxilla. Compensation is available for loss of teeth only if due to loss of substance of the body of the maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of teeth, bone loss through trauma or disease such as to osteomyelitis must be shown for purposes of compensability. The loss of the alveolar process as a result of periodontal disease is not considered disabling. 38 C.F.R. § 4.150, DC 9913, Note (2012). It should be noted that for the purposes of determining whether a veteran has treatment eligibility, the term "service trauma" does not include the intended effects of treatment provided during the Veteran's military service. The regulations are intended to cover dental trauma involving external, sudden-force injury, such as a combat wound to the teeth and jaw. VAOPGCPREC 5-97 (1997); see also Nielson v. Shinseki, 23 Vet. App. 56, 60-61 (2009). A review of the Veteran's STRs show no evidence that the Veteran complained of or sought treatment for trauma to the mouth during service, to include lost, loose, or broken teeth. His separation examination revealed he had several missing teeth, but there was no evidence showing any such teeth were was lost due trauma. Additionally, the evidence of record does not show that the Veteran has a compensable dental disability. Notably, he has not submitted any competent evidence showing that he suffers from any of the disabilities included under 38 C.F.R. § 4.150. Moreover, although the Veteran has recently contended he received dental trauma/injuries to include loss of teeth from an in-service injury, he has provided two different stories as to the source of the injury - one being hit in the mouth with the butt of a machine gun and the second falling onto a wooden board. He has also indicated he has had a continuity of dental problems since the injury in service. In that regard, the Veteran is competent to report observable symptoms, such as broken teeth, loose teeth, and subsequent teeth/mouth problems. See Layno v. Brown, 6 Vet. App. 465, 470 (1994); 38 C.F.R. § 3.159(a)(2). However, the Board finds that the Veteran's statements with regard to his in-service trauma are not credible as the record contains conflicting lay and medical evidence. As noted above, the Veteran has provided two different and conflicting stories as to the source of his reported in-service mouth trauma. Additionally, STRs show no report of or treatment for mouth or dental injury/trauma, and subsequent to service, there is no competent and credible medical evidence of record indicating that the Veteran has current dental problems are a result of any dental trauma that occurred during active service. The Board acknowledges that the Veteran contends his current dental problems are related to mouth trauma that occurred during military service, however, the Veteran, as a layperson, is not competent to provide statements and/or testimony regarding the etiology of his claimed dental disorder. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). Simply put, the Veteran's statements that his current dental problems are related to active military service, to include in-service mouth/dental trauma, have no probative value because lay persons are not competent to offer medical opinions as to specific diagnoses that require special knowledge. Based on the foregoing, the Board finds that the preponderance of the evidence shows that the Veteran did not experience loss of teeth due to loss of substance of the maxilla or mandible due to any in-service dental trauma or disease. Additionally, his report of in-service trauma is not credible. Thus, service connection may not be established for compensation purposes for missing or damaged teeth, or periodontal disease under 38 C.F.R. § 4.150. The Board also notes that absent a demonstration of dental trauma, service connection may not be considered for compensation purposes, but service connection may be considered solely for the purpose of determining entitlement to dental examinations or outpatient dental treatment. See Woodson v. Brown, 8 Vet. App. 352, 354 (1995). Additionally, the Court has held that a claim for service connection for dental compensation is also a claim for service connection for outpatient dental treatment purposes. Mays v. Brown, 5 Vet. App. 302 (1993). As noted above, however, for VA dental treatment purposes, the Veteran is entitled to a 100 percent rating by reason of his TDIU rating, and based o his testimony in September 2012, he has received his "percentage to be able to go get dental care". Thus, herein, the Board need not consider whether he is entitled to service connection for VA outpatient dental treatment purposes. 38 C.F.R. § 17.161 ORDER Service connection for peripheral neuropathy is denied. Service connection for diabetes mellitus is granted. Service connection for a dental or mouth trauma for VA compensation purposes is denied. REMAND The Veteran essentially contends he should be entitled to a compensable rating for his service-connected left ear hearing loss. At the hearing in September 2012, the basically contended that his hearing loss had worsened since his last VA audiological examination, which the record reflects was in 2008. The United States Court of Appeals for Veterans Claims (Court) has held that where a veteran claims that a disability is worse than when originally rated, and the available evidence is too old to adequately evaluate the current state of the condition, VA must provide a new examination. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). Given the above, the Board finds that further VA audiological examination of the Veteran is required in order to properly decide this appeal. Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for a VA audiological examination to determine the current severity of his left ear hearing loss. The claims folder must be made available to, and reviewed by, the examiner. Any indicated tests should be accomplished. The examiner is requested to fully describe the functional effects caused by the Veteran's left ear hearing loss disability. The examiner should also obtain the Veteran's auditory thresholds at frequencies of 1000, 2000, 3000, and 4000 Hertz , as well as speech recognition scores based on the Maryland CNC tests. The examiner must explain the rationale for any opinion(s) given, and if unable to provide opinions without resorting to speculation, it should be so stated and explained why this is so. 2. Thereafter, readjudicate the issue on appeal. If any benefit sought on appeal is not granted to the Veteran's satisfaction, he and his representative should be provided with a supplemental statement of the case and afforded the opportunity to respond thereto. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). ______________________________________________ ROBERT E. SULLIVAN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs