Citation Nr: 18141198 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-15 939 DATE: October 9, 2018 REMANDED Service connection for essential tremor of the right hand with dystonia, to include as due to exposure to high levels of manganese in service, is remanded. Service connection for essential tremors of the left hand with dystonia, to include as due to exposure to high levels of manganese in service, is remanded. Service connection for rheumatoid arthritis of the left foot, mainly in the great toe, to include as due to jet gun inoculations in service, is remanded. Service connection for rheumatoid arthritis of the left hand, to include as due to jet gun inoculations in service, is remanded. Service connection for rheumatoid arthritis of the left shoulder, to include as due to jet gun inoculations in service, is remanded. Entitlement to an evaluation in excess of 10 percent disabling for fracture, lateral wall of left maxillary antrum is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1967 to October 1970 with service in Vietnam. The Veteran previously submitted a claim of entitlement to service connection for right hand essential tremors which was denied in an April 1994 rating decision. The April 1994 rating decision became final because the Veteran did not submit a Notice of Disagreement or new evidence in connection with the claims within the appeal period. See 38 C.F.R. § 3.156(b). In connection with the Veteran’s claim to reopen, he submitted a letter from his private physician regarding a new theory of service connection based on exposure to manganese and a Yellow Fever vaccination in service. Thus, the Board finds that new and material evidence has been received sufficient to reopen his previously denied claim. 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Board notes that in August 2016 the Veteran filed a substantive appeal requesting Board review of his claim for service connection for major depressive disorder, originally claimed as posttraumatic stress disorder (PTSD). At present, these issues have not been certified by the Regional Office (RO) to the Board for appellate disposition. Of note, VA mental health treatment records have been associated with the file since the substantive appeal was received. While the certification of issues through a VA Form 8 does not confer or deprive the Board of jurisdiction, it is a signal that the Veterans Benefits administration has completed its action regarding the certified issues. Thus, when this appeal for service connection for major depressive disorder is certified to the Board for appellate review, the Veteran and his representative will be notified in writing of the certification and of the time limit for requesting a change in representation, for requesting a personal hearing, and for submitting additional evidence. See 38 C.F.R. §§ 19.36, 20.1304(a). As this has not yet been done, the Board declines to take any further action on these issues. This delay, while regrettable, is necessary to ensure that the Veteran is afforded full due process in the matter. See 38 C.F.R. § 3.103; Gray v. McDonald, 27 Vet. App. 313, 327 (2015) (due process protections apply to disability compensation proceedings before the Board) (citing Cushman v. Shinseki, 576 F.3d 1290 (Fed. Cir.2009)). 1. Service connection for essential tremor of the right hand with dystonia, to include as due to exposure to high levels of manganese is remanded. 2. Service connection for essential tremors of the left hand, to include as due to exposure to high levels of manganese in service is remanded. The Veteran asserts that his diagnosed right and left-hand tremors, with dystonia, are a result of his in-serve exposure to high levels of manganese in the drinking water in Vietnam, from the unregulated disposal of dry cell batteries, and/or the Yellow Fever vaccination he received in service. To date, the Veteran has not been afforded a VA examination to determine whether there is a nexus between his current condition and his claimed in-service exposures. The Board requires a medical opinion addressing the Veteran’s contentions. 3. Service connection for rheumatoid arthritis of the left foot, mainly in the great toe, to include as due to jet gun inoculations is remanded. 4. Service connection for rheumatoid arthritis of the left hand, to include as due to jet gun inoculations in service is remanded. 5. Service connection for rheumatoid arthritis of the left shoulder, to include as due to jet gun inoculations in service is remanded. The Veteran asserts that his “spreading rheumatoid arthritis is a side effect of military inoculations via ‘jet injection gun’ that he received in service and has provided scientific and medical evidence to support his contention.” To date, the Veteran has not been afforded a VA examination to determine whether there is a nexus between his current condition and his in-service exposures. The Board requires a medical opinion addressing the Veteran’s contentions, as well as the medical and scientific evidence submitted. 6. Entitlement to an evaluation in excess of 10 percent disabling for residuals of fracture, lateral wall of left maxillary antrum is remanded. As an initial matter, the Board notes that the last VA examination regarding the Veteran’s residuals of fracture, left maxillary antrum fracture was in March 2013. The Veteran asserts that his fracture residuals caused “nerve damage which has caused premature discoloration of teeth. An evaluation should be made to determine the extent of the nerve damage as it pertains to the anterior superior alveolar nerve and the posterior superior alveolar nerves.” Here, the most recent examination of the Veteran’s residuals of fracture of left maxillary antrum was over 5 years ago. Although age of an examination is not, in itself, an automatic reason for remand, a current examination is necessary in determining the overall disability picture. In addition, as noted above, the Veteran has provided evidence in his Notice of Disagreement that his condition has worsened and now involves nerves and discolored teeth. As such, the claim must be remanded for a medical examination to address these assertions. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right-hand and left-hand tremors with dystonia. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s claimed exposure to high levels of manganese from drinking contaminated water in Vietnam, from handling dry cell batteries, and his exposure to the Yellow Fever vaccination. The examiner must address the scientific and medical literature submitted by the Veteran and associated with the claims file, specifically: the August 2014 letter from the Veteran’s treating physician; the article, “The Clinical Effects of Manganese;” and the MedLine Plus article, “Yellow Fever Vaccine,” 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any rheumatoid arthritis, claimed in the left foot, the left hand, and the left shoulder. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the Veteran’s claimed exposure to jet gun injections. The examiner must address the scientific and medical literature associated with the claims file, specifically the HCVets.com article, “Jetgun Injections” and the free dictionary.com article, “Immunodeficiency.” 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his residuals from fracture of left maxillary antrum. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must also address the Veteran’s assertions that the fracture resulted in nerve damage (“An evaluation should be made to determine the extent of the nerve damage as it pertains to the anterior superior alveolar nerve and the posterior superior alveolar nerves.”), which has caused premature discoloration of teeth. 4. Then, the record should again be reviewed. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and be given the opportunity to respond. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Nelson, Associate Counsel