Citation Nr: 18155168 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 15-13 731 DATE: December 4, 2018 ORDER New and material evidence has not been received to reopen a claim of entitlement to service connection for right ankle disability; the appeal is denied. New and material evidence has been received to reopen a claim of entitlement to service connection for lumbar spine disability; the claim is reopened. New and material evidence has not been received to reopen a claim of entitlement to service connection for fibromyalgia; the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for an eye disability; the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for a bilateral knee disability; the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for obstructive sleep apnea; the appeal is denied. New and material evidence has been received to reopen a claim of entitlement to service connection for irritable bowel syndrome (IBS); the claim is reopened. New and material evidence has not been received to reopen a claim of entitlement to service connection for migraine headaches; the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for sinusitis; the appeal is denied. New and material evidence has not been received to reopen a claim of entitlement to service connection for chronic depression and anxiety; the appeal is denied. Service connection for lumbar spine disability is denied. Service connection for IBS is denied. Service connection for right foot plantar fasciitis is denied. Service connection for bilateral shoulder disability is denied. Service connection for a heart disability is denied. Service connection for left hip disability is denied. Service connection for right hip disability is denied. Service connection for bilateral tibia/fibula disability is denied. Service connection for bilateral arm/wrist disability is denied. Service connection for a uterine disability is denied. Service connection for a skin disability, claimed as scar is denied. Service connection for a variously diagnosed psychiatric disability, to include posttraumatic stress disorder (PTSD) is denied. Service connection for a dental disability for treatment purposes is denied. REMANDED Entitlement to a rating more than 10 percent for cervical spine disability is remanded. Entitlement to a compensable rating for left ankle disability is remanded. Entitlement to a rating more than 10 percent for a left foot disability is remanded. Entitlement to a total disability rating based on unemployability (TDIU) is remanded. FINDINGS OF FACT 1. An unappealed October 2006 rating decision denied service connection for right ankle, eye, bilateral knee, and sinusitis disabilities. 2. Evidence received since the time of the final October 2006 rating decision is not material to establishing an element for service connection, and does not raise a reasonable possibility of substantiating the claims for service connection for right ankle, eye, bilateral knee, and sinusitis disabilities. 3. An unappealed February 2009 rating decision denied service connection for lumbar spine, fibromyalgia, sleep apnea, IBS, headaches and depression/anxiety disabilities. 4. Evidence received since the time of the final February 2009 rating decision is not material to establishing an element for service connection, and does not raise a reasonable possibility of substantiating the claims for service connection for fibromyalgia, sleep apnea, headaches, and depression/anxiety disabilities. 5. Evidence received since the time of the final February 2009 rating decision is material to establishing an element for service connection, and does raise a reasonable possibility of substantiating the claims for service connection for lumbar spine and IBS disabilities. 6. The Veteran’s current lumbar spine disability is not causally related to service. 7. The Veteran’s current gastrointestinal disability, claimed as IBS, is not causally related to service. 8. At no time during the appeal period has the Veteran had a right foot disability. 9. At no time during the appeal period has the Veteran had a disability of either shoulder. 10. A heart disability has not been demonstrated at any time during or immediately prior to the appeal period. 11. The Veteran’s left hip disability is not causally related to service. 12. At no time during the appeal period has the Veteran had a disability of the right hip at any time during the appeal period. 13. At no time during the appeal period has the Veteran had a disability of either leg (bilateral tibia/fibula). 14. At no time during the appeal period has the Veteran had a disability of either arm/wrist during. 15. The Veteran’s menstrual disability/uterine fibroids are not causally related to service. 16. The residual scar is shown to be associated with the Veteran’s non-service connected uterine surgery. 17. The Veteran has not had a PTSD diagnosis at any time during the appeal period. 18. The Veteran did not have dental trauma during service. There is no evidence of a current dental condition which is related to an in-service dental trauma, and there is no current dental condition otherwise related to military service. CONCLUSIONS OF LAW 1. The October 2006 and February 2009 rating decisions denying the service connection claims are final. 