Citation Nr: 20034498 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 11-10 096 DATE: May 18, 2020 THE ISSUES 1. Entitlement to service connection for a mental incapacitation disability, to include as secondary to Agent Orange and/or toxic chemical exposure. 2. Entitlement to service connection for brittle teeth, to include as secondary to Agent Orange and/or toxic chemical exposure or a mental incapacitation disability. REMANDED Entitlement to service connection for a mental incapacitation disability, to include as secondary to Agent Orange and/or toxic chemical exposure, is remanded. Entitlement to service connection for brittle teeth, to include as secondary to Agent Orange and/or toxic chemical exposure or a mental incapacitation disability, is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Air Force from June 1983 to December 1983, and on multiple periods of active duty for training (ACDUTRA) until September 1987 and inactive duty for training (INACDUTRA) until February 1988. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. Jurisdiction of this matter has since transferred to the RO in Los Angeles, California. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing in October 2014. A transcript of that hearing has been associated with the claims file. In April 2015, the Board found there was new and material evidence to reopen the claim for service connection for mental incapacitation. All of the above matters were remanded to the RO for further development. These matters were last before the Board in June 2017, and November 2018, at which time they were again remanded for further development. In the November 2018 Bord decision, the Board also remanded the issue of entitlement to service connection for a neck disability. The Veteran was granted service for a neck disability in a March 2020 rating decision, and that issue is no longer before the Board. Although the Board regrets the further delay, it finds that an additional remand is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a mental incapacitation disability, to include as secondary to Agent Orange and/or toxic chemical exposure, is remanded. In its November 2018 decision, the Board remanded this matter to obtain new VA examination and opinion. Specifically, the Board noted that an August 2005 treatment record from Dr. J. A. H. of the Holiner Psychiatric Group noted the Veteran being diagnosed with paranoid schizophrenia and further noted the Veteran as being psychotic. The Board found that this, and other treatment records from Holiner Psychiatric were not discussed in the prior February 2018 VA opinion which indicated to the Board that the examiner did not fully review the Veteran’s claims file. The Board, therefore, remanded for a new VA examination and opinion, asking the examiner to opine as to whether the psychiatric disability at least as likely as not (1) began during active service or (2) was noted during service with continuity of the same symptomatology since service. The Veteran was afforded a VA examination in October 2019. The examiner found “the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.” While the October 2019 VA examiner’s rationale discussed the fact that there was no evidence the Veteran had been exposed to chemicals, the examiner did not actually explain if the Veteran’s mental condition began during service or was noted during service with continuity of the same symptomatology since service. Indeed, the examiner appears to indicate that the Veteran had been complaining of a “WWII mite burrowed in [her posterior]” since 1984. Additionally, the October 2019 VA examiner did not address the above-mentioned medical treatment records from Holiner Psychiatric. Therefore, the Board finds a remand is necessary to obtain an addendum opinion which complies with its November 2018 remand directives, and to clarify whether the Veteran had a mental incapacity in service or whether such mental incapacity was noted during service with continuity of the same symptomatology. See Stegall, 11 Vet. App. 268 (1998). 2. Entitlement to service connection for brittle teeth, to include as secondary to Agent Orange and/or toxic chemical exposure or a mental incapacitation disability, is remanded. The Veteran was afforded a VA oral and dental conditions examination in February 2018. It was noted that the Veteran has been diagnosed with anterior chipped teeth on incisor and bruxism. The chipped incisors noted on the examination were described as being due to bruxism from stress. The Board notes that this finding raises the issue of whether the Veteran's bruxism from stress is secondary to the Veteran's asserted mental incapacity claim. As such, because a decision on the issue of entitlement to service connection for mental incapacity could significantly impact a decision on entitlement to service connection for brittle teeth, the issues are inextricably intertwined, and a remand is required. The matters are REMANDED for the following action: 1. Obtain any outstanding and relevant VA or private treatment records. Should such exist, associate them with the claims folder. After completing the aforementioned, return the Veteran’s electronic claims file to the examiner who conducted the October 2019 VA examination for the purpose of obtaining an addendum medical opinion. If the requested examiner is no longer available, another appropriate examiner should be asked to review the electronic file and answer the questions posed below. If the clinician determines that another examination is needed, the Veteran should be scheduled for a new examination (or telehealth interview). The examination report must reflect that review of the claims folder occurred, to include the additional records and a copy of this remand. The examiner must opine whether the Veteran’s mental incapacitation is at least as likely as not related to an in-service injury, event, or disease. The examiner must opine as to whether it at least as likely as not (1) began during active service or (2) was noted during service with continuity of the same symptomatology since service. The examiner is asked to discuss treatment records from Holiner Psychiatric, including an August 2005 treatment record from Dr. J. A. H., which indicated a diagnosis of paranoid schizophrenia and further noted the Veteran as being psychotic. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. 2. After completing the requested actions, and any additional development deemed warranted, readjudicate the claims in light of all pertinent evidence and legal authority, including the inextricably intertwined issue of entitlement to service connection for brittle teeth. If the benefits sought remain denied, furnish to the Veteran a Supplemental Statement of the Case and afford appropriate time for response before the claims file is returned to the Board for further appellate consideration Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. E. Geary, 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.