Citation Nr: 21064634 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-02 786 DATE: October 21, 2021 REMANDED Entitlement to service connection for a right arm disability (claimed as a right elbow disability) is remanded. Entitlement to service connection for a dental disorder for compensation purposes is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from October 1975 to September 1978. 1. Entitlement to service connection for a right arm disability is remanded. 2. Entitlement to service connection for a dental disorder for compensation purposes is remanded. In November 2020, the Board remanded these claims for additional development, to including providing the Veteran VA examinations to assess the nature and etiology of his claimed right elbow/arm disability and his dental disability. Unfortunately, after close review of the VA examination reports acquired on remand, the Board finds that the provided nexus opinions acquired are inadequate; and remand is once against required for the VA to fulfill its duty to the Veteran. With specific regards to the Veteran's claim for a right arm/elbow disability, the Regional Office (RO) acquired a VA examination and nexus opinion in June 2021 to assess the nature an etiology of the Veteran's claimed disability. The VA examiner, after an examination of the Veteran, noted a finding that the Veteran did not have a disability related to his elbow, and as such, no such condition could be related to his active service period. Subsequent to this examination report, the RO acquired an addendum opinion in July 2021 to address the Veteran's previously diagnosed right elbow strain. In this opinion, the examiner opined that the Veteran's pervious right elbow strain diagnosis was an error, and that he did not have such condition, based on his medical and treatment history. Instead, the VA examiner noted that the pain and functional loss noted by the Veteran's complaints is actually attributed to a diagnosis of ulnar neuropathy. The examiner noted evidence of such condition developing during the claims period in the treatment records, and concluded that the Veteran had ulnar neuropathy, and did not have any elbow disability contemporaneous to the claims period. While the VA examiner provided a conclusion and rationale with regards to any potential right elbow disability during the claims period, and to that end, provided an alternate diagnosis of ulnar neuropathy, the opinion was silent on the etiology of this neuropathy. Here, the Board finds that while the Veteran's initial claim was for a right elbow/arm disability, such claim must be liberally construed in favor of the Veteran to include any and all symptoms and diagnoses "reasonably encompassed" in such claim. Clemons v. West, 206 F.3d 1401, 1403 (Fed. Cir. 2000). Therefore, the VA must also address whether service connection is warranted for the newly defined and diagnosed right ulnar neuropathy; and the issue has been recharacterized accordingly as noted above. The Board likewise finds that the June 2021 VA examination afforded to the Veteran for his claim for a dental condition was also inadequate. Specifically, the Board find that such nexus opinion regarding the Veteran's dental disabilities was again construed as too narrow, to only include his periodontal issues, and ignored previously noted loss of tooth and cracked molars. Here, the VA examiner concluded, comprehensively, that periodontal issues are different from trauma related dental issues, in that they relate to hygiene, and that as such, the Veteran's condition was not related to his loss of tooth, or trauma during service. The Board, however, points out that the Veteran's claim included those dental conditions such as loss of tooth and/or cracked tooth, that he claims were caused by trauma caused during his active service. As such, the Board much find that the VA examiner's opinion is incomplete, and only address part of the Veteran's claim regarding his dental issues; and remand is again required for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain all VA treatment medical records not already of record. 2. Then, schedule the Veteran for a VA examination of his claimed right elbow/arm disability. The examiner must review the claims file and should note that review in the report. All testing deemed necessary should be performed. A complete rationale for all opinions should be provided in the examination report. The examiner is asked to provide opinions regarding the nature and etiology of the claimed right elbow/arm disability, to include a current diagnosis. (a) The examiner should opine, whether it is at least as likely as not (50 percent or greater probability) that any right elbow/arm disability was incurred in service or is the result of any incident in service, to explicitly include right ulnar neuropathy. (b) Additionally, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any right elbow/arm disability, to explicitly include right ulnar neuropathy, is due to or the result of any service-connected disabilities. (c) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any right elbow/arm disability, to explicitly include right ulnar neuropathy, has been aggravated (worsened beyond the natural progress of the disorder) by service-connected disabilities. The examiner should reconcile the opinion with previous opinions and should discuss prior diagnoses. The examiner should also consider all medical research evidence submitted by the Veteran and representative. 3. Schedule the appropriate VA examination in order to assist in determining the nature and etiology of the dental disorder. The relevant documents from the record should be provided to the VA examiner and should be reviewed by the VA examiner in connection with the examination. An interview of the Veteran regarding the history, a physical examination, and all tests and studies required to respond to the following questions should be performed. Based on review of the appropriate records, the examiner should offer opinions on the following questions: (a) Is it as likely as not (i.e., probability of 50 percent or more) that the currently diagnosed periodontal disease was incurred in or caused by active service? (b) What is the most likely etiology of each current dental disorder? In rendering the opinion, the VA examiner should address the Veteran's contentions of his head injury during service and loss of teeth. Please explain the basis for all opinions. The term "as likely as not" does not mean within the realm of possibility. Rather, it means that the weight of evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation or aggravation as to find against causation or aggravation. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ziheng Zhu, 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.