38 U.S.C. § 7105; 38 C.F.R. § 3.104. 2. New and material evidence has not been received to reopen the claims of service connection for right ankle, fibromyalgia, eye, bilateral knee, sleep apnea, headaches, sinusitis, and depression/anxiety disabilities. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The claims for service connection for a lumbar spine and IBS disabilities have been reopened. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 4. The criteria for an award of service connection for lumbar spine disability are not met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for an award of service connection for IBS are not met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for the award of service connection for right foot plantar fasciitis have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for the award of service connection for bilateral shoulder disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for the award of service connection for heart disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. The criteria for the award of service connection for bilateral hip disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 10. The criteria for the award of service connection for bilateral tibia/fibula disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 11. The criteria for the award of service connection for bilateral wrist disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 12. The criteria for the award of service connection for a uterine disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 13. The criteria for the award of service connection for a skin disability have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 14. The criteria for the award of PTSD have not been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 15. A dental condition, including one which would entitle the Veteran to VA outpatient dental treatment, was not incurred in or aggravated by active service. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.303, 3.381, 17.161. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1983 to May 1987. These matters come before the Board of Veterans’ Appeals (Board) on appeal from various rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). In an April 2013 statement included with her substantive appeal, the Veteran requested a Central Office Hearing, although she would not be in attendance. In December 2016 correspondence, the Board informed her that she was scheduled for a Hearing before the Board in Washington, DC in February 2017. The Veteran responded in February 2017 correspondence, that she wished for her hearing to be scheduled, however she would not be there. She stated that her representative from Disabled American Veterans (DAV) would be attend the hearing on her behalf. In June 2017, DAV submitted an Appellant’s Brief on behalf of the Veteran. The Board observes that a hearing before a Veterans Law Judge did not take place; however, pursuant to 38 C.F.R. §20.700(b), the purpose of a hearing is to receive argument and testimony relevant and material to the appellate issue. It is contemplated that the appellant and witnesses, if any, “will be present.” The regulatory provision further reflects that a hearing will not normally be scheduled solely for receiving argument by a representative and such argument should be submitted in the form of a written brief. Indeed, the purpose of a hearing before a Board member is to hear the appellant’s arguments and opinions, and to elicit testimony regarding the pertinent medical and historical facts of an appellant’s claim. In this case, the Veteran indicated that she would not be present at the time of her scheduled hearing. Her representative did present argument in the form of a written brief. New and Material evidence Generally, a claim that has been denied in an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim that has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. Moreover, new and material evidence received prior to the expiration of the appeal period, or prior to the appellate decision if a timely appeal has been filed, will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). New evidence is defined as existing evidence not previously submitted to agency decisionmakers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The Court has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold, and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). For establishing whether new and material evidence has been submitted, the credibility of evidence is presumed unless the evidence is inherently incredible or consists of statements that are beyond the competence of the person or persons making them. See Justus v. Principi, 3 Vet. App. 510, 513 (1992); Meyer v. Brown, 9 Vet. App. 425, 429 (1996); King v. Brown, 5 Vet. App. 19, 21 (1993). Historically, an October 2006 rating decision denied the Veteran’s claims of service connection for, among others, right ankle, eye, and bilateral knee disabilities on the basis that there was no evidence to support that the claimed disabilities were due to service. A February 2009 rating decision denied the claims of service connection for lumbar spine, fibromyalgia, sleep apnea, IBS, headaches, and depression/anxiety disabilities on