Citation Nr: 18143603 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 15-22 095 DATE: October 23, 2018 REMANDED Entitlement to service connection for a dental disability for compensation purposes is remanded. Entitlement to service connection for a dental disability for dental service and treatment purposes is remanded. Entitlement to service connection for thoracolumbar spine disability is remanded. Entitlement to service connection for chest pain is remanded. REASONS FOR REMAND The Veteran served on active duty for training from February 27, 2007 to June 15, 2007, and active duty from January 17, 2008 to February 3, 2009, from May 11, 2009 to March 26, 2010 and from April 17, 2010 to July 6, 2011. The Veteran has various periods of active duty for training and inactive duty for training. 1. Entitlement to service connection for a dental disability, claimed as loss of teeth, is remanded. As an initial matter, the Board of Veterans’ Appeals (Board) has split the Veteran’s claim of service connection for a dental disability into two issues. Claims for service connection for dental disabilities are treated differently than claims for service connection for other medical disabilities, and the Board must construe a claim for service connection for a dental disability as both a claim for compensation and a claim for treatment. See Mays v. Brown, 5 Vet. App. 302, 306 (1993). Upon review of the record, the Board finds remand is warranted to ensure compliance with VA’s duty to assist, particularly to obtain service treatment records and provide an examination. The Veteran has not been provided a VA examination for this claim. However, an August 22, 2014 VA examination report, in connection with a claim for service connection for a deviated septum, notes in the Veteran’s medical history section that he lost maxillary incisors and sustained a nasal fracture when he struck a tree at night during basic training. The Board did not locate service treatment records of the Veteran being injured due to striking a tree. However, the Veteran was service connected for his deviated septum that was reportedly incurred at the same time as his loss of teeth. Furthermore, the Veteran’s service treatment records are nearly devoid of dental records, except for a few pages that were provided by the Veteran himself. See medical records received November 10, 2014 (includes 2007 service dental records covering a tooth fracture and possible extraction). This suggests the Veteran’s service treatment records in the claims file are incomplete and a remand is warranted to obtain them and provide an examination. 2. Entitlement to service connection for thoracolumbar spine disability is remanded. In additional to the incomplete service records, remand is warranted for an examination. The Veteran has not been provided a VA examination in relation to this claim. However, there is evidence of a current disability, an in-service injury and a nexus between the two, thus warranting an examination. For example, during a period of training, the Veteran was involved in a motor vehicle accident on February 21, 2014. Computerized tomography of the lumbar spine taken the day of the accident revealed straightening of the spine probably secondary to muscle spasm, mild diffuse posterior bulging and degenerative disc disease. However, the examining clinician did not opine whether these were pre-existing or a result of the motor vehicle accident. In March 2014, the Veteran reported his back pain existed prior to this time, but that it has been severe since the motor vehicle accident. 3. Entitlement to service connection for chest pain is remanded. In additional to the incomplete service records, remand is warranted for additional examination and clarification of the issue. The Veteran was denied service connection after a VA muscle injuries examination was provided in which the examiner did not render a medical nexus opinion, “because no pathology was identified on muscle chest examination during todays evaluation.” However, the evidence of record does not support limiting the pathology to muscular in nature. Notably, in the rating decision code sheet accompanying the denial of service connection, the Reginal Office coded the disability as analogous to coronary artery disease. Of particular concern to the Board is that there is no indication the Veteran complained about his chest muscles. In the section of the examination report that is supposed to “[d]escribe the history (including onset and course) of the Veteran’s muscle injury”, it merely states the Veteran is seeking service connection for chest pain secondary to military service and that he complains of occasional left anterior chest pain. Similarly, the Veteran’s application does not mention chest pain, let alone explain his theory of entitlement. Additionally, evidence of record implicates another possible issue related to the Veteran’s chest that was not addressed by the examiner. See June 2014 cervical spine MRI (“All visualized bone marrow is abnormally hypointense (sclerotic) consistent with an infiltrating process with a wide differential diagnosis. Involved areas include the base of skull, cervical and included upper thoracic spine and included ribs.”) (emphasis added). The Veteran is service-connected for a cervical spine disability. Review of the record raises multiple possible pathologies beyond a muscle issue. Therefore, remand is warranted so the Veteran may be provided an examination and the opportunity to clarify the circumstances of his chest pain and theory of entitlement. The matters are REMANDED for the following action: 1. Obtain the Veteran’s complete service personnel records, to include all documents pertaining to his service in the National Guard. Verify all active duty for training and inactive duty training dates. If necessary, a request should be made to the Defense Finance and Accounting Service (DFAS). In particular, confirm service in 2014, if it exists. Document all requests for information as well as all responses in the claims file. 2. Obtain the Veteran’s complete service treatment records, to include dental records and the service records relied on to grant service connection for the Veteran’s deviated septum. 3. Schedule the Veteran for an examination by an appropriate clinician to identify and determine the nature and etiology of any dental disability, to include tooth loss. The examiner must opine whether each disability is at least as likely as not related to an in-service injury or disease. The examiner must address the following: Does the Veteran have loss of any teeth due to loss of substance of the body of the maxilla or mandible without loss of continuity? If so, the examiner must also address whether there is any lost masticatory surface for any tooth, and indicate whether it is restorable by suitable prosthesis. 4. Schedule the Veteran for an examination by an appropriate clinician to identify and determine the nature and etiology of any thoracolumbar disability. The examiner must opine whether each disability is at least as likely as not related to an in-service injury or disease, including lipoma excisions and the Veteran’s 2014 motor vehicle accident. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s chest pain. The examiner must opine whether the Veteran’s chest pain is at least as likely as not related to an in-service injury or disease, or proximately due to service-connected disability. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Gregory T. Shannon, Associate Counsel