Citation Nr: 1321124 Decision Date: 07/01/13 Archive Date: 07/12/13 DOCKET NO. 06-34 535 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for tinnitus. 3. Entitlement to service connection for residuals of pilonidal cyst surgery, to include pain, bilateral leg numbness and a tender scar. 4. Entitlement to service connection for a dental condition. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Catherine Cykowski, Counsel INTRODUCTION The Veteran had active duty service from November 1955 to November 1958. This matter comes before the Board of Veterans Appeals (Board) on appeal from rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). In September 2009, the Veteran testified at a hearing before a Veterans Law Judge. In April 2013, the Board advised the Veteran that the judge who conducted the hearing was no longer available to consider his appeal. He was advised of his right to another hearing before another Veterans Law Judge. The Veteran did not return a request for another hearing within the 30-day time period specified in the letter. In March 2012, the Board remanded this claim for additional development. The requested development included requesting the Veteran's service treatment records from the National Personnel Records Center and affording the Veteran a VA examination by an ear, nose and throat specialist. The requested development has been completed. The development ordered in the March 2012 remand has been completed. Stegall v. West, 11 Vet. App. 268 (1998). The issue of entitlement to service connection for residuals of pilonidal cyst surgery, to include pain, bilateral leg numbness and a tender scar 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 Veteran experienced acoustic trauma in service. 2. The Veteran did not sustain a disease or injury (other than acoustic trauma) of the bilateral ears in service. 3. Symptoms of bilateral hearing loss were not chronic in service. 4. Symptoms of bilateral hearing loss did not manifest to a compensable degree within one year of separation. 5. Symptoms of bilateral hearing loss have not been continuous since service separation. 6. The Veteran's bilateral hearing is not etiologically related to service. 7. The Veteran's tinnitus is not etiologically related to service. 8. The Veteran does not have a dental disorder that resulted from in-service trauma, and does not otherwise meet the requirements for service connection for the purposes of receiving VA outpatient dental treatment. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss are not met. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385 (2012). 2. The criteria for service connection for tinnitus are not met. 38 U.S.C.A. §§ 1131, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2012). 3. The criteria for service connection for a dental disorder have not been met. 38 U.S.C.A. §§ 1131, 5107 (West 2002); 38 C.F.R. § 3.303, 3.381, 4.150, 17.161 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. VA's Duties to Notify and Assist As provided for by VCAA, VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, 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 in accordance with 38 C.F.R. § 3.159(b)(1). This notice must be provided prior to an initial unfavorable decision on a claim by the AOJ, in this case the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). In Dingess v. Nicholson, 19 Vet. App. 473 (2006), the United States Court of Appeals for Veterans Claims (Court) held that, upon receipt of an application for a service-connection claim, 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b) require VA to review the information and the evidence presented with the claim and to provide the claimant with notice of what information and evidence not previously provided, if any, will assist in substantiating, or is necessary to substantiate, each of the five elements of the claim, including notice of what is required to establish service connection and that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. A March 2003 letter advised the Veteran of the evidence required to substantiate the claim for service connection for a dental condition. A September 2004 informed the Veteran of the evidence required to substantiate the claim for service connection for hearing loss and tinnitus. A July 2009 letter provided notice of how disability ratings and effective dates are determined. VA also has a duty to assist the Veteran in the development of the claims. This duty includes assisting the Veteran in the procurement of service medical records and pertinent treatment records and providing an examination when necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The RO attempted to obtain the Veteran's service treatment records from the National Personnel Records Center (NPRC). In March 2003, it was determined by the NPRC that the records are unavailable due to a fire at that facility in July 1973. A July 2005 memorandum noted that procedures to obtain service treatment records and clinical records for the Veteran were correctly followed and that efforts to obtain the information were exhausted. In December 2012, the RO issued a formal finding of unavailability of service treatment records. The memorandum noted that further attempts to obtain the records would be futile. The Board recognizes that it has a heightened duty to explain its findings and conclusions because of the missing records and to carefully consider the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991); Pruitt v. Derwinski, 2 Vet. App. 83, 85 (1992). The Veteran has been advised of the RO's unsuccessful efforts and was requested to send any pertinent records he had. Thus, the Board concludes that VA's heightened duty to assist the Veteran is satisfied. The Board is also mindful of the heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. The record before the Board includes private treatment records and the Veteran's statements. The Veteran underwent adequate and probative VA examinations for his hearing loss and tinnitus disabilities, and the findings were sufficient to adjudicate his pending service connection claims for these disorders. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Veteran was not afforded a VA examination for his claimed dental disability. The duty to assist requires VA to provide a medical examination or obtain a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C.A. § 5103A(d)(1) (West 2002). An examination or medical opinion is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, a VA examination is not required as the Veteran's disability, which consists of replaceable missing teeth, is not a disability for which compensation may be granted. The Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained the available relevant records, and has provided adequate examinations to the Veteran. Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist the Veteran 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, 16 Vet. App. 183 (2002). II. Analysis of Claims Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship of nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Sensorineural hearing loss is a "chronic disease" listed under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. § 3.303(b) based on chronic symptoms in service and continuous symptoms since service apply to the claim for service connection for bilateral hearing loss. Tinnitus and dental disabilities are not "chronic diseases" listed under § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply to the claims for service connection for tinnitus and a dental condition. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In rendering a decision on appeal the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). Service Connection for Bilateral Hearing Loss and Tinnitus The Veteran asserts that current hearing loss and tinnitus disabilities are related to noise exposure during service. He asserts that he was exposed to anti-aircraft fire and noise from diesel generators during service. In cases involving service connection for hearing loss, impaired hearing will be considered to be a disease when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. With regard to in-service injury or disease, the Board finds that the Veteran is shown to have been exposed to loud noise (acoustic trauma) in service. The Veteran's service occupation was powerman. In his testimony and statements, the Veteran indicated that he worked in power stations where there were loud diesel generators. Accordingly, his exposure to loud noise in service has been demonstrated. In this case, the service treatment records are not available for review. After a review of all of the evidence, lay and medical, the Board finds that bilateral hearing loss was not chronic in service. The history of hearing loss reported by the Veteran in medical records and in statements in support of his claim does not support a finding that a hearing loss disorder was chronic in service. Upon VA examination in December 2008, the Veteran reported that he noticed hearing loss around 1960. At the Board hearing in September 2009, the Veteran testified that he initially noticed hearing loss in 1981. At the VA examination in 2012, he reported that he initially noticed hearing loss in 1981. The Board finds that tinnitus was not manifested in service. The Veteran has not reported a history of tinnitus in service. A private audiological evaluation dated in May 1979 reflects that the Veteran denied tinnitus. At a Board hearing in 2009, the Veteran reported that his tinnitus started when he worked at Columbia Plywood in 1981. Upon VA examination in 2012, the Veteran testified that he noticed tinnitus in 1981. The Board also finds that the weight of the evidence demonstrates that hearing loss did not manifest to a compensable degree within one year of service separation. The Veteran separated from service in November 1958. The evidence demonstrates no hearing loss complaints or symptoms during the one year period after service, and no diagnosis or findings of hearing loss of any severity during the one year post-service presumptive period. See 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100 (2012). For these reasons, the Board finds that hearing loss did not manifest to a compensable degree within one year of service separation; therefore, the presumptive provisions for hearing loss are not applicable in this case. 38 C.F.R. §§ 3.307, 3.309. Next, the Board finds that the weight of the evidence is against a finding of continuity of bilateral hearing loss symptomatology since service. In a written statement dated in December 2008, the Veteran reported that he had hearing problems since discharge from service. The report of the 2012 VA examination reflects that the Veteran has reported the onset of hearing loss symptoms occurred in 1981. Upon VA examination in December 2008, the Veteran reported that he began to notice hearing loss in 1960. Private audiograms performed after service in August 1973, December 1975, December 1976, January 1977, May 1979 and May 1980 reflect normal audiometric findings. The absence of findings of hearing loss in post-service audiology records is one factor that weighs against the claim. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). A private audiological evaluation dated in December 1982 reflects audiometric thresholds which meet the criteria for bilateral hearing loss, as defined by § 3.385. The Board emphasizes that the gap of more than 20 years between discharge from active duty service and initial findings of hearing loss weighs against the claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board's denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability). Therefore, based on the evidence which reflects that there were no complaints or findings regarding hearing loss in several post-service audiometric evaluations prior to 1982 and that the Veteran has provided inconsistent statements regarding the onset of hearing loss symptoms, the Board finds that the continuity of hearing loss symptomatology since service is not demonstrated. The Board next finds that the weight of the evidence demonstrates that bilateral hearing loss and tinnitus are not related to service. In December 2008, the Veteran had a VA examination. The examination report reflects that the claims file was not available for the VA examiner's review. The Veteran's chief complaints were tinnitus and hearing loss. The Veteran reported that he began to notice hearing loss around 1960. The Veteran reported that his military noise exposure included machine guns, generator noise in a small room and some small caliber rifles. He reported that his other noise exposures included work as an electrician, in which he used hearing protection. The Veteran reported occasional hunting with hearing protection. The VA examiner opined that the sensorineural component of the Veteran's hearing loss is at least as likely as not (50/50 probability) caused by or a result of military noise exposure. The VA examiner opined that tinnitus is at least as likely as not caused by or the result of military noise exposure. The VA examiner stated that there is a conductive component bilaterally, and this is very likely not related to military service. The VA examiner recommended an ENT consult to explore the cause of bilateral conductive component and abnormal tympanograms. In February 2009, the audiologist who performed the December 2008 VA examination reviewed the claims file and provided an addendum opinion. The VA examiner opined that hearing loss and tinnitus are less likely than not caused by noise exposure during military service. The VA examiner stated that, although there are no service medical records available, there are multiple serial pure tone audiograms done by the Veteran's employers from August 1973 throug the 1990's. The VA examiner noted that the first two audiograms, provided by Weyerhauser, revealed borderline normal to mild hearing loss at 4000 and 6000 Hertz (August 1973 and October 1974). The VA examiner stated that it is possible, but unlikely, that this mild loss was related to military service, as the Veteran served in the military from 1955 to 1958, 15-18 years before the initial industrial audiogram was administered. The VA examiner stated that, additionally, the Veteran did not begin to perceive hearing loss until about 1960, after the conclusion of his military service. The VA examiner noted that there is no evidence in the claims file that the Veteran's hearing levels were within normal limits at the time of separation from the military. Therefore, a relationship between the Veteran's hearing loss and military service cannot be completely ruled out. With regard to tinnitus, the VA examiner noted that the Veteran reported that his awareness of tinnitus began about August 1981. The VA examiner noted that this would be more than 23 years after service. The VA examiner opined that it is therefore unlikely that tinnitus is related to military service. The VA examiner noted that the December 2008 hearing evaluation revealed a conductive component in both ears, as well as abnormal tympanograms. The VA examiner indicated that these findings suggest a need for medical referral. In October 2012, the Veteran had a VA examination by an ENT specialist. The Veteran reported that he had a subjective problem with understanding singing after leaving the military. The Veteran reported that he began to notice definite hearing loss and tinnitus shortly after starting to work for Columbia Plywood in 1981. The VA examiner diagnosed mixed hearing loss, both ears, with a pattern typical for noise-induced hearing loss. The VA examiner noted that the Veteran's records show audiograms from 1975 to 1980 which were all essentially normal. The VA examiner noted that the Veteran reported that he noticed hearing loss and tinnitus within 3 months of starting work for Columbia Plywood in 1981. The VA examiner observed that an audiogram done in December 1982 clearly showed a pattern indicating a noise-induced hearing loss by that time. The VA examiner noted that a threshold pattern on an audiogram in October 2012 appeared to show a conductive component in the lower frequencies and a moderate to severe mixed hearing loss in the mid and high frequencies. The VA examiner summarized that the Veteran had normal audiograms