Citation Nr: A19001549 Decision Date: 09/26/19 Archive Date: 09/25/19 DOCKET NO. 190326-7861 DATE: September 26, 2019 REMANDED Entitlement to service connection for tinea pedis/tinea versicolor is remanded. Entitlement to service connection for temporomandibular joint disorder (TMJ) is remanded. Entitlement to service connection for right shoulder strain with degenerative arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1980 to January 2005. For his lengthy and meritorious service, the Veteran was awarded (among other decorations) the Southwest Asia Service Medal, and the Navy and Marine Corps Achievement and Commendation Medals. A brief review of the procedural history of the Veteran’s claim is instructive. This appeal comes to the Board of Veterans’ Appeals (Board) from February 2018, March 2018, and August 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2018 and September 2018, the Veteran filed notice of disagreements (NODs) with the respective rating decisions regarding the issues of entitlement to service connection for tinea pedis/tinea versicolor, service connection for TMJ, service connection for left shoulder strain and degenerative arthritis, and service connection for right shoulder strain and degenerative arthritis. In December 2018, the Veteran opted in to the Appeals Modernization Act (AMA) review system by submitting a Rapid Appeals Modernization Program (RAMP) election form; he elected to have all eligible issues currently on appeal processed in the Higher-Level Review Lane. The Veteran requested an informal hearing conference before the Decision Review Officer (DRO). In March 2019, an informal hearing conference was held. Additionally, in March 2019, the RO issued a RAMP rating decision that continued the denial for the issues on appeal. Subsequently, the Veteran timely appealed this decision to the Board by submitting a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) specifically for the issues of service connection for TMJ, service connection for tinea pedis, and service connection for right shoulder strain with degenerative arthritis and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ). A hearing before the Board was not requested. In the March 2019 RAMP rating decision, the AOJ found that new and relevant evidence was submitted to warrant readjudicating the claim for service connection for right shoulder strain with degenerative arthritis. The Board is bound by this favorable finding. 38 C.F.R. § § 3.104(c) (2019). 1. Entitlement to service connection for tinea pedis/tinea versicolor is remanded. The Veteran is seeking service connection for tinea pedis/tinea versicolor. The Veteran contends that he was diagnosed with tinea pedis while in service, and his current diagnosis is related to his military service. He claims he was treated for the condition with over the counter and prescribed medication after service. Indeed, the Veteran’s service treatment records show that he had been diagnosed with tinea pedis and tinea versicolor in January 1982, January 1989, and August 1998. In March 2018, the Veteran was afforded a VA examination for his skin condition. He claimed that he was diagnosed in the 1990s and that it was reoccurring. The VA examiner opined that it was less likely than not that the Veteran’s tinea pedis was incurred in or caused by his military service. The VA examiner explained that during service, the condition was acute only. There was no chronicity of care in the Veteran’s medical records. Tinea pedis was documented in service in September 1981 and then diagnosed in January 2017, which was many years later. A nexus had not been established. The Board finds the March 2018 VA medical opinion regarding the etiology of the Veteran’s skin disorder to be inadequate because the VA examiner inadequately relied on the absence of evidence in rendering his negative opinion and did not consider the Veteran’s lay statements that his tinea pedis was reoccurring and that he was diagnosed with the skin disorder multiple times in service. A remand is warranted for a more adequate medical opinion. 2. Entitlement to service connection for TMJ is remanded. The Veteran is seeking service connection for TMJ. The Veteran claims that his TMJ is related to when he was involved in a motor vehicle accident in October 1981 during his time in the military. He suffered from a jaw fracture and dental trauma to his teeth. Indeed, service treatment records do show that the Veteran suffered from dental trauma due to a motor vehicle accident in the 1980s. He also had a laceration to his upper and lower lips. In March 2018, the Veteran had a VA examination for TMJ. The Veteran was diagnosed with unspecified TMJ. The VA examiner opined that it was less likely than not that his TMJ was related to his military service. The examiner explained that there was no confirmed diagnosis of TMJ. Service treatment records showed the Veteran