Citation Nr: 21061794 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 18-46 291 DATE: October 5, 2021 REMANDED Service connection for a facial deformity (claimed as residuals of dental surgery) is remanded. REASONS FOR REMAND Service connection for a facial deformity (claimed as residuals of dental surgery or facial indentation) is remanded. The Veteran served on active duty from January 1966 to December 1967. This matter is on appeal from an August 2017 rating decision issued by the Regional Office (RO). The Veteran testified in San Juan, Puerto Rico, at a Board videoconference hearing in January 2019 before the undersigned Veterans Law Judge. The hearing transcript has been associated with the record. In a June 2019 Board decision, the Board remanded the issues of service connection for a noncompensable dental disorder for the loss of tooth #3 due to caries for the purpose of obtaining VA dental examinations and outpatient dental treatment under 38 C.F.R. § 17.161 and service connection for facial deformity (claimed as residuals of dental surgery). The Board remanded in order to send notice to the Veteran to inform him of the relevant dental regulations outlining the requirements to receive service connection for dental treatment purposes under 38 C.F.R. § 17.161, then directed VHA to adjudicate Class eligibility in the first instance under 38 C.F.R. § 3.381 (effective February 29, 2012). See 38 C.F.R. § 17.161. The Board also remanded in order to schedule a VA examination to assess the claim for service connection for a facial deformity. In July 2021 a rating decision, the RO established that basic eligibility for service connection for dental treatment purposes of loss of tooth #3 as due to the noncompensable service-connected pathological dental condition of caries is warranted. A July 2021 supplemental statement of the case denied service connection for a facial deformity (claimed as a residual of dental surgery). The Veteran contends that the facial deformity is related to an in-service extraction of tooth #3. The Veteran explained that, while the military dentist was removing tooth #3 in service, he used an instrument, and instead of pulling down the tooth, he raised the machinery and it slipped off the tooth and it went up into the Veteran's sinus cavity. The Veteran states that he had sinus surgery in service to repair the sinus injury, but he can still feel a sinus opening and pressure when he sneezes. The Veteran contends that the extraction and associated complications resulted in the current facial deformity. During the January 2019 Board videoconference hearing, the Veteran credibly testified that he has a facial indentation and explained that it was related to the in-service tooth #3 extraction. While April 2021 VA examination indicates that the Veteran does not have a current disability, noting that the Veteran had a beard and that the face appeared to be symmetrical, the Board finds that the Veteran is competent and credible to report a current disability such as an indention in the skin. See McCartt v. West, 12 Vet. App. 164, 167-68 (1999) (veteran alleged skin disorder of boils, blotches, rash, soreness, and itching since service; Court implied that this may be the type of condition lending itself to lay observation and satisfy the nexus requirement, even though still seemed to require medical nexus opinion relating current skin disorder to in-service herbicide exposure); Layno v. Brown, 6 Vet. App. 465, 469 (1994) ("Personal knowledge is that which comes to the witness through the use of his senses that which is heard, felt, seen, smelled, or tasted."). The Veteran submitted to a VA examination in April 2021. The April 2021 VA examiner opined that, without an existing diagnosis of facial scar or facial deformity, the claimed facial deformity is less likely than not (less than 50 percent probability) incurred during service. This purported opinion was based on the inaccurate factual assumption that there was currently no facial scar or facial deformity; however, as the evidence does show current disability, a VA examination addendum opinion based on that assumption is warranted. The matter is REMANDED for the following action: Obtain a VA examination addendum opinion to help determine service connection for a facial deformity or indentation. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. The VA examiner should render the following opinion: Is it at least as likely as not (50 percent probability or greater) that the current facial deformity or indentation is related to the in-service extraction of tooth #3 and its associated complications? J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Costantino, 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.