Citation Nr: 20046763 Decision Date: 07/13/20 Archive Date: 07/13/20 DOCKET NO. 12-02 580 DATE: July 13, 2020 REMANDED Service connection for trigeminal neuralgia is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Marine Corps from January 1970 to January 1972. This matter comes to the Board of Veterans’ Affairs (Board) on appeal from an October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in October 2013, and a transcript of the hearing is of record. The Veteran also testified at a personal hearing before a Decision Review Officer (DRO) in January 2013, and a transcript of the hearing is also of record. This matter was previously before the Board, and, in October 2013 and in July 2018, the Board remanded this matter for further development. (CONTINUED ON NEXT PAGE) Service connection for trigeminal neuralgia is remanded. At issue is whether the Veteran is entitled to service connection for trigeminal neuralgia. Unfortunately, this matter must be remanded for further development. In July 2018, the Board remanded this matter for a VA examination in order to address the following: (a) whether the Veteran’s claimed disability was related to an in-service incurrence to include teeth extraction; (b) in the event that the Veteran’s claimed disability was due to a dental condition, whether the dental condition was related to any dental or head trauma sustained in-service; and (c) in the event that clear and unmistakable evidence established that the Veteran’s claimed disability pre-existed service, whether clear and unmistakable evidence established that the Veteran’s disability was NOT aggravated by a period of service. Additionally, the examiner was specifically instructed to address the following medical literature: Maria Penarrocha, David Penarrocha, Jose Bagan, & Miguel Penarrocha, Post-traumatic Trigeminal Neuropathy: A Study of 63 Cases, Med Oral Patol Oral Cir Bucal 2012 Mar 1,17 (2) e297-300 (2011); Trigeminal Neuralgia Fact Sheet: National Institute of Neurological Disorders and Stroke, National Institute of Health (last updated February 23, 2015), http:/www.ninds.nih. gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm; and J Stephen Huff, Rick Kulkami, et. al., Trigeminal Neuralgia in Emergency Medicine, MedScape Reference: Drugs, Diseases, and Procedure (last updated April 25, 2014), http://emedicine.medscape.com/article/794402-overview. The Veteran underwent a VA examination in May 2019. The examiner opined that the Veteran’s claimed disabilities were not related to any in-service incurrence or a dental condition related to a period of service. Nevertheless, the examiner failed to discuss any of the pertinent medical literature. Additionally, the examination report was silent on whether or not clear and unmistakable evidence demonstrated that the Veteran’s claimed conditions preexisted a period of service or whether or not it was aggravated by a period of service. Therefore, the examination was not in substantial compliance with the Board’s previous remand instructions, and this matter must be remanded for a new VA examination. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to discuss the following: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between any facial nerve disorder or dental condition and an in-service injury, event, or disease, including documented teeth extractions in 1970? Why or why not? (b.) If the Veteran has a facial nerve disorder that is related to a dental condition, then the examiner should opine on whether it is at least as likely as not (50 percent or more) that the dental condition is related to any dental is related to dental trauma or head trauma during active service. The examiner should also discuss why or why not this is the case. (c.) Is it clear and unmistakable (obvious or manifest) that either a nerve disorder or a dental disorder pre-existed service? Why or why not? In answering this question the examiner should keep in mind that “clear and unmistakable” means so much evidence as to be obvious or manifest and is a much higher standard of evidence then “as likely as not” which mere means an even balance of evidence for and against. Any statement that uses the phrases “at least as likely as not,” “less likely than not,” or any phrase with similar wording is unresponsive to this question. (d.) Is it clear and unmistakable (obvious or manifest) that any pre-existing nerve or dental disorder was NOT aggravated by a period of service? Why or why not? In answering this question the examiner should keep in mind that “clear and unmistakable” means so much evidence as to be obvious or manifest and is a much higher standard of evidence then “as likely as not” which mere means an even balance of evidence for and against. Any statement that uses the phrases “at least as likely as not,” “less likely than not,” or any phrase with any similar wording is unresponsive to this question. (e.) What is the medical significance, if any, of the following medical literature: Maria Penarrocha, David Penarrocha, Jose Bagan, & Miguel Penarrocha, Post-traumatic Trigeminal Neuropathy: A Study of 63 Cases, Med Oral Patol Oral Cir Bucal 2012 Mar 1,17 (2) e297-300 (2011)? Why? This medical literature is available in the Veterans Benefits Management System (VBMS) (Receipt Date: May 5, 2015; Document Type: Web/HTML Documents; Subject: Evidence for Appeal; Pages 1-4 out of 13 pages). (f.) What is the medical significance, if any, of the following medical literature: Trigeminal Neuralgia Fact Sheet: National Institute of Neurological Disorders and Stroke, National Institute of Health (last updated February 23, 2015), http:/www.ninds. nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm? Why? This medical literature is available in VBMS (Receipt Date: May 5, 2015; Document Type: Web/HTML Documents; Subject: Evidence for Appeal; Pages 5-11 out of 13 pages). (g.) What is the medical significance, if any, of the following medical literature: J Stephen Huff, Rick Kulkami, et. al., Trigeminal Neuralgia in Emergency Medicine, MedScape Reference: Drugs, Diseases, and Procedure (last updated April 25, 2014), http://emedicine.medscape.com/ article/794402-overview? Why? This medical literature is available in VBMS (Receipt Date: May 5, 2015; Document Type: Web/HTML Documents; Subject: Evidence for Appeal; Pages 12-13 out of 13 pages)? DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David R. Seaton, 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.