Citation Nr: 20033045 Decision Date: 05/12/20 Archive Date: 05/12/20 DOCKET NO. 16-35 705 DATE: May 12, 2020 REMANDED Entitlement to service connection for a dental condition, to include teeth damage and temporomandibular joint dysfunction (TMJ), is remanded. Entitlement to service connection for back degeneration, including as secondary to a dental condition, is remanded. Entitlement to service connection for a left knee condition, including as secondary to a dental condition, is remanded. Entitlement to service connection for sleep apnea, including as secondary to a dental condition, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a dental condition, is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a dental condition, to include teeth damage and TMJ The Veteran contends that he suffers from a dental condition, to include teeth damage and TMJ, as a result of his service. The Veteran claims that he began grinding his teeth in service due to the stress of training to be an air traffic controller (ATC). He claims that he currently suffers from grinding of his teeth (bruxism), gum disease, and TMJ. Additionally, the Veteran contends that his dental condition began in service and has continued since service. See April 2020 Appellate Brief. The Veteran’s military occupational specialty while in service was an ATC operator. The Veteran’s service treatment records show that he had four wisdom teeth and two molars extracted in October 1985. Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These conditions include various problems of the maxilla, mandible, or temporomandibular articulation, loss of whole or part of the ramus, loss of the condyloid process or coronoid process, or loss of the hard palate. See 38 C.F.R. § 4.150, Diagnostic Code 9913. Compensation is also available for the loss of teeth due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis, and is not available in cases where the loss of teeth is a result of periodontal disease since such loss is not considered disabling. Id. However, as the Veteran contends that he suffers from a compensable disability for VA purposes, the Board finds that the Veteran should be provided with a VA examination to determine the nature and etiology of his dental condition, to include teeth damage and TMJ. 2. Entitlement to service connection for back degeneration, including as secondary to a dental condition The Veteran contends that he suffers from a back disability as a result of his service and that he has continued to experience back symptomatology. In the alternative, the Veteran contends that his back disability is secondary to his dental condition. See April 2020 Appellate Brief. The Veteran’s service treatment records show that he was treated for back pain in April 1987. He was diagnosed with a mild strain in the right mid-thoracic trapezius. In May 1987, it was noted that his trapezius spasm had resolved. As noted, the Veteran has alleged that he has continued to experience back pain since service. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for back degeneration because no VA examiner has opined whether the Veteran’s current back complaints are related to his symptoms in service. 3. Entitlement to service connection for a left knee condition, including as secondary to a dental condition The Veteran contends that he suffers from a left knee condition as a result of his service. Specifically, the Veteran claims that he damaged his knee during basic training. He also claims that his duties as an ATC required him to walk up 20 stories of stairs in the control tower, causing his current disability. In the alternative, the Veteran contends that he suffers from a knee disability as a result of his dental condition. Private treatment records from December 2002 indicate that the Veteran was diagnosed with a torn medial meniscus with arthritis in his left knee. The Board cannot make a fully informed decision on the issue of entitlement to service connection for a bilateral knee condition because no VA examiner has opined whether the Veteran’s current knee disability is related to his service. 4. Entitlement to service connection for sleep apnea, including as secondary to a dental condition The Veteran contends that he suffers from sleep apnea as a result of his service. He claims that he was waking up three to four times a night and snoring loudly in service as a result of his shift work. See April 2013 notice of disagreement. In the alternative, the Veteran contends that his sleep apnea is secondary to his dental condition. The Board cannot make a fully informed decision on the issue of entitlement to service connection for sleep apnea because no VA examiner has opined whether the Veteran’s sleep apnea is related to his service. 5. Entitlement to service connection for a mental condition, to include as secondary to a dental condition The Veteran contends that he suffers for a psychiatric disability as a result of his service. Specifically, the Veteran claims that as an ATC, he had a high-stress job because any mistakes he made could have cost someone their life. See April 2013 notice of disagreement. The Veteran also argues that his mental condition is due to shift work in service. In the alternative, the Veteran claims that his mental condition is secondary to his dental condition. The Board cannot make a fully informed decision on the issue of entitlement to service connection for a mental condition because no VA examiner has opined whether the Veteran’s mental condition is related to his service. Finally, the record indicates that the Veteran authorized VA to obtain, in part, his records from West Suburban Dental and Christiana Care Hospital System. While requests for records were sent in October 2010, it does not appear that a second attempt was ever made to obtain these records. The matters are REMANDED for the following action: 1. Contact the Veteran in order to have him identify the names and addresses of all health care providers who have treated him for the issues on appeal. The Veteran should also be notified that he may submit evidence or treatment records to support his claim. The Board is particularly interested the private medical records from West Suburban Dental and Christiana Care Hospital System. The AOJ should attempt to obtain any such records. All efforts to obtain such records should be documented in the claims folder. All available records should be associated with the Veteran’s VA claims folder. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any dental condition, to include teeth damage and TMJ. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. If the Veteran suffers from loss of teeth, please comment on whether this is due to loss of substance of the body of the maxilla or mandible due to trauma or disease such as osteomyelitis or is a result of periodontal disease. For any other identified dental disability, the examiner should opine on whether it is at least as likely as not (50 percent or greater) that any disability had causal origins in service or is otherwise related to the Veteran’s active duty service. A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any back disability. The examiner must provide an opinion regarding the following: a) Is it at least as likely as not that the Veteran suffers from a back disability that is related to an in-service injury, event, or disease, including his mild strain in the right mid-thoracic trapezius in April 1987? b) If service connection is warranted for a dental condition, is at least as likely as not that the Veteran’s back disability is (1) proximately due his dental condition, or (2) aggravated beyond its natural progression by his dental condition? A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left knee disability. The examiner must provide an opinion regarding the following: a) Is it at least as likely as not that the Veteran suffers from a left knee disability that is related to an in-service injury, event, or disease? b) If service connection is warranted for a dental condition, is at least as likely as not that the Veteran’s left or right knee disability is (1) proximately due his dental condition, or (2) aggravated beyond its natural progression by his dental condition? A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed sleep apnea. The examiner must provide an opinion regarding the following: a) Is it at least as likely as not that the Veteran suffers from sleep apnea that is related to an in-service injury, event, or disease? b) If service connection is warranted for a dental condition, is at least as likely as not that the Veteran’s claimed sleep apnea is (1) proximately due his dental condition, or (2) aggravated beyond its natural progression by his dental condition? A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any acquired psychiatric disorder. The examiner must provide an opinion regarding the following: a) Is it at least as likely as not that the Veteran suffers from a mental condition that is related to an in-service injury, event, or disease? b) If service connection is warranted for a dental condition, is at least as likely as not that the Veteran’s mental condition is (1) proximately due his dental condition, or (2) aggravated beyond its natural progression by his dental condition? A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran’s medical history and the relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morrad, 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.