Citation Nr: 20060232 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 20-14 717 DATE: September 14, 2020 ORDER New and material evidence has been submitted and the claim for service connection for hypertension is reopened; to this extent only, the claim is granted. New and material evidence having not been received, the petition to reopen the claim for service connection for arthritis (also claimed as legs-both, right hip bad, painful) is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for gout is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for bilateral eye viruses is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for diabetes mellitus is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for a lumbar spine disability is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for prostate cancer is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for residuals of asbestos exposure, including respiratory problems is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for lung cancer is denied. New and material evidence having not been received, the petition to reopen the claim for service connection for sinusitis is denied. Entitlement to service connection for loss of teeth is denied. REMANDED Entitlement to service connection for hypertension, to include as due to the service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to an increased disability rating in excess of 70 percent for the service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. FINDINGS OF FACT 1. A July 2016 rating decision reopened the Veteran’s claim for service connection for hypertension but denied the claim on the merits; the Veteran did not perfect an appeal or submit new and material evidence within the appeal period, and the July 2016 rating decision is final. 2. Evidence received since the previous final denial is new and relates to an unestablished fact necessary to substantiate the claim for service connection for hypertension. 3. A February 2008 rating decision denied the claims of entitlement to service connection for arthritis and gout; the Veteran did not perfect an appeal or submit new and material evidence within the appeal period, and the February 2008 rating decision is final. 4. Evidence added to the record since the February 2008 final denial, when considered with previous evidence, does not relate to an unestablished fact necessary to substantiate the claims and/or raise a reasonable possibility of substantiating the claims for service connection for arthritis and/or gout. 5. An October 2010 rating decision denied the claim of entitlement to service connection for bilateral eye viruses; the Veteran did not perfect an appeal or submit new and material evidence within the appeal period, and the October 2010 rating decision is final. 6. Evidence added to the record since the October 2010 final denial, when considered with previous evidence, does not relate to an unestablished fact necessary to substantiate the claim and/or raise a reasonable possibility of substantiating the claim for service connection for bilateral eye viruses. 7. A July 2016 rating decision reopened the Veteran’s claims for service connection for diabetes mellitus, a lumbar spine disability, prostate cancer, residuals of asbestos exposure (including sinus and respiratory problems), lung cancer, and sinusitis but denied the claim on the merits; the Veteran did not perfect an appeal or submit new and material evidence within the appeal period, and the July 2016 rating decision is final. 8. Evidence added to the record since the July 2016 final denial, when considered with previous evidence, does not relate to an unestablished fact necessary to substantiate the claims and/or raise a reasonable possibility of substantiating the claims for service connection for diabetes mellitus, a lumbar spine disability, prostate cancer, residuals of asbestos exposure (including sinus and respiratory problems), lung cancer, and sinusitis. 9. The most probative evidence of record does not show that the Veteran lost any teeth due to bone loss of the body of the maxilla or the mandible as a result of trauma or disease during service. CONCLUSIONS OF LAW 1. The July 2016 rating decision is final with respect to the Veteran’s claim to establish service connection for hypertension; new and material evidence has been received to reopen the claim of service connection for hypertension. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. § 3.156. 2. The February 2008 rating decision is final with respect to the Veteran’s claims to establish service connection for arthritis and/or gout; new and material evidence has not been received to reopen the claims for service connection for arthritis and/or gout. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. § 3.156. 3. The October 2010 rating decision is final with respect to the Veteran’s claim to establish service connection for bilateral eye viruses; new and material evidence has not been received to reopen the claim for service connection for bilateral eye viruses. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. § 3.156. 4. The July 2016 rating decision is final with respect to the Veteran’s claims to establish service connection for diabetes mellitus, a lumbar spine disability, prostate cancer, residuals of asbestos exposure (including sinus and respiratory problems), lung cancer, and sinusitis; new and material evidence has not been received to reopen the claims for service connection for diabetes mellitus, a lumbar spine disability, prostate cancer, residuals of asbestos exposure (including sinus and respiratory problems), lung cancer, and/or sinusitis. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. § 3.156. 5. The criteria for establishing service connection for loss of teeth for VA compensation purposes is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.381, 4.150. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from June 1946 to April 1948 and in the U.S. Air Force from November 1949 to October 16, 1953 and from October 21, 1953 to November 1960. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). New and Material Evidence Generally, if a claim of entitlement to service connection has been previously denied and that decision became final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. The threshold to reopen the claim is low. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). For the purpose of establishing whether new and material evidence has been received, the credibility of the evidence, not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). 1. New and material evidence has been received to reopen the claim for service connection for hypertension. In a May 1988 rating decision, the RO denied service connection for hypertension based upon a finding that hypertension was not shown in service or within one year after separation from service. In December 2015, the Veteran requested to reopen his claim of service connection for hypertension. In a July 2016 rating decision, the RO reopened the claim for hypertension but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). In March 2018, the Veteran submitted the present claim for service connection for hypertension, which was denied in a September 2018 rating decision. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Upon review of the record, the Board finds that evidence received since the July 2016 rating decision includes evidence that is new and material to the claim for service connection for hypertension. For example, a December 2019 VA examination diagnosed hypertension since 1970 and the examiner provided a negative nexus opinion for both direct and secondary service connection. This evidence contributes to a more complete picture of the Veteran’s disability. As such, the claim for service connection for hypertension is reopened. See Shade, 24 Vet. App. at 118. 2. New and material evidence has not been received to reopen the claim for service connection for arthritis (also claimed as legs-both, right hip bad, painful). The Veteran’s claim for of service connection for arthritis was initially denied by the RO in a February 2008 rating decision. The Veteran was provided notice of the decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for arthritis. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the February 2008 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The February 2008 rating decision denied the Veteran service connection for arthritis on the basis that there was no evidence that the Veteran’s arthritis occurred during or was otherwise related to service or manifested to a compensable degree within one year after separation from service. Evidence added to the record since the February 2008 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document arthritis. However, new and material evidence showing that the Veteran has arthritis as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for arthritis does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed arthritis to military service. Since new and material evidence has not been received, the previously denied claim for service connection for arthritis is not reopened, and the appeal concerning the claim is denied. 3. New and material evidence has not been received to reopen the claim for service connection for bilateral eye viruses. The Veteran’s claim for of service connection for bilateral eye viruses was initially denied by the RO in an October 2010 rating decision. The Veteran was provided notice of the decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for bilateral eye viruses. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the October 2010 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The October 2010 rating decision denied the Veteran service connection for bilateral eye viruses on the basis that there was no evidence that the Veteran’s condition occurred during or was caused by service. Evidence added to the record since the October 2010 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document treatment for a bilateral eye condition. However, new and material evidence showing that the Veteran has bilateral eye viruses as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for bilateral eye viruses does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed bilateral eye viruses to military service. Since new and material evidence has not been received, the previously denied claim for service connection for bilateral eye viruses is not reopened, and the appeal concerning the claim is denied. 4. New and material evidence has not been received to reopen the claim for service connection for gout. The Veteran’s claim for of service connection for gout was initially denied by the RO by way of a February 2008 rating decision. The Veteran was provided notice of the decision and his appellate rights but did not appeal the decision or submit new and material evidence within one year of the decision. Therefore, the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for gout. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the February 2008 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The February 2008 rating decision denied the Veteran service connection for gout on the basis that there was no evidence that the Veteran’s gout occurred during service or is otherwise related to his service. Evidence added to the record since the February 2008 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document gout. However, new and material evidence showing that the Veteran has gout as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for gout does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed gout to military service. Since new and material evidence has not been received, the previously denied claim for service connection for gout is not reopened, and the appeal concerning the claim is denied. 