the basis that there was no evidence of current lumbar spine and IBS diagnoses; and no evidence that the other claimed disabilities were related to service or a service-connected disability. The Board observes that no additional evidence was received during the applicable period after either rating decision; and no additional service department records have been associated with the claims file. As such the provisions of 38 C.F.R. § 3.156(b) and 38 C.F.R. § 3.156(c) are inapplicable. Accordingly, the October 2006 and February 2009 rating decisions are final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.200, 20.202, 20.1103. The instant claims for service connection were received in May 2011. The April 2013 rating decision denied reopening most of the claims, as no new and material evidence had been received. The Board observes that the claims for lumbar spine disability and IBS were reopened and denied on the merits. Review of the record shows that, the evidence associated with the claims file includes: the current claim in May 2011, VA and private treatment records that shows no current chronic disabilities that are due to service or a service-connected disability. The current claim provided no new information as to the right ankle, fibromyalgia, eye, bilateral knees, sleep apnea, headaches, sinusitis, or anxiety/depression. The treatment records from VA and private healthcare providers show no evidence the claimed disabilities were due to her military service, to include any incident therein, or secondary to a service-connected disability. The Board observes; however, a January 2013 VA examination report documents a current lumbar spine disability as well as a gastrointestinal disability. The Board finds that the evidence added to the claims file since the prior final rating decisions in October 2006 and February 2009 fail to demonstrate, suggest, or raise a reasonable possibility that claimed right ankle, fibromyalgia, eye, bilateral knee, sleep apnea, headaches, sinusitis, and depression/anxiety that was incurred in, or aggravated by the Veteran’s military service; or that any disability is secondary to a service-connected disability. In summary, even when considering the newly submitted evidence together with the previous evidence of record, the evidence does not raise a reasonable possibility of substantiating the Veteran’s claims of service connection for right ankle, fibromyalgia, eye, bilateral knee, sleep apnea, headaches, sinusitis, and depression/anxiety. Accordingly, new and material evidence has not been received sufficient to reopen the previously denied claims, and the petition to reopen such claims is denied. There is no doubt to be resolved as to these issues. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v Derwinski, 1 Vet. App. 49 (1990). Regarding the lumbar spine disability and IBS, the evidence does raise a reasonable possibility that the disabilities are due to military service, or a service-connected disability. Accordingly, new and material evidence has been received sufficient to reopen the previously denied lumbar spine and IBS claims, and the petition to reopen such claims is granted. Service Connection Generally, service connection is granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection may also be granted for a disease diagnosed after discharge, where all evidence, including that pertinent to service, establishes that the disease was incurred therein. 38 C.F.R. § 3.303(d). Service connection may also be granted for certain chronic diseases when such disability is manifested to a degree of 10 percent or more within one year of discharge from service. See 38 U.S.C. §§ 1101, 1112(a); 38 C.F.R. §§ 3.307, 3.309; see Fountain v. McDonald, 27 Vet. App. 258; 38 C.F.R. § 3.309(a). “Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Court has held that the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary’s adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Service connection for right foot plantar fasciitis, bilateral shoulders, right hip, bilateral tibia/fibula, bilateral arm/wrist The Veteran contends that these disabilities are related to her military service. The service treatment records (STRs) show complaints of pain in her feet, shoulders, right hip, legs, and arms/wrist. However, post-service treatment records show no complaints of or treatment for right foot, bilateral shoulder, right hip, bilateral tibia/fibula, or bilateral arm/wrist disabilities. The question for the Board in this matter is whether the Veteran has or has had the disabilities in question. In the absence of proof of a current disability, there can be no valid claim. Based on the evidence of record, the Board finds that the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for right foot, bilateral shoulder, right hip, bilateral tibia/fibula, or bilateral arm/wrist disabilities as she does not have any of the current diagnoses of such disabilities, and has not, at any point during the appeal, had any diagnoses of such disabilities. The Board notes right foot and right hip pain as well as arm and leg pain is listed in the records during the appeal. The Board recognizes the recent decision in Saunders v. Wilkie that “pain alone can serve as a functional impairment and therefore qualify as a disability.” Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, the Court in Saunders cautioned that a Veteran cannot demonstrate service connection simply by asserting subjective pain. Id. Rather, the Court stated “[t]o establishes the presence of a disability, the veteran will need to show that her pain reaches the level of functional impairment of earning capacity.” Id. In this case, the Board acknowledges the Veteran’s subjective reports of pain, however, the pain is not severe enough to reach the level of functional impairment of earning capacity. The Board bases its finding on the fact that there is no documentation that shows no functional impairment of the right foot, bilateral shoulder, right hip, bilateral tibia/fibula, and bilateral arm/wrist. Moreover, the Veteran reported during the January 2013 examination that she currently is employed, and had not missed any time from work due to any of the disabilities. Although the Veteran reports pain, the most probative evidence of record does not show that the severity of the pain rises to the level of the functional impairment required to constitute a disability under VA regulations. Although pain and ache may be constant, it does not functionally impair the hip, wrist/arm, and/or leg. Accordingly, service connection for these conditions is not warranted. Entitlement to service connection for heart disability After a review of all the evidence, lay and medical, the Board finds that a heart disability has not been demonstrated at any time during or immediately prior to the appeal period. The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328 (1997). The evidence in this case includes post-service treatment records, which show a history of heart murmur, but include no findings suggesting a heart disability. At a January 2013 general VA examination, the VA examiner specifically found no diagnosis of a heart disability. Examination revealed normal rate and rhythm and no murmur. Although the Veteran’s representative has noted that she did not receive a VA examination specific for a heart disability, a medical examination or medical opinion is not necessary in this case because there is sufficient competent medical evidence of record to decide the claim. The record includes her reports of symptoms that do not reflect a heart disability, a VA examiner’s review of treatment records and findings, VA examination report findings, and treatment records that are negative for history or complaints of a heart disorder. Because the Veteran does not have a current diagnosis for service connection purposes, the Board need not reach the in-service incurrence or nexus prongs of the analysis because the weight of the evidence is against a current diagnosis of a heart disability. Accordingly, as there is no current diagnosis of a heart disability, a preponderance of the evidence is against the claim, and service connection for a heart disability must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 Entitlement to service connection for left hip disability The Veteran contends that her left hip disability is related to her military service, to include hip complaints noted in service. The STRs reflect the Veteran was seen in service in September 1984 for a single complaint of left hip pain. She had no further left hip complaints noted in her STRs, and separation examination was normal. Post-service treatment records do not reflect complaints of or treatment for left hip disability. During a January 2013 VA examination, physical examination of the Veteran’s left hip revealed tendonitis. The x-rays obtained were interpreted as normal. The VA examiner opined, in part, that the current hip disability was not related to the Veteran’s military service. The examiner provided a diagnosis of mild tendonitis however, stated that this condition is not related to service as there was never any indication of chronic tendonitis during service. Based on the foregoing, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for left hip disability. The Board places great probative weight on the January 2013 VA examiner’s opinion that the left hip disability was not related to military service. The VA examination report clearly reflects consideration of the lay statements of record and provides adequate rationale supported by the service treatment records and the Veteran’s post-service medical history. Furthermore, the opinion offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, the Board accords the greatest probative weight to the VA examiner’s opinion provided in January 2013. Entitlement to service connection for IBS The Veteran is claiming service connection for IBS. The STRs show she was seen in July 1984 for complaints gastrointestinal symptoms. Probable IBS was assessed. There were no further complaints for any gastrointestinal disorders. Post-service treatment records show treatment for a gastrointestinal disorder/IBS in 2003. No further treatment was shown. During January 2013 VA examination, the Veteran reported that she experiences gastrointestinal distress and that she takes over the counter medication. The examiner indicated that the Veteran’s current gastrointestinal disorder was not related to service to include the one episode noted in service. He reasoned that there was no chronic symptomatology from the episode in 1984 until the first noted post-service treatment in 2003. The Board finds that service connection for IBS is not warranted. There is no evidence of chronic gastrointestinal problems in service and the evidence shows that these symptoms did not begin until 2003, some 19 years after separating from service, which weighs against her claim. There is no evidence in the record beyond the Veteran’s own statements to suggest that IBS or any chronic digestive condition began in service or continued since that time. Treatment records are silent for ongoing symptoms of IBS and there have been no medical records associated between the Veteran’s separation from service to the present that would allow the Board to find a causal connection between in-service indigestion and bowel troubles and a current diagnosis of IBS. The Board cannot assign significant probative value to the Veteran’s statements regarding continuity of IBS symptoms. See Jandreau, 492 F.3d at 1372. Overall, the evidence does not support a finding that events in service caused or are related to IBS and, accordingly, service connection is not warranted. Entitlement to service connection for lumbar spine disability The Veteran contends that she has a lumbar spine disability that is due to her military service. The STRs show no complaints of, or treatment for, a lumbar spine disability. Post-service treatment records show no complaints related to a lumbar spine disability. During the January 2013 VA examination, the Veteran reported that she noticed stiffness in her lower back, but did not know when it began. She indicated that she has not been treated for her low back. Physical examination was unremarkable. X-ray showed mild calcification. The examiner diagnosed mild lumbar strain. No etiology was provided. The Veteran asserts that her lumbar spine disability is due to her military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, although the Veteran has a diagnosis of mild lumbar strain, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show the Veteran was not diagnosed with a lumbar spine disability until January 2013, many years after her separation from service. Although the Veteran is competent to report having experienced low back symptomatology intermittently since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a lumbar disability. The issue is medically complex, as it requires knowledge of the musculoskeletal system as well as interpretation of complicated diagnostic medical testing. Further there is no competent medical evidence that shows a nexus between the Veteran’s current lumbar strain and her military service. Although the Veteran believes her lumbar spine disability is related to her active military service, the Board reiterates that the preponderance of the evidence weighs against findings that any in-service injury, event, or disease occurred. Entitlement to service connection for a uterine disability The Veteran seeks entitlement to service connection for uterine fibroids because of her military service. There is no dispute that the Veteran has a current diagnosis of uterine fibroids. See January 2013 VA examination report. The Board acknowledges the Veteran’s contentions that her current uterine fibroids are the result of her military service. However, no diagnosis of uterine fibroids was rendered in service, and there are no probative medical opinions in favor of the claim. Indeed, STRs do not reflect any treatment or symptomatology related specifically to uterine fibroids. STRs documented an instance of vaginitis while in service; however, there is no evidence of record linking these in-service complications with the post-service occurrence of uterine fibroids. Post-service treatment records show the Veteran was seen in 2006 for uterine fibroids and subsequently underwent surgery for removal of the fibroids. There is no indication from the private treatment records the etiology of the fibroids. In this case, the preponderance of the evidence is against a finding that there is a link between the Veteran’s uterine fibroids and her military service. Entitlement to service connection for residual scar The Veteran contends that her residual scar from fibroid removal surgery is painful. The preponderance of the evidence is against service connection. The residual scar is not shown to be due to the Veteran’s military service, but as a residual from uterine surgery which is not service-connected. As such, the claim for service connection is denied. Entitlement to PTSD The Veteran has also claimed entitlement to service connection for PTSD. However, the Board concludes that the Veteran does not have a current diagnosis of PTSD and has not had one at any time during the pendency of the claim or recent to the filing of the claim. The preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD. The evidence of record throughout the appeal period indicates the Veteran had a diagnosis of anxiety and depression which have not been found to be service-connected; further as noted above, she presented no new and material evidence to open those claims. Therefore, entitlement to PTSD is denied as there is no current diagnosis. Although the Veteran believes she has a current diagnosis of PTSD, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Consequently, the Board gives more probative weight to the competent medical evidence showing no diagnosis of PTSD. Absent a current disability, service connection is not warranted. Entitlement to a dental disability To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially 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). Current regulations provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not disabling, and may be considered service connected solely for establishing eligibility for VA outpatient dental treatment. 