Citation Nr: 18159756 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 11-02 246 DATE: December 20, 2018 ORDER Service connection for Meniere’s Disease, to include as secondary to a jaw fracture disability, is denied. Service connection for a jaw disability, to include loss of teeth, to include as secondary to a jaw fracture disability, is denied. REMANDED Service connection for a skin disability, to include as due to exposure to herbicide agents, is remanded. FINDING OF FACT 1. The Veteran’s Meniere’s Disease is not due to the Veteran’s time in service nor is it proximately due to any of his service connected disabilities, to include a jaw fracture disability. 2. The Veteran’s jaw disability, to include loss of teeth, is not due to the Veteran’s time in service nor is it proximately due to any of his service connected disabilities, to include a jaw fracture disability. CONCLUSION OF LAW 1. The criteria for the establishment of service connection for Meniere’s Disease, to include as secondary to service connected disabilities, are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.310. 2. The criteria for the establishment of service connection for a jaw disability, to include as secondary to service connected disabilities, are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1967 to September 1969. The Veteran had a hearing before the undersigned Veteran’s Law Judge in December 2015. This case was previously before the Board and was remanded in April 2016 for further development, which has been completed. Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) 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 or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016), Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The Veteran contends his Meniere’s Disease was incurred in and due to his time in service or it is proximately due to the jaw fracture he suffered while in service. The Veteran has been diagnosed with Meniere’s Disease. The Veteran’s service treatment records (STRs) are negative for diagnosis or treatment of Meniere’s Disease while in service. Therefore, service connection on a direct basis must be denied. The Veteran also contends his Meniere’s Disease is proximately due to or was aggravated by his service connected jaw fracture. In his December 2015 hearing, the Veteran said he noticed his Meniere’s Disease when his jaw was out of alignment and he would get pain in his ear when this happened. The Veteran was afforded an examination for his Meniere’s Disease in December 2016. The examiner opined it was less likely than not the Veteran’s diagnosed condition of Meniere’s disease was caused by or aggravated by his service connected jaw fracture. The examiner explained Meniere’s Disease is a condition of the middle ear and there is no documented literature suggesting a relationship it may have to a person’s jaw. The Board has reviewed the rest of the Veteran’s record and notes that while the Veteran continues to seek treatment for his Meniere’s Disease symptoms, the Veteran’s record does not contain a link between his service connected jaw fracture and his Meniere’s Disease nor does it contain a direct link between the Veteran’s Meniere’s Disease and his time in service. Therefore, the claim must be denied. The Board turns now to the Veteran’s claim of a jaw disability, to include loss of teeth. The Veteran contends he has a jaw disability, to include the loss of teeth, that is due to his time in service or is proximately due to his service connected jaw fracture disability. The Board notes the Veteran has had multiple teeth removed after his time in service. (See August 2010 medical record.) In his December 2015 hearing, the Veteran said that due to his jaw facture, his teeth were wearing down. The Veteran further explained he believed this was due to his jaw being out of alignment. The Veteran was afforded a temporomandibular joint (TMJ) examination in August 2015. The examiner noted the Veteran did not have a diagnosed TMJ disability and opined it was less likely than not the Veteran currently had any disability relating to the nonunion of the lower jaw. To insure accuracy, the Veteran was afforded a dental examination in December 2016. The examiner noted the Veteran showed no residuals of a fractured jaw and tooth number 17 was extracted around the same time as the Veteran’s jaw fracture, but it is considered to be a tooth that is commonly extracted and does not need replacement. The examiner also noted all the other teeth the Veteran was missing were extracted following the Veteran’s service and have been replaced to give him adequate function. The examiner opined it was less likely than not the Veteran’s loss of teeth was caused by or aggravated by his fractured jaw or his Meniere’s Disease and it was more likely than not the Veteran’s loss of functional teeth was caused by more common conditions like dental caries and periodontal disease. The Board notes the Veteran’s record shows he continues to be treated for dental issues. However, the Veteran’s medical record does not contain a link between any currently diagnosed jaw or tooth disability and the Veteran’s time in service or his service connected jaw fracture disability. Regarding the claims above, the Board acknowledges the Veteran’s statements that he believes his conditions are due to his time in service or his service connected disabilities. The Board also acknowledges the Veteran’s conditions continue to cause him pain and discomfort. However, while the Veteran is competent to discuss the symptoms of his conditions, the Veteran is not competent to opine on medical issues, such as the nature and etiology of his medical conditions. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board places more probative weight on the objective medical evidence of record. It is important for the Veteran to understand that these medical findings provide highly probative evidence against these claims that the Board cannot, unfortunately, ignore, outweighing the Veteran’s belief that these problems were the result of service, providing a highly clear basis for the opinion. Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). REASONS FOR REMAND The Board regrets the delay, but finds a remand is necessary for the Veteran’s claims of service connection for a skin disability, to include as due to herbicide agents. The Veteran had an examination for his skin disability in August 2016. The examiner noted the Veteran had a diagnosis of rosacea. However, the examiner did not offer an opinion as to the etiology of the Veteran’s skin condition. In May 2017, an opinion was requested. The examiner opined the Veteran’s skin disability was at least as likely as not related to his military service. The examiner noted while the Veteran had previously been noted to have chloracne, rosacea and chloracne were different from each other. At the Veteran’s examination, the Veteran did not present with chloracne. The examiner opined rosacea has not been linked to halogenated aromatic hydrocarbons exposure. The examiner opined the Veteran’s rash in service is not related to his current skin condition of rosacea. The examiner noted the Veteran had experienced redness and a rash on his bilateral cheeks. The examiner explained the etiology of rosacea is poorly understood. The Board finds a clarification of this opinion is required. While the examiner at one point opined the Veteran’s rosacea was at least as likely as not related to his military service, the examiner also opined the Veteran’s rash in service was not related to his current skin condition of rosacea. The examiner also noted that while the etiology of rosacea is poorly understood, there have been reports of familial rosacea so an underlying genetic predisposition has not been ruled out. Because the opinion is unclear, a remand for a clarification is required. The matters are REMANDED for the following action: 1. The AOJ should obtain any of the Veteran’s outstanding VA and private medical records and associate them with the claims file. If possible, the Veteran himself should submit any pertinent new evidence regarding the condition at issue in order to expedite the claim. 2. After completing the above development and all outstanding records have been associated with the claims file, the Veteran’s file should be returned to the examiner who offered the May 2017 opinion regarding the etiology of the Veteran’s skin condition. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. The examiner should clarify and opine on the following: What kind of skin disability does the Veteran have? Whether the Veteran’s skin condition was at least as likely as not incurred in and due to his time in service. Whether the Veteran’s skin condition was at least as likely as not caused by exposure to herbicide agents. Whether the Veteran’s skin condition is proximately due to or aggravated by any of his service connected disabilities. 3. If the May 2017 examiner is unavailable, the Veteran should be afforded an appropriate VA examination for his skin condition. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner and the examiner should offer an opinion as to the above. 4. After undertaking any other appropriate development deemed necessary, readjudicate the issues on appeal based on the additional evidence of record. If the determinations remain adverse to the Veteran, he must be provided with a supplemental statement of the case. An appropriate period of time must then be allowed for a response before the record is returned to the Board for further review. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Snoparsky, Associate Counsel