5. New and material evidence has not been received to reopen the claim for service connection for diabetes mellitus. In a February 2008 rating decision, the RO denied service connection for diabetes mellitus based upon a finding that diabetes mellitus was not shown in service or within one year after separation from service and that there was no evidence to confirm radiation exposure or that diabetes is associated with such exposure. In December 2010, the Veteran requested to reopen his claim of service connection for diabetes. In a February 2011 rating decision, the RO declined to reopen the claim for diabetes as no new and material evidence had been submitted. In December 2015, the Veteran requested to reopen his claim of service connection for diabetes. In a July 2016 rating decision, the RO reopened the claim for diabetes but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for diabetes. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for diabetes on the basis that there was no evidence that the Veteran’s diabetes occurred during service or was otherwise aggravated by his service. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document diabetes. However, new and material evidence showing that the Veteran has diabetes as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for diabetes does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed diabetes to military service. Since new and material evidence has not been received, the previously denied claim for service connection for diabetes is not reopened, and the appeal concerning the claim is denied. 6. New and material evidence has not been received to reopen the claim for service connection for a lumbar spine disability. In a November 1976 rating decision, the RO originally denied service connection for a back disability on the basis that his current back issues were not shown to be related to incidents in service. In December 2015, the Veteran requested to reopen his claim of service connection for a back disability. In a July 2016 rating decision, the RO reopened the claim for a back disability but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for a back disability. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for a back disability on the basis that there was no evidence that the Veteran’s back disability was incurred in or aggravated by his service. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document a lumbar spine disability. However, new and material evidence showing that the Veteran has a back disability as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for a back disability does not relate to the bases of the prior denial. Specifically, the evidence does not relate the diagnosed back disability to military service. Since new and material evidence has not been received, the previously denied claim for service connection for a back disability is not reopened, and the appeal concerning the claim is denied. 7. New and material evidence has not been received to reopen the claim for service connection for prostate cancer. In a February 2008 rating decision, the RO denied service connection for prostate cancer based upon a finding that prostate cancer was not shown in service or within one year after separation from service nor was there evidence to confirm radiation exposure. In December 2015, the Veteran requested to reopen his claim of service connection for prostate cancer. In a July 2016 rating decision, the RO reopened the claim for prostate cancer but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for prostate cancer. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for prostate cancer on the basis that there was no evidence that the Veteran’s prostate cancer was incurred in service, manifested to a compensable degree within one year after service or that it was related to exposure to ionizing radiation. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document prostate cancer. However, new and material evidence showing that the Veteran has prostate cancer as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for prostate cancer does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed prostate cancer to military service, to include exposure to ionizing radiation therein. Since new and material evidence has not been received, the previously denied claim for service connection for prostate cancer is not reopened, and the appeal concerning the claim is denied. 8. New and material evidence has not been received to reopen the claim for service connection for residuals of asbestos exposure, including respiratory problems. In a March 1999 rating decision, the RO denied service connection for residuals from asbestos exposure, including respiratory problems based upon a finding that the Veteran failed to establish a well-grounded claim as the evidence failed to confirm exposure to asbestos, show a chronic disorder occurred in service or show a relationship between the Veteran’s respiratory problems and his service, to include asbestos exposure therein. In December 2015, the Veteran requested to reopen his claim of service connection for residuals of asbestos exposure. In a July 2016 rating decision, the RO reopened the claim for residuals of asbestos exposure but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for residuals of asbestos exposure. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for residuals of asbestos exposure on the basis that there was no evidence that the Veteran’s residuals of asbestos exposure, including respiratory problems was incurred in or aggravated by his service. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document respiratory problems. However, new and material evidence showing that the Veteran has residuals of asbestos exposure, including respiratory problems as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for residuals of asbestos exposure does not relate to the bases of the prior denial. Specifically, the evidence does not relate the diagnosed respiratory problems to military service, to include asbestos exposure therein. Since new and material evidence has not been received, the previously denied claim for service connection for residuals of asbestos exposure, including respiratory problems is not reopened, and the appeal concerning the claim is denied. 