Citation Nr: 18148811 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 10-12 417 DATE: November 8, 2018 ORDER Service connection for left-sided oral lesions, granulation tissue, and chronic infection of tooth number 20 (“a left-sided oral disorder”) is denied. FINDING OF FACT A left-sided oral disorder was not caused by any in-service event, disorder, disease, or injury, including exposure to contaminated water at Camp Lejeune, North Carolina; and was not caused or aggravated by any service-connected disorder. CONCLUSION OF LAW The criteria for service connection for a left-sided oral disorder have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310, 3.326(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Marine Corps from November 1965 to November 1967 and from June 1969 to August 1969. In November 2011, the Veteran was afforded a hearing before the undersigned Veterans Law Judge sitting at the Philadelphia, Pennsylvania, Regional Office (RO). Entitlement to service connection for a left-sided oral disorder. Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. § 1110. Service connection may 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). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310 where it is demonstrated that a service-connected disorder has caused or aggravated a nonservice connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Effective March 14, 2017, VA amended its adjudication regulations relating to presumptive service connection, adding eight diseases, that are associated with contaminants present in the water supply at Camp Lejeune. 82 Fed. Reg. 4184 4185 (Jan. 13, 2017) (codified at 38 C.F.R. §§ 3.307, 3.309). In order to establish presumptive service connection for a disease associated with exposure to contaminated water at Camp Lejeune, a claimant must show the following: (1) that the veteran served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) from August 1, 1953 to December 31, 1987; (2) that the veteran suffered from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309(f); and (3) that the disease process manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). The diseases presumed to have been caused by contaminated water at Camp Lejeune are kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, Parkinson’s disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. § 3.309(f). An August 2018 Veterans Health Administration (VHA) medical opinion states that the Veteran had left-sided oral lesion biopsies in February and July 2009 due to granulation tissue and chronic infection of tooth number 20 which was odontogenic in origin. The Veteran’s DD214 indicates that he was stationed at Camp Lejeune, North Carolina. At his November 2011 Board hearing, the Veteran testified that he had had infections on the left side of the lower jaw and that he had a procedure to have the infected area removed. His primary left-sided oral complaints were muscle spasms and pain from overuse, for which he was granted service connection in March 2017. In a May 2014 statement, the Veteran wrote that he was missing several teeth on the right side of his mouth and he, therefore, primarily chewed on the left side. He again indicated that his left-side oral complaints were primarily muscular in nature. He also indicated that he believed exposure to contaminated water at Camp Lejeune had caused his left-sided oral disorders. In June 2014, the Veteran was afforded a VA examination. The examiner noted malunion or nonunion of the mandible, muscular symptoms in the jaw, and a scar under the jaw. The Veteran is currently service-connected for these disorders. In a November 2014 VA medical opinion, the examiner indicated that the left-sided lesions were not caused by the service-connected right-angle mandible fracture. No rationale was provided and the opinion is, therefore, inadequate. A private medical opinion received by VA in March 2015 indicates that the Veteran had only “some vague and infrequent soreness in the left side of his mandible,” but had no other left-sided oral complaints or disorders. In February 2017, the Veteran was afforded another VA examination. The examiner did not indicate that the Veteran had any left-sided oral disorder other than the muscle disorder for which he is service-connected, and several missing teeth. In April 2018, the Board requested the VHA medical opinion. In a July 2018 statement, the Veteran reiterated that he believed contaminated water at Camp Lejeune caused his disorders. The August 2018 VHA opinion states that the lesions, granulation tissue, and chronic infection were not caused or aggravated by the Veteran’s service connected right mandible fracture residuals. The clinician stated that odontogenic infections are caused by dental caries and periodontal disease resulting from poor oral hygiene. She explained that bacterial infections arose due to a lack of proper dental hygiene and caused the odontogenic infections. The clinician noted that treatment records from 1969 and 1981 indicated that the right mandible fracture and healed and resulted in “[n]o significant deformity” and no complications were noted at that time. The clinician concluded that, given the proper healing of the right mandible fracture with no on-going infection, the 2009 infections and lesions were not caused or aggravated by the fracture. VA and private medical opinions do not indicate that any left-sided oral disorder, other than a left facial muscle injury for which the Veteran is already service connected, was caused by service or was caused or aggravated by any service connected disorder, including residuals of a right-angle mandible fracture with surgical scar. No competent medical provider has opined that any in-service event, injury, disease, or disorder, including exposure to contaminated water at Camp Lejeune, caused the Veteran’s left-sided lesions, granulation tissue, and chronic infection. Additionally, no competent medical provider has opined that the Veteran’s left-sided oral disorders were caused or aggravated by any service connected disorder. The Veteran’s left-sided oral disorders are also not diseases for which service connection is granted on a presumptive basis due to exposure to contaminated water at Camp Lejeune. The Veteran has indicated that he believes exposure to contaminated water at Camp Lejeune caused his left-sided oral disorders. He has also stated that his service-connected right mandible fracture residuals caused or aggravated his left sided oral disorders. The Veteran, however, is a lay person who is not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183 (1997). The etiology of oral lesions, granulation tissue, and chronic infections are not something with “unique and readily identifiable features” that are “capable of lay observation” and, therefore, not something on which a lay person, such as the Veteran, could provide a competent medical opinion. See, e.g., Barr v. Nicholson, 21 Vet. App. 303 (2007). As no competent medical provider has opined that the Veteran’s left-sided oral disorders were caused by service or were caused or aggravated by his service connected right mandible fracture residuals, service connection is not warranted and the claim is denied. D.C. SPICKLER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Miller, Associate Counsel