through 1980. The VA examiner noted that, by his own admission, hearing loss and tinnitus became noticeable within 3 months of beginning work at a plywood company in 1981. It was noted that, on his first audiogram following this, in December 1982, he had evidence of a noise-induced hearing loss. The VA examiner noted, before starting work at Columbia Plywood, the Veteran's hearing was within normal limits. Shortly after starting work there, he developed tinnitus and a threshold curve typical of a noise-induced hearing loss. The VA examiner concluded that it is therefore less likely than not that either his mixed hearing loss or tinnitus are related to noise exposure during active duty service from 1955 to 1958. In this case, there are conflicting medical opinions regarding the etiology of hearing loss and tinnitus. The probative value of medical evidence is based on the expert's knowledge and skill in analyzing the data, and the medical conclusion the expert's reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). The factors for assessing the probative value of a medical opinion include the expert's access to the claims folder and the Veteran's history, and the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444 (2000). The weight of a medical opinion is diminished where that opinion is ambivalent, based on an inaccurate factual premise, based on an examination of limited scope, or where the basis for the opinion is not stated. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Sklar v. Brown, 5 Vet. App. 140, 146 (1993); Guerrieri, 4 Vet. App. at 470-71. The December 2008 VA examiner opined that hearing loss is related to military service but also stated that the "conductive component of hearing loss was not related to military service." The December 2008 opinion is ambivalent and is therefore lacking in probative value. The December 2008 medical opinion did not include a rationale for the conclusion that tinnit The February 2009 VA audiologist's opinion which indicated that a relationship to service "could not be ruled out" is speculative and therefore lacks probative value. See Bloom v. West, 12 Vet. App. 185 (1999); Obert v. Brown, 5 Vet. App. 30, 33 (1993). The October 2012 medical opinion provided a detailed and thorough rationale for the conclusions, based upon a review of the Veteran's medical records. For these reasons, the Board accords greater probative weight to the October 2012 medical opinion than to the December 2008 and February 2009 opinions. The Board acknowleges the article submitted by the Veteran regarding noise induced hearing loss. To the extent that the internet article rises to the level of a medical article or medical treatise, the Board notes that the Court has held that a medical article or treatise "can provide important support when combined with an opinion of a medical professional" if the medical article or treatise evidence discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least "plausible causality" based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222, 228 (1999); see also Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). The Court has also held, however, that "[g]enerally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise 'is too general and inconclusive'." Id. Based on the evidence of record, the weight of the competent credible and probative evidence demonstrates no relationship between the Veteran's current bilateral hearing loss and tinnitus and his military service, including no credible evidence of continuity of symptomatology of hearing loss; therefore, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for bilateral hearing loss and tinnitus. For these reasons, the claim must be denied. Because the preponderance of the evidence is against the claims, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. Service Connection for Dental Injury The Veteran asserts that he sustained a dental injury during service. He asserts that the corner of one his teeth was broken off by an accidental elbow jolt. He asserts that an Army dentist pulled the tooth instead of capping it. The Veteran asserts that the tooth above it subsequently shifted down and had to be removed. 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 (2012), 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 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, Diagnostic Code 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). In this case, the service treatment records are not available. The Board accepts as competent and credible the Veteran's statement that a tooth was broken off when he was in service and was pulled. The Veteran submitted post-service dental records, dated from 1979 to 2000. The dental records do not reflect findings or treatment of loss of teeth due to loss of the substance of the body of the maxilla or mandible. Even assuming that the Veteran sustained a dental trauma in service, the evidence of record does not establish loss of the body of the maxilla or mandible. 38 C.F.R. § 4.150. The Veteran has not been diagnosed with any such disability set forth in 38 C.F.R. § 4.150, such as chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion and malunion of the mandible or maxilla, temporomandibular articulation or limited jaw motion, loss of the ramus, loss of the condyloid process, or loss of the hard palate. Therefore, even assuming that the Veteran suffered some injury to his tooth during service, he has not been diagnosed with a disability set forth in 38 C.F.R. § 4.150. 