9. New and material evidence has not been received to reopen the claim for service connection for lung cancer. In a February 2008 rating decision, the RO denied service connection for lung cancer based upon a finding that lung cancer was not shown in service or within one year after separation from service. In December 2015, the Veteran requested to reopen his claim of service connection for lung cancer. In a July 2016 rating decision, the RO reopened the claim for lung cancer but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362. In March 2018, the Veteran submitted the present claim for service connection for lung cancer. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for lung cancer on the basis that there was no evidence that the Veteran’s lung cancer was incurred in or aggravated by service. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document lung cancer. However, new and material evidence showing that the Veteran has lung cancer as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for lung cancer does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed lung cancer to military service. Since new and material evidence has not been received, the previously denied claim for service connection for lung cancer is not reopened, and the appeal concerning the claim is denied. 10. New and material evidence has not been received to reopen the claim for service connection for sinusitis. In a March 1977 rating decision, the RO denied service connection for sinusitis based upon a finding that the evidence failed to show chronic sinusitis. In December 2015, the Veteran requested to reopen his claim of service connection for sinusitis. In a July 2016 rating decision, the RO reopened the claim for sinusitis but denied it on the merits. The Veteran did not appeal the rating decision or submit new and material evidence within one year of the decision, and the decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 3.156, 20.302, 20.1103; see also Bond, 659 F.3d at 1362]. In March 2018, the Veteran submitted the present claim for service connection for sinusitis. In the September 2018 rating decision that is the subject of this appeal, the RO declined to reopen the claim and continued the denial issued in the July 2016 final rating decision. Regardless of the RO’s actions, the Board has a jurisdictional responsibility to consider whether it is proper for that claim to be reopened before addressing the merits of that claim. See Jackson, 265 F.3d at 1369. The July 2016 rating decision denied the Veteran service connection for sinusitis on the basis that there was no evidence that the Veteran’s sinusitis was incurred in or aggravated by his service. Evidence added to the record since the July 2016 rating decision includes the Veteran’s lay statements, the representative’s brief, and both VA and private treatment records, which do document sinusitis. However, new and material evidence showing that the Veteran has sinusitis as a result of service has not been submitted. In short, the evidence submitted since the prior final denial of the claim for service connection for sinusitis does not relate to the bases of the prior denial. Specifically, the evidence does not relate diagnosed sinusitis to military service. Since new and material evidence has not been received, the previously denied claim for service connection for sinusitis is not reopened, and the appeal concerning the claim is denied. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Evidence of continuity of symptomatology from the time of service to the present is required where the chronicity of a chronic condition manifested during service either has not been established or might reasonably be questioned. 38 C.F.R. § 3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1340 (Fed. Cir. 2013) (holding that only conditions listed as chronic diseases in 38 C.F.R. § 3.309(a) may be considered for service connection under 38 C.F.R. § 3.303(b)). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 11. Entitlement to service connection for loss of teeth is denied. Service connection for dental disabilities for compensation purposes is only available for dental disabilities that are the result of osteomyelitis or osteoradionecrosis, or due to the loss, malunion, or limited motion of the mandible, maxilla, ramus, condyloid process, or hard palate, or due to the loss of teeth due to loss of substance of the upper or lower jaw. 38 C.F.R. § 4.150. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). Compensation is not available for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease. 38 C.F.R. § 3.381. The Veteran contends that his loss of teeth is due to service, to include a May 1953 injury to his face where he sustained an abrasion from shrapnel for which he was awarded the Purple Heart Medal. The Board notes the Veteran has been awarded the Purple Heart medal, indicative of combat participation. Pursuant to 38 U.S.C. § 1154(b), with respect to combat veterans, “[VA] shall accept as sufficient proof of service- connection... satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions and hardships of such service... Service-connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary.” See also 38 C.F.R. § 3.304(d). However, 38 U.S.C. § 1154(b), can only be used to provide a factual basis upon which a determination could be made that a particular disease or injury was incurred or aggravated in service, not to link the claimed disorder etiologically to the current disorder. See Libertine v. Brown, 9 Vet. App. 521, 522- 23 (1996). 