had dental work. Although the Veteran was diagnosed with TMJ on the current examination, the Veteran was released from active duty in January 2005, which was 13 years ago; there was no chronicity of care. The Veteran’s separation examination was negative of complaints of TMJ. Therefore, it would be mere speculation to assume that the Veteran’s claim of TMJ/dental trauma was related to his motor vehicle accident during service. A nexus had not been established. The Board finds the March 2018 VA medical opinion regarding the etiology of the Veteran’s TMJ to be speculative. The VA examiner inappropriately relied on the absence of post-service medical evidence in rendering his negative opinion. As such, a remand is warranted for a new adequate medical opinion. 3. Entitlement to service connection for right shoulder strain with degenerative arthritis is remanded. The Veteran claims that his right shoulder disability is related to his shoulder injury in service and to lifting objects in service. Indeed, the Veteran’s service treatment records show that the Veteran had problems with his right shoulder during service and afterwards. In January 2018, the Veteran was afforded a VA examination for his shoulder condition. The Veteran was diagnosed with right shoulder strain. The VA examiner opined that it was less likely than not that the Veteran’s right shoulder disability was caused by his military service. The VA examiner reported that he could not confirm the diagnosis of right shoulder arthritis. The medical records were absent for imaging confirming right shoulder arthritis. An x-ray examination performed on the right shoulder in January 2018 was negative/normal. Additionally, right shoulder pain noted in medical records had been associated/attributed to cervical radiculopathy. A nexus had not been established. In June 2018, the Veteran was afforded another VA examination. The Veteran was diagnosed with right shoulder strain and right shoulder osteoarthritis. The VA examiner opined that it was less likely than not that the Veteran’s right shoulder disability was related to his military service. The examiner explained that a review of the available medical records did not reveal an injury to the right shoulder, but a history of cervical radiculopathy. The recent diagnosis of right shoulder arthritis was probably an incidental finding on films while evaluating cervical radiculopathy and would be most likely due to advancing age. The Board finds both the January 2018 and June 2018 VA medical opinions to be inadequate. The January 2018 VA medical opinion is inadequate because the VA examiner found that the Veteran did not have a diagnosis of right shoulder arthritis, when in fact, the Veteran does have such a diagnosis. Also, both medical opinions did not address whether the Veteran’s diagnosed right shoulder strain was related to his naval service. Additionally, the June 2018 VA examiner incorrectly states that the Veteran’s service treatment records did not reveal a right shoulder injury. The Veteran’s service treatment record show complaints of right shoulder pain and on his November 2003 Report of Medical History, the physician noted that the Veteran had a right shoulder strain. Also, the medical opinions did not consider the Veteran’s lay statements that he hurt his right shoulder from lifting objects. The Board finds that a remand is warranted for a new VA medical opinion to address these matters. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records and associate with the claims file. 2. After the above development has been completed, obtain adequate VA medical opinions for the Veteran’s claimed TMJ, right shoulder disability, and tinea pedis/tinea versicolor from an appropriate clinician. If a VA medical opinion cannot be rendered without first examining the Veteran, then appropriate examinations should be scheduled. The entire claims file and a copy of this remand must be made available to the examiner for review. The VA examiner is to answer the following questions: (a.) Whether it is at least as likely as not that the Veteran’s right shoulder disability (to include all diagnoses, such as arthritis and strain) is related to his naval service, to include lifting objects and his in-service complaint of a shoulder strain? (b.) Whether it is at least as likely as not that the Veteran’s TMJ is related to his naval service, to include a motor vehicle accident in which the Veteran sustained dental trauma? (c.) Whether it is at least as likely as not that the Veteran’s tinea pedis/tinea versicolor is related to his naval service? In rendering these opinions, the VA examiner should consider the Veteran’s lay statements regarding the etiology of his disabilities and should not rely on the absence of evidence in forming a negative opinion. A complete rationale for all requested opinions must be provided. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.