38 C.F.R. § 3.381(a). Service connection may be granted for a dental condition of each tooth and periodontal tissue shown by the evidence to have been incurred in or aggravated by service. When applicable, a determination will be made as to whether it is due to a combat wound or other service trauma, or whether the veteran was interned as a prisoner of war (POW). 38 C.F.R. § 3.381(b). The significance of finding a dental condition is due to service trauma is that a veteran will be eligible for VA dental treatment for the condition, without the usual restrictions of timely application and one-time treatment. 38 C.F.R. § 17.161(c). The following will not be service connected for treatment purposes: (1) calculus; (2) acute periodontal disease; (3) 3rd molars, unless disease or pathology of the tooth developed after 180 days or more of active service, or was due to combat or in-service trauma; (4) impacted or malposed teeth, and other developmental defects, unless disease or pathology of these teeth developed after 180 days or more of active service. Teeth extracted because of chronic periodontal disease will be service-connected only if they were extracted after 180 days or more of active service. 38 C.F.R. § 3.381(e). The Veteran submitted a claim for service connection for a dental condition in May 2011. The Veteran’s STRs reveal no trauma to the teeth. Post-service treatment records show no treatment for or complaints of a dental disorder. The record does not demonstrate the existence of a current dental condition for which service connection might be granted. As noted the STRs do not show, and that the Veteran does not allege, any service dental trauma. Thus, service connection for a dental condition involving service trauma may not be granted, and there is no related eligibility for treatment under Class II(a). The Board notes that the Veteran is not shown to be entitled to service connection or treatment under any of the other possible classes of eligibility. For instance, there could be no eligibility for Class I dental care since she is not shown to have a service-connected compensable dental condition. (See 38 C.F.R. § 4.150). She also does not allege, and the evidence does not otherwise suggest, that she applied for dental treatment within a year of her release from active duty, so there could be no eligibility for one-time Class II treatment for any service-connected noncompensable dental condition. She is not a POW, which could otherwise provide a basis of entitlement under Classes II(b) and II(c). Other classes discussed under 38 C.F.R. § 17.161 are also not for application in the instant case. In sum, the Board observes that there is no evidence that the Veteran currently has any dental condition which would meet eligibility criteria for VA treatment, as none of the criteria outlined in 38 C.F.R. § 17.161 have been met. There is also no evidence of dental trauma or that the Veteran was a POW. Given the foregoing, the Board must find that the preponderance of the evidence is against the claim of service connection for a dental condition. REASONS FOR REMAND Increased ratings for cervical spine, left ankle, and left foot tendonitis The Veteran’s most recent VA musculoskeletal examinations were in January 2013, over five years ago. In statements is April 2015 and May 2015 the Veteran indicated that her disabilities have increased in severity since her last examination. Given the fact that it has been over five years since the last orthopedic examinations, and the evidence of increased symptomatology, the Board finds that remand for more contemporaneous VA examinations is warranted to determine the current severity of the Veteran’s cervical spine, left ankle, and left foot disabilities. Entitlement to TDIU The Veteran’s claim of TDIU is inextricably intertwined with his increased rating claims and adjudication of the TDIU claim must be deferred until the RO has adjudicated the Veteran’s outstanding increased rating claims. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a Veteran’s claim for the second issue) The matters are REMANDED for the following action: 1. Updated treatment records should be obtained and added to the claims folder/e-folder. 2. Following completion of the above, schedule the Veteran for a new VA examination to determine the current severity of her service-connected neck, left ankle, and left foot disabilities. (Continued on the next page)   The examiner is asked to provide all information required for rating purposes—including the functional impact of her neck, left ankle, and left foot disabilities. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. McPhaull, Counsel