38 U.S.C. § 1154(b) does not establish service connection for a combat veteran; it aids him or her by relaxing the adjudicative evidentiary requirements for determining what happened in service. See Wade v. West, 11 Vet. App. 302, 305 (1998) (holding that “a combat veteran who has successfully established the in-service occurrence or aggravation of an injury pursuant to § 1154(b), must still submit sufficient evidence of a causal nexus between that in-service event and his or her current disability”). A veteran must still generally establish the claim by competent medical evidence tending to show a current disability and a nexus between that disability and those service events. See Gregory v. Brown, 8 Vet. App. 563, 567 (1996). The Veteran’s service treatment records show that in December 1946 he received fillings for teeth #18 and 31. In June 1947, tooth #19 was extracted. In September 1951 the Veteran was diagnosed with pulpitis of tooth #18. A September 1951 dental examination revealed that space for tooth #30 partially closed and the Veteran had slight calculus, no periodontoclasia or stomatitis, and needed a partial lower denture. In November 1951, he underwent abscess dentoalveolar for tooth #12. A November 1951 dental examination indicates that the Veteran had slight calculus and needed a partial lower denture. In March 1952, teeth #18, 19 and 30 were noted as missing and the Veteran was impressed for a lower partial denture, which was thereafter inserted in April 1952. In July 1952, the Veteran had pulpitis of tooth #32. In October 1956, the Veteran presented to the emergency room for a tooth ache. The Veteran’s November 1960 separation dental examination revealed moderate calculus. The Veteran underwent VA examination in April 2018 and the Veteran reported no dental care was provided while in war and stated that the food and water were bad. The examiner noted that the Veteran’s remaining lower teeth were extracted more recently. The examiner diagnosed loss of teeth and reported the Veteran was currently missing all of his teeth (#1-32). However, the examiner reported that the Veteran’s loss of teeth was not due to loss of substance of body of maxilla or mandible nor was the loss of teeth due to trauma or disease (such as osteomyelitis). The examiner stated that the masticatory surfaces could be restored by suitable prosthesis with implant retained or supported lower denture. Upon review of the record, the Board concludes that service connection for loss of teeth for VA compensation purposes is not warranted. As the Veteran does not have the type of dental condition for which compensation is payable, his claim must be denied. The Board has carefully considered the Veteran’s contention that he sustained dental trauma in service that resulted in loss of his teeth, and that he should be compensated accordingly. Regarding whether such an injury was actually sustained in service, the Board need not address the credibility of this assertion, as it is ultimately not germane to the claim. The Board acknowledges that the Veteran had combat service and was awarded the Purple Heart medal for injuries sustained therein. Thus, his lay assertions regarding a shrapnel wound to the area of the mouth are accepted by the Board as true and credible lay evidence. However, even acknowledging a loss of the teeth due to trauma during service, because there is no evidence to show that the loss of such teeth was due to bone loss of the maxilla or mandible, the Veteran’s loss of teeth is not compensable under the provisions in 38 C.F.R. § 4.150. In sum, the preponderance of the evidence is against the claim of service connection of loss of teeth for VA compensation purposes ss the Veteran has not been diagnosed with a dental disability for which compensation be granted. Accordingly, the claim for service connection for a dental disability (claimed as loss of teeth) for compensation purposes must be denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board is sympathetic to the Veteran and is grateful for his honorable service. However, given the record before it, the Board finds that evidence in this case does not reach the level of equipoise. See 38 U.S.C. § 5107(a) (“[A] claimant has the responsibility to present and support a claim for benefits....”); Fagan v. Shinseki, 573 F.3d 1282, 1286 (Fed. Cir. 2009) (stating that the claimant has the burden to “present and support a claim for benefits” and noting that the benefit of the doubt standard in section 5107(b) is not applicable based on pure speculation or remote possibility); Skoczen v. Shinseki, 564 F.3d 1319, 1323-29 (Fed. Cir. 2009) (interpreting section 5107(a) to obligate a claimant to provide an evidentiary basis for his or her benefits claim, consistent with VA’s duty to assist, and recognizing that “[w]hether submitted by the claimant or VA... the evidence must rise to the requisite level set forth in section 5107(b),” requiring an approximate balance of positive and negative evidence regarding any issue material to the determination). REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as due to the service-connected posttraumatic stress disorder (PTSD) is remanded. The Veteran claims that his hypertension is related to service, or alternatively, to his service-connected PTSD. As mentioned, the Veteran underwent VA examination in December 2019 and the examiner provided negative nexus opinions as the claim for hypertension pertained to direct service connection and partial secondary service connection. In this regard, while the VA examiner addressed whether the Veteran’s hypertension was caused by his service-connected PTSD, the examiner did not provide an opinion as to whether such was aggravated by his PTSD. Accordingly, remand is required so that the question of aggravation may be answered. 2. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran underwent VA audiology examination in April 2018 and the examiner diagnosed bilateral hearing loss. The examiner also provided a negative nexus opinion regarding whether the Veteran’s bilateral hearing loss was related to service based on the fact that the Veteran’s in-service audiometric examinations do not indicate there was any hearing loss as of his separation from service. However, the Board notes that the absence of a hearing loss in service is not fatal to a claim of service connection for hearing loss (see Hensley v. Brown, 5 Vet. App. 155, 159 (1993)). In light of the above, the Board finds that development for a fully adequate opinion is necessary upon remand. 3. Entitlement to service connection for a cervical spine disability is remanded. The Veteran claims his cervical spine disability (claimed as degenerative arthritis of the cervical spine) results from a May 1953 in-service incident wherein he was sustained an abrasion on his upper lip by a physical empty cartridge and for which he was awarded the Purple Heart Medal for his wounds received while serving in action against an enemy of the United States. The Veteran has not undergone VA cervical spine examination in connection with his claim and the Board finds upon remand, such should be scheduled. 