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. Thus, service connection may not be established for compensation purposes for missing or damaged teeth under 38 C.F.R. § 4.150. In the current case, although the Veteran has perfected an appeal as to a claim for service connection for a dental condition, the U.S. Court of Appeals for Veterans Claims has specifically held that a claim for service connection for a dental disorder is also a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302 (1993). The Board has considered the classifications of dental disability under 38 C.F.R. §§ 3.381 and 17.161 and has found none that would apply to the Veteran. In this regard, the Veteran does not meet the requirements of Class I because, as explained above, he does not have a service-connected compensable dental condition or disability. The Veteran is not eligible for Class II treatment, one-time dental treatment for Veterans having a noncompensable service-connected dental condition or disability in existence at the time of discharge, because a claim for such treatment must be made within one year after a claimant's separation from active military service. The Veteran's claim for service connection for a dental condition was received in September 2002. The Veteran does not meet the requirements of Class IIa because he does not have a dental condition or disability that is the result of combat wounds or other service trauma. The Veteran is not eligible for Class II(b), II(c), IIR, because he does not claim and the record does not show that he was ever a prisoner of war or that he filed a claim for dental treatment prior to the September 2002 claim. He does not meet the requirements of Class III, because he does not have a dental condition or disability that has been medically determined to be aggravating a service-connected condition. The Veteran is not service-connected for any disability and therefore he is not in receipt of a 100 percent disability rating for a service-connected disability. Thus, the Veteran does not meet the requirements of Class IV. The Veteran is not eligible for Class V and VI treatment, as the record does not show that he participates in a rehabilitation program under 38 U.S.C. Chapter 31 or he is otherwise receiving care and services under 38 U.S.C. Chapter 17. See 38 C.F.R. § 17.161(a). For these reasons, the Board concludes that there is a preponderance of the evidence against the claim for service connection for a dental injury, including for outpatient treatment purposes. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102. ORDER Service connection for hearing loss is denied. Service connection for tinnitus is denied. Service connection for a dental injury is denied. REMAND Additional development is warranted with respect to the claim for service connection for residuals of pilonidal cyst surgery, to include pain, bilateral leg numbness and a tender scar. The Veteran has indicated that he underwent surgery for a pilonidal cyst during service in September 1958. At a Board hearing in September 2009, the Veteran stated that he has a tender scar and has burning in his left leg. In July 2012, a request was submitted to NPRC for records pertaining to surgery for a pilonidal cyst. A response received in July 2012 indicated that the SGO (Surgeon General's Office) provided information confirming in-service treatment of a cyst. The Veteran has not been afforded a VA examination for residuals of a pilonidal cyst. Based upon the evidence of treatment for a pilonidal cyst during service and the Veteran's competent and credible testimony of a residual scar and bilateral leg numbness, the Board finds that the threshold requirements of McLendon are met. Therefore, a remand is necessary to obtain a VA examination to identify any residuals of pilonidal cyst surgery. Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. Schedule the Veteran for an appropriate VA examination by a physician to identify residuals of pilonidal cyst surgery. The claims file should be provided for the VA examiner's review in VA examiner should review the claims file. The VA examination report should indicate that a review of the claims file was conducted. Following a review of the claims file and an examination of the Veteran, the VA examiner should render an opinion as to whether it is at least as likely a not (50 percent or greater likelihood) that the Veteran has residuals of the pilonidal cyst surgery that he had in service. The VA examiner should identify the residuals that are related to the surgery for a pilonidal cyst. The VA examiner should provide a detailed rationale for the opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should state why it is not possible to provide an opinion. 2. After completion of the requested development, the RO/AMC should review the case again based on the additional evidence. If the benefit sought is not granted, the RO/AMC should furnish the Veteran and his representative with a Supplemental Statement of the Case, and should give the Veteran a reasonable opportunity to respond before returning the record to the Board for further review. The appellant has the right to submit additional evidence and argument on the matter 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. 2012). ______________________________________________ T. D. JONES Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs