Citation Nr: 19131908 Decision Date: 04/25/19 Archive Date: 04/24/19 DOCKET NO. 16-00 283A DATE: April 25, 2019 ORDER New and material evidence having been received, the Veteran’s application to reopen his previously denied claim of entitlement to service connection for erectile dysfunction is granted. Entitlement to an effective date earlier than March 24, 2010, for the grant of service connection of left fifth cranial nerve deficit, is denied. Entitlement to service connection for a skin disorder (claimed as skin rash on back and ears) is denied. Entitlement to service connection for loss of taste secondary to fifth cranial nerve deficit is denied. Entitlement to service connection for a dental disorder secondary to fifth cranial nerve damage is denied. REMANDED Entitlement to service connection for erectile dysfunction secondary to depressive disorder is remanded. Entitlement to a rating higher than 50 percent for depressive disorder is remanded. FINDINGS OF FACT 1. A claim for service connection for erectile dysfunction was denied by a February 2014 rating decision; the Veteran did not perfect a timely appeal as to that decision and it became final. 2. Evidence relating to the Veteran’s erectile dysfunction added to the record since the February 2014 rating decision is not cumulative or redundant; and it raises a reasonable possibility of substantiating the claim. 3. The Veteran’s claim for entitlement to service connection for left fifth cranial nerve deficit was received on March 24, 2010; that is the earliest effective date allowable under the law. 4. The Veteran does not have a current skin disorder. 5. The Veteran does not have a current separately ratable disability for loss of taste; he is currently being compensated for the residuals of his left cranial nerve deficit, which includes loss of taste. 6. The Veteran does not have a dental disability for which service connection can be granted. CONCLUSIONS OF LAW 1. The February 2014 rating decision that denied service connection for erectile dysfunction is final. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 20.1100 (2018). 2. Evidence received since the February 2014 rating decision relating to the Veteran’s claim for service connection for erectile dysfunction is new and material; the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156(a) (2018). 3. The criteria for an effective date prior to March 24, 2010, for the grant of service connection for left fifth cranial nerve deficit have not been met. 38 U.S.C. § 1155 (2012); 38 U.S.C. §§ 5110, 5107; 38 C.F.R. § 3.400 (2018). 4. The criteria for entitlement to service connection for a skin disorder (claimed as skin rash on back and ears) have not been met. 38 U.S.C. §§1101, 1110, 1112, 1116, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 5. The criteria for entitlement to service connection for loss of taste have not been met. 38 U.S.C. §§1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for entitlement to service connection for a dental disorder, secondary to fifth cranial nerve damage, have not been met. 38 U.S.C. §§1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the United States Navy from September 1982 to September 2002. He, along with his wife, testified before the undersigned Veterans Law Judge (VLJ) at a videoconference hearing in December 2018. A transcript of the hearing is of record. 1. Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for erectile dysfunction. Generally, a claim which has been denied in an unappealed Board decision or an unappealed RO decision may not thereafter be reopened and allowed. 38 U.S.C. §§ 7104(b), 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 which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. A February 2014 rating decision originally denied the Veteran’s claim for entitlement to service connection for erectile dysfunction. His claimed was denied on the basis that the erectile dysfunction “neither occurred in nor was caused by service.” Essentially, his claim was denied on a direct basis. However, since that time, the Veteran has provided testimony that his depressive disorder makes it difficult for him to achieve an erection. This evidence is both new and it is material as it raises an alternative theory of entitlement that had not been previously considered. As a result, the Veteran’s application to reopen his previously denied claim for entitlement to service connection is granted. The claim is reopened, and to this extent only, the appeal is granted. 2. Entitlement to an effective date earlier than March 24, 2010, for the grant of service connection of left fifth cranial nerve deficit. Unless specifically provided otherwise in the statute, the effective date of an award based on an original claim for compensation benefits shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date of an award of disability compensation shall be the day following separation from service or the date entitlement arose if the claim is received within one year of separation, otherwise the date of claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b) (2012); 38 C.F.R. § 3.400(b)(2). The Veteran originally filed a claim for Ramsay Hunt prior to his release from Active Duty in May 2002. His claim was denied by an October 2002 rating decision; a September 2008 rating decision; and numbness and eye swishing and crying on the left side of the face was denied by a September 2010 rating decision. He was again denied for Ramsey Hunt Syndrome by an April 2011 rating decision. His claim was ultimately granted by a May 2013 rating decision. The effective date of the fifth cranial nerve deficit was given an evaluation of 30 percent effective March 24, 2010; the date the Veteran filed his claim. The evidence of record did not establish that the Veteran had fifth cranial nerve deficit until VA examination in March 2013. Under the law, this means that the date of claim is the earliest possible effective date. It is worth noting that the Veteran is in receipt of a 20 percent rating for his seventh cranial nerve deficit since the date of discharge. The seventh cranial nerve showed a deficit at the time of discharge while the fifth cranial nerve did not. Therefore, the Veteran’s claim for entitlement to an effective date earlier than March 24, 2010, for the grant of service connection of left fifth cranial nerve deficit, must be denied. 3. Entitlement to service connection for a skin disorder (claimed as skin rash on back and ears); entitlement to service connection for loss of taste secondary to fifth cranial nerve deficit. The Veteran seeks entitlement to service connection for a skin disorder and loss of taste in his mouth. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran was afforded VA examinations in connection with his claims for a skin disorder and loss of taste disorder. On VA examination in February 2016, the examiner found that a diagnosis could not be rendered as there was no objective evidence of a skin rash disorder. Although VA treatment records document some instances of skin rashes no persistent disorder has been demonstrated. Similarly, on VA examination February 2016, the examiner found that there was no separately diagnosable disorder related to the Veteran’s loss of taste. The examiner explained that medical literature states: Ramsay Hunt Syndrome (RHS) type 2 also known as herpes zoster oticus which is a disorder that is caused by the reactivation of pre-existing Varicella zoster virus in the geniculate ganglion, a nerve cell bundle, of the facial nerve. Ramsay Hunt syndrome type 2 typically presents with inability to move many facial muscles, pain in the ear, taste loss on the front of the tongue, dry eyes and mouth, and the eruption of an erythematous rash. Essentially, the examiner stated that although the Veteran does sometimes experience rashes and does have loss of taste, these are not separate disabilities. Instead, they are symptoms of the Veteran’s Ramsay Hunt syndrome, of which he is currently being compensated at the rate of 30 percent for the fifth cranial nerve, and 20 percent for the seventh cranial nerve. VA does not separately compensate for each symptom of a disability. Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. In this case, the disability is Ramsay Hunt syndrome, and the Veteran is currently being compensated for all of the symptoms associated with that disability. The evidence of record does not demonstrate that these symptoms are their own separate disabilities. In the absence of a current disability, service connection cannot be established; and the Veteran’s claims must be denied. 4. Entitlement to service connection for a dental disorder secondary to fifth cranial nerve damage. The Veteran seeks entitlement to compensation for his broke/smashed teeth. Specifically, at his Board hearing, he reported as a result of his fifth cranial nerve damage he “chew[s] harder and broke a couple of molars in the process.” Compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. 38 C.F.R. § 4.150 (2018). Compensation is available for loss of teeth only if such loss is due to loss of substance of the body of the maxilla or mandible during service due to trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Code 9913 (Note). Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease cannot be service-connected for purposes of compensation. 38 C.F.R. § 3.381. In this case, regardless of the Veteran’s theories of entitlement for his broken molars, the Board finds that service connection for compensation purposes is denied as a matter of law. The Veteran was afforded a VA examination for his teeth in August 2015. The examiner found that the Veteran did not have any diagnosable dental disability for which service connection would be warranted. Indeed, the Veteran admitted at his Board hearing that his teeth were treatable; albeit extremely expensive. The record otherwise does not show any evidence of prothesis, loss of bone of the hard palate, osteoradionecrosis of the maxilla or mandible, and osteomyelitis of the maxilla or mandible. Similarly, there is no evidence of dental trauma during service. To be clear, the Board acknowledges the Veteran’s lay statements regarding him breaking his molars as a result of chewing too hard. He is competent to make such statements and the Board has no reason to question his credibility in that regard. However, the evidence does not show a dental disorder subject to compensation under the laws and regulations administered by VA. Additionally, the Board notes that the medical evidence of record does not convey any other dental disability for which the Veteran may be entitled to service connection for compensation purposes. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916 (2018). As a result, his claim must be denied. REASONS FOR REMAND 1. Entitlement to service connection for erectile dysfunction secondary to depressive disorder is remanded. At his Board hearing, the Veteran provided testimony regarding his depression impacting his ability to get an erection. To-date, a VA medical opinion has not been obtained to address whether his erectile dysfunction is secondary to his service-connected depressive disorder. As a result, a remand is warranted. 2. Entitlement to a rating higher than 50 percent for depressive disorder is remanded. The Veteran contends that his depressive disorder has worsened since his last VA examination. In addition, there are outstanding VA treatment records related to the Veteran’s claim for an increased rating. As a result, remand is warranted for a new VA examination and to obtain these records. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Schedule the Veteran for a VA examination to determine the current severity of his service-connected depressive disorder. 3. Obtain a VA medical opinion from an appropriate clinician regarding the Veteran’s erectile dysfunction. The examiner is asked to opine: (a) Whether the Veteran’s erectile dysfunction was at least as likely as not caused by his service-connected depressive disorder; and (b) Whether the Veteran’s erectile dysfunction was at least as likely as not aggravated by his service-connected depressive disorder. The examiner is asked to provide opinions as to both causation and aggravation. A complete rationale must be provided for any opinion rendered. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Martha R. Luboch, Associate Counsel