4. Entitlement to an increased disability rating in excess of 70 percent for the service-connected posttraumatic stress disorder (PTSD) is remanded. The Veteran last underwent VA PTSD examination in April 2018. Per the June 2020 representative’s brief, the representative stated the Veteran contends that his PTSD is more severe than the current 70 percent rating provides and believes a total rating should be awarded. In light of the above, the Board finds that the record as is may not accurately reflect the current severity of the Veteran’s PTSD. Accordingly, the Board finds that the Veteran should be scheduled for VA PTSD examination upon remand. 5. Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded. The Veteran contends that he is entitled to SMC based on the need for aid an attendance due to in part to chronic pain and depressive disorder. The Board notes that the Veteran is service-connected for PTSD and bilateral foot and hand cold injury residuals. In July 2018, the Veteran submitted VA examination for housebound status or permanent need for regular aid and attendance which was completed by his VA provider, E.F., who reported the Veteran was able to feed himself and prepare his own meals. E.F. further reported that the Veteran did not need assistance in bathing and tending to hygiene needs, was not legally blind, did not require nursing home care, did not require medication management and was able to manage his own financial affairs. The VA provider then stated that the Veteran needed assistance in his activities of daily living. In June 2020, the Veteran submitted a statement that his wife helps dress him, aids in bathing him and does all the cooking and cleaning. In light of the fact that the July 2018 VA provider reported contradicting information coupled with the Veteran’s 2020 statement and the fact that the his claim for an increased rating for his PTSD is being remanded herein, the Board finds the Veteran should be scheduled for a new VA examination for housebound status or permanent need for regular aid and attendance upon remand. Updated treatment records should also be obtained. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. After the above record development is completed, send the Veteran’s claims file to the December 2019 VA examiner, if available, to obtain an addendum opinion to determine if the Veteran’s hypertension is aggravated by his service-connected PTSD. If a new examination is required in order to respond to the request, such should be scheduled. Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s hypertension is worsened beyond natural progression (aggravated) by his service-connected PTSD? Please explain why or why not, to include explaining the significance, if any, of the lay statements of the Veteran and his family. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that a claimed disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. 3. Arrange for the Veteran’s record to be sent to the April 2018 VA audiologist, if available, to obtain an addendum medical opinion regarding the etiology of the Veteran’s bilateral hearing loss. If further examination and/or interview of the Veteran is deemed necessary for an opinion sought, such should be arranged. The consulting provider should respond to the following: Following review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current bilateral hearing loss arose during service or is otherwise related to service. Please explain why or why not, to include explaining why the Veteran’s hearing loss is/is not a delayed response to in-service noise exposure. 4. Schedule the Veteran should for a VA cervical spine examination to determine the nature of his cervical spine disability and to obtain an opinion as to whether such is possibly related to service. The claims file should be reviewed by the examiner in conjunction with the examination. All necessary tests should be conducted, and the results reported. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current cervical spine disability arose during service or is otherwise related to service. Please explain why or why not, to include addressing the May 1953 in-service incident where the Veteran was hit with a physical empty cartridge, which he states is the cause of his cervical spine disability. 5. Schedule the Veteran for a VA PTSD examination to determine the current severity of the service-connected PTSD. The claims file should be reviewed by the examiner. All necessary tests should be performed, and the results reported. All symptomatology associated with the PTSD should be reported. 6. Schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine if he meets the requirement for aid and attendance due solely to his service-connected disabilities. All pertinent evidence of record must be made available to the examiner for review. Any indicated studies should be performed. The examiner must address whether it is at least as likely as not that, due only to his service-connected disabilities, the Veteran is unable to dress or undress himself; is unable to keep himself ordinarily clean and presentable; requires frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; is unable to feed himself through loss of coordination of the upper extremities or through extreme weakness; is unable to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect a claimant from the hazards or dangers incident to his daily environment. (Continued on the next page)   A complete rationale for all opinions should be provided. The examiner should address the lay statement from the Veteran and his wife and the medical evidence of record, including the July 2018 VA examination for housebound status or permanent need for regular aid and attendance. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Medina, 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.