Citation Nr: 21066163 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 12-31 216A DATE: October 28, 2021 REMANDED Entitlement to service connection for broken and loose teeth, claimed as due to the use of methotrexate and/or as secondary generally to medications taken for multiple sclerosis is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1970 to October 1970. The Veteran testified at a hearing before a Veterans Law Judge (VLJ) in March 2016. A transcript of the hearing has been associated with the record. The VLJ who conducted the hearing is no longer employed by the Board. The Veteran was informed of his right to a new hearing with a different VLJ in a September 2021 letter. The Veteran did not respond. As such, the Board will consider his claims based on the evidence of record. Entitlement to service connection for broken and loose teeth, claimed as due to the use of methotrexate and/or as secondary generally to medications taken for multiple sclerosis is remanded. The claim must be remanded again because the July 2021 VA examination did not substantially comply with the Board's November 2020 remand directives that directed the VA examiner to discuss any potential side effects of Methotrexate, and other medications used to treat the Veteran's service connected multiple sclerosis (MS) over the years, to include whether any dental problems may have been related to dry mouth or changes in saliva. The examiner was also directed to discuss prior opinions that the Veteran's dry mouth from medications taken for his MS caused his current dental condition. The July 2021 VA examiner did not comply with these directives. Additionally, the July 2021 medical opinion is inadequate because the examiner only opined that the medications taken by the Veteran for his MS did not cause his dental condition, but this opinion was not adequately supported with a rationale as to why this is so. The matters are REMANDED for the following action: 1. Forward the claims file and copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the likelihood of a nexus between the Veteran's dental condition and his service-connected MS, to include medications taken for MS. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. Based on a review of the record, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any dental disorder is (i) caused by or (ii) aggravated by (defined as any increase in disability) the service-connected MS, and specifically the medication used to treat the MS. The examiner must review and discuss (i) any potential side effects of Methotrexate, and other medications used to treat the Veteran's service-connected MS over the years to include whether any dental problems may have been related to dry mouth or changes in saliva; and (ii) the December 2013 Statement (received by VA on July 8, 2014) by the Veteran's treating dentist that the Veteran's dental condition was caused by long-term medications that cause dry mouth. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state why that is and what additional information is needed to provide the opinion. 2. Confirm that the VA medical opinions provided comports with this remand, to include that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.