Citation Nr: 18143519 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 12-03 629 DATE: October 19, 2018 REMANDED Entitlement to service connection for residuals of dental surgery is remanded. Entitlement to service connection for residuals of a circumcision is remanded. REASONS FOR REMAND The Veteran had active service from October 1971 to September 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2010 rating decision by the Department of Veterans (VA) Regional Office (RO) in Atlanta, Georgia. In January 2017, the Veteran appeared at a videoconference hearing before the undersigned. A transcript of the hearing is of record. Entitlement to service connection for residuals of dental surgery and residuals of a circumcision. Once VA undertakes the effort to provide an examination in connection with a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one, or at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion will be considered adequate when it is based upon consideration of the Veteran’s prior medical history and examinations and provides a sufficiently detailed description of the disability so that the Board’s evaluation will be a fully informed one. Id.; Green v. Derwinski, 1 Vet. App. 121, 124 (1991). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran indicated that since having teeth extractions and some bone restructuring in his mouth during service, the resulting gaps have caused his teeth to move over the years and require frequent follow-up with his dentist to avoid infections. In accordance with the Board’s June 2017 remand directives, the Veteran underwent a VA disability benefits questionnaire (DBQ) for residuals of dental surgery in August 2017. The examiner provided a diagnosis of periodontal disease and indicated that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or disease because shifting teeth and bleeding gums were most likely the result of a periodontal condition. However, the examination did not address whether it was at least as likely as not that the disability experienced by the Veteran constituted an unusual effect or unintended result of his in-service dental procedure, as instructed by the Board. Moreover, the VA examiner failed to address a statement provided by the Veteran’s private dentist indicating that the Veteran needed constant periodontal maintenance treatment of his teeth and supporting structure as a result of a periodontal condition which was exacerbated by the edentulous areas in both the maxillary and mandibular arches. The Veteran also reported that ever since his circumcision during active service, the resulting scar has caused him to experience pain, irritation, and tenderness. He testified during his January 2017 hearing that the scar caused him discomfort quite easily. Service treatment records reveal that the Veteran underwent an elective circumcision in February 1975, and the Veteran is competent to report ongoing symptoms. The Veteran was afforded a male reproductive system conditions VA DBQ in August 2017, in which the examiner noted that the Veteran did not have a male reproductive disability. The examination noted that the Veteran experienced redness and inflammation, especially after intercourse, and friction was sometimes painful, but the examiner indicated that “[h]istorically there is no connection between circumcision and pain or inflammation later in life.” The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness because there was no objective evidence of any reproductive system condition. The examiner did not comment specifically on the Veteran’s residual scar. As the August 2017 VA examinations are inadequate, they do not comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Consequently, new VA examinations are required to adequately decide the merits of the claims. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a new VA examination regarding nature and etiology of any residuals resulting from the dental surgery performed during service. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination. (a.) The examiner should identify any residuals currently experienced by the Veteran that are related to the in-service dental surgery. (b.) For any identified current chronic residuals diagnosed, the examiner should clearly state whether it is at least as likely as not (a 50 percent or greater probability) that the residual disability experienced by the Veteran following his in-service dental procedure constituted a usual effect or intended result of this treatment. The examiner should also explain if any identified residuals are beyond the expected or intended effects of the in-service procedure. (c.) The examiner’s opinion should also specifically consider the statement by the Veteran’s private dentist regarding his current disability. The examiner should provide a detailed rationale for any opinion expressed. 2. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any residuals resulting from the circumcision performed during service, to include scars. (a.) The examiner should identify any residuals, currently experienced by the Veteran, that are related to the in-service circumcision. Specifically consider his complaints of symptoms that he believed to be associated with the circumcision, including pain, tenderness, and irritation in the area of the scar. (b.) For any identified current chronic circumcision residuals diagnosed, the examiner should clearly state whether it is at least as likely as not (a 50 percent or higher probability) that the residual disability experienced by the Veteran following his in-service circumcision constituted a usual effect of this treatment. The examiner should also explain if any identified residuals are beyond the expected or intended effects of the in-service procedure. (c.) In providing the rationale for this opinion, the examiner should take into consideration statements of the Veteran regarding in-service and post-service symptoms. The examiner should provide a detailed rationale for any opinion expressed. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Hite, Associate Counsel