Citation Nr: 18140100 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 14-31 729A DATE: October 2, 2018 ORDER Entitlement to service connection for residuals of dental care is denied. ORDER REMANDED Entitlement to a rating in excess of 10 percent for left shoulder strain is remanded. Entitlement to a rating in excess of 10 percent for right shoulder strain is remanded. Entitlement to a rating in excess of 20 percent for degenerative joint disease of the lumbar spine is remanded. Entitlement to a rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is remanded. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran current has a dental disorder for which VA compensation may be paid. CONCLUSION OF LAW The criteria for entitlement to service connection for residuals of dental care have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.150, Diagnostic Code 9913. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from March 2007 to February 2012. In April 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans’ Law Judge. A transcript of that hearing has been associated with the record. During the Veteran’s April 2018 videoconference hearing, the Veteran reported that his claim for service connection for a dental disability included a claim for dental treatment. In this regard, the Board notes that a claim for service connection for a dental disorder is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302 (1993). To date, the only adjudicated issue has been entitlement to service connection for a dental disorder for VA compensation purpose and therefore, the claim for outpatient dental treatment is referred for appropriate action. Entitlement to service connection for residuals of dental care The Veteran and his representative assert that the Veteran is entitled to service connection for residuals of dental care based on the Veteran requiring follow-up dental treatment after getting a cavity filled while on active duty. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247 (1999). Dental conditions for which service-connected compensation benefits are available are set forth under 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. These conditions include loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, loss of the condyloid or coronoid process, or loss of any part of the hard palate. Compensation is also available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. For loss of the teeth, bone loss through trauma or disease, such as osteomyelitis, must be shown for compensable purposes. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See, 38 C.F.R. § 4.150, Diagnostic Code 9913. In addition, to be compensable, the lost masticatory surface for any tooth cannot be restorable by suitable prosthesis. Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service connected solely for the purpose of establishing eligibility for outpatient dental treatment and cannot be considered for compensation purposes. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150. The Veteran was afforded a dental VA examination in February 2012. At this examination, the VA examiner reported that the Veteran had caries involving the pulp on tooth 14 and a defective filling on tooth 14, which resulted from a routine filling in December 2011 during which the pulp was encountered and a root canal had to be performed. The examiner opined that the issue with tooth 14 could be resolved by routine dental restoration or a crown. The examiner noted that the Veteran did not have any anatomical loss or bony injury to the mandible or maxilla. He had no anatomical loss or bony injury leading to loss of any teeth. There was no osteomyelitis, osteoradionecrosis, bisphosphonate-related osteonecrosis of the jaw. Further, there were no tumors or neoplasms. See, February 2012 VA examination. As the February 2012 VA examination opinion was rendered following a review of the Veteran’s record and is not contradicted by any other evidence of record, the Board has assigned the opinion significant probative value. As outlined above, service connection for a dental disability for compensation purposes may be established when there is loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, loss of the condyloid or coronoid process, or loss of any part of the hard palate. There is no indication in the medical evidence of record that the Veteran’s dental disability has manifests loss of whole or part of the mandible, nonunion or malunion of the mandible, loss of whole or part of the ramus, loss of whole or part of the maxilla, nonunion or malunion of the maxilla, loss of the condyloid or coronoid process, or loss of any part of the hard palate. Therefore, while the Board is sympathetic to the Veteran’s claim, entitlement to service connection for a dental disability must be denied. REASONS FOR REMAND While the Board sincerely regrets the delay, additional development is required before the Veteran’s remaining claims may be adjudicated on the merits. Entitlement to a rating in excess of 10 percent for left shoulder strain is remanded. Entitlement to a rating in excess of 10 percent for right shoulder strain is remanded. Entitlement to a rating in excess of 20 percent for degenerative joint disease of the lumbar spine is remanded. Entitlement to a rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is remanded. The Veteran and his representative assert that the Veteran is entitled to higher ratings for his bilateral shoulder disability, his degenerative joint disease of the lumbar spine, his bilateral knee disability, and his GERD. During the Veteran’s April 2018 videoconference hearing, the Veteran stated that since his last examination, which occurred in February 2012, his symptoms have increased. Specifically, the Veteran stated that since the February 2012 VA examination, he has increased pain and less range of motion in both of his shoulders and in his back. With respect to the Veteran’s bilateral knee disability, he stated that in addition to increased pain and limited range of motion, he also experiences instability and occasional locking. Finally, the Veteran noted that he has increased his medication for GERD and has had to change his diet. See, April 2018 videoconference hearing. As the Board finds that the Veteran’s symptoms have worsened since his last VA examination in February 2012, VA is required to afford the Veteran with a contemporaneous VA examination to assess the current nature, extent, and severity of his bilateral shoulder disability, his degenerative joint disease of the lumbar spine, his bilateral knee disability, and his GERD. Snuffer v. Gober, 10 Vet. App. 400 (1997). Additionally, with respect to the Veteran’s bilateral shoulder disability, his degenerative joint disease of the lumbar spine, and his bilateral knee disability, the Board notes that while the Veteran’s claim was pending, two precedential decisions were issued which also require the Veteran’s claim to be remanded. In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that in order for an examination to be adequate, it must include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing, and, if possible, with range of motion measurements of the opposite undamaged joint. A review of the Veteran’s last VA examinations indicates that new examinations are warranted in light of Correia. The Court’s recent holding in Sharp v. Shulkin, 29 Vet. App. 26 (2017) also requires that the claim be remanded. In Sharp, the Court noted that for a joint examination to be adequate, the examiner “must express an opinion on whether pain could significantly limit” a veteran’s functional ability, and that determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Furthermore, the Court stated that the examiner must “obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment [resulting from flare-ups] from the veterans themselves.” Sharp, 29 Vet. App. at 34. The examiner must also “offer flare opinions based on estimates derived from information procured from relevant sources, including the lay statements of veterans,” and the examiner’s determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Id. at 10. As the Veteran reported flare-ups in regards to his shoulders, back, and knees at his February 2012 VA examination, this constitutes additional basis for remand. The matters are REMANDED for the following action: Obtain any outstanding VA and private treatment records and associate them with the Veteran’s claims file. Once any outstanding records have been obtained, schedule the Veteran for VA examinations with the appropriate medical personnel with respect to his claims for entitlement to increased ratings for his bilateral shoulder disability, his degenerative joint disease of the lumbar spine, his bilateral knee disability, and his GERD. The Veteran’s claims file, to include a copy of this remand, should be provided to the examiner. Following a complete review of the record, the examiner is asked to provide the following opinions: a. Determine the current severity of the Veteran’s bilateral shoulder disability, his degenerative joint disease of the lumbar spine, and his bilateral knee disability. Report the range of motion for each in degrees. In accordance with Correia, the range of motion should be tested actively and passively, in weight bearing, and after repetitive use. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why this is so. In providing this opinion, the examiner should consider the Veteran’s lay statements regarding his decreased range of motion. The extent of any weakened movement, excess fatigability and incoordination should also be described by the examiner. The examiner should assess the additional functional impairment due to weakened movement, excess fatigability, or incoordination in terms of the degree of additional range of motion loss. The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups. The examiner should further assess the additional functional impairment on repeated use or during flare-ups in terms of the degree of additional range of motion loss. The examiner should consider all procurable and assembled data by obtaining all tests and records that might reasonably illuminate the medical analysis. This includes the Veteran’s statements regarding the extent of functional loss during flare-ups. b. Determine the current severity of the Veteran’s GERD. A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Daugherty, Associate Counsel