Citation Nr: 21066504 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 19-06 345 DATE: November 1, 2021 REMANDED Entitlement to service connection for a right forearm and/or elbow disorder, to include as secondary to service-connected right fourth and fifth finger disabilities, is remanded. Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a dental disorder for compensation purposes is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1976 to March 1980. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in February 2016 by a Department of Veterans Affairs (VA) Regional Office. In December 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the Veteran waived Agency of Original Jurisdiction (AOJ) consideration of the evidence received since the issuance of the January 2019 statement of the case. 38 C.F.R. § 20.1305(c). The undersigned also held the record open for 60 days for the submission of additional evidence; however, none has been received to date. 1. Entitlement to service connection for a right forearm and/or elbow disorder, to include as secondary to service-connected right fourth and fifth finger disabilities. 2. Entitlement to service connection for a left hip disorder. 3. Entitlement to service connection for a dental disorder for compensation purposes. The Veteran contends that he has right forearm and/or elbow, left hip, and dental disorders as a result of in-service injuries. In this regard, he reports experiencing pain and cramping in the right forearm and elbow, pain and swelling in the left hip, and pain and clicking of his jaw since service. In the alternative, he claims that his right forearm and/or elbow disorder is caused or aggravated by his service-connected right fourth and fifth finger disabilities. As pertinent to his claimed right forearm and/or elbow disorder, the Veteran testified at the December 2020 Board hearing that he injured his right hand and arm when he slipped, fell, and landed with his arm under his M-16. In this regard, his service treatment records (STRs) included an undated record reflecting the Veteran's report of an injury to his finger when he fell on his weapon. X-rays performed in September 1978 were negative and a contusion was diagnosed. In October 1978, he was seen for complaints of a deformed right little finger. Additionally, in June 1979, the Veteran complained of pain and swelling in his right fifth finger. It was noted that he fell on his weapon eight months previously resulting in injury to the same region and he had reinjured it a day ago playing basketball. A week later, it was noted that he had possible torn extensor tendons. Based on such injuries, the Veteran is currently service-connected for flexion deformity of the fourth and fifth fingers of the right hand. However, a February 2016 VA examination reflected that the Veteran did not have a current right forearm or elbow disorder, and the examiner opined that he did not have a diagnosis of a right forearm or elbow disorder resultant from his in-service right fifth digit injury. He further noted the Veteran's report of experiencing cramping in the forearm when using his right hand, but found that such complaints were not associated with the right fifth digit. However, private treatment records dated after such examination, reflect the Veteran's reports of chronic pain in his right pinky and ulnar aspect of his hand that radiates to his elbow, which occurs after activities involving gripping, such as using a hammer or screwdriver, in April 2016. As relevant to the Veteran's claimed left hip disorder, the Veteran testified at the December 2020 Board hearing that he injured his hip after jumping off a loading dock falling on his back and hip in service. In this regard, his STRs reflect that, in March 1976, he reported problems with his left hip joint after falling on it three days previously. However, a February 2016 VA examination reflected that the Veteran did not have a current left hip disorder, and the examiner opined that such claimed disorder was unrelated to his military service as the March 1976 STR showed no diagnosis and such resolved, and there was no evidence of treatment after service. Finally, as pertinent to the Veteran's claimed dental disorder, he claims that he incurred an injury to his mouth during a parachute jump, which resulted in cellulitis and the extraction of his two upper front teeth (numbers 9 and 10). In this regard, his STRs confirm such events in March 1977 and he subsequently underwent generalized restorations on the maxillary and mandibular dentition from May to October 1977 and the placement of a bridge in March 1978. However, a January 2016 VA examination showed that, while the Veteran had loss of teeth due to trauma or disease in service, his masticatory surfaces can be restored by suitable prosthesis as he currently had implants and a bridge, and there was no evidence of loss of the mandible or maxilla bone. Nonetheless, at the December 2020 Board hearing, the Veteran reported that the aforementioned in-service injury also resulted in a jaw disorder, with symptoms of clicking in the jaw, pain, and deterioration of bone, which ultimately resulted in bone grafts. As relevant to all three claims, the Board acknowledges that, while the January 2016 and February 2016 VA examinations did not find evidence of current dental, right forearm/elbow, or left hip disorders, respectively, the Veteran has reported ongoing symptomatology related to such disorders, to include pain and cramping in the right forearm and elbow, pain and swelling in the left hip, and pain and clicking of his jaw. Furthermore, he testified to receiving treatment for such claimed disorders, to include from Mount Nittany Physicians Group and a private dentist, and, while provided an additional 60 days to submit such records, he did not do so. Nonetheless, in light of the Veteran's reported symptomatology, the Board finds that he should be afforded new VA examinations so as to determine whether such results in functional impairment of earning capacity and, thus, constitutes a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). If so, the examiner should then be requested to offer an opinion as to the etiology of such disabilities. Furthermore, while on remand, the Veteran should be provided with another opportunity to submit, or authorize VA to obtain, all outstanding private treatment records pertaining to his claimed disorders, to include updated records from Mount Nittany Physicians Group, for consideration in his appeal. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to submit, or authorized VA to obtain, all outstanding private treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, obtain all outstanding records, to include those from Mount Nittany Physicians Group dated from October 2016 to the present, and any outstanding dental records. Make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. 2. Afford the Veteran appropriate VA examination(s) so as to determine the nature and etiology of his claimed right forearm and/or elbow, left hip, and dental disorders. Following a full review of the record and conducting all indicated testing, the examiner should address the below inquiries: (A) Identify all right forearm and/or elbow, left hip disorders, and dental disorders that have been present at any time proximate to the Veteran's October 2015 claim, even if such are asymptomatic or have since resolved. With respect to the Veteran's claimed right forearm/ elbow disorder, the examiner should consider his report of chronic pain in his right pinky and ulnar aspect of his hand that radiates to his elbow, which occurs after activities involving gripping, such as using a hammer or screwdriver, as reflected in an April 2016 private treatment record. As pertinent to the Veteran's claimed dental disorder, the examiner should consider whether he has a jaw disorder, to include temporomandibular joint dysfunction. If the examiner finds that the Veteran does not have a current diagnosed right forearm and/or elbow, left hip, or dental disorder, he or she should offer an opinion as to whether his reported symptomatology results in functional impairment of earning capacity. If so, the examiner should accept that the Veteran has a current disability for VA purposes. (B) For each right forearm and/or elbow disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his military service, to include his documented injury when he slipped, fell, and landed with his arm under his M-16. If not, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a right forearm and/or elbow disability is caused or aggravated by the Veteran's service-connected right fourth and fifth finger disabilities. For any aggravation found, the examiner should state, to the best of their ability, the baseline symptomatology, and the amount, quantified, if possible, of aggravation beyond the baseline symptomatology. (C) For each left hip disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his military service, to include his documented in-service March 1976 complaints of left hip pain after a fall. (D) For each diagnosed dental disability, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset it, or is otherwise related to, the Veteran's military service, to include his acknowledged in-service mouth injury following a parachute jump. In offering such opinions, the examiner should consider the Veteran's report of the onset of his claimed disorders in service and a continuity of symptomatology thereafter, to include pain and cramping in the right forearm and elbow, pain and swelling in the left hip, and pain and clicking of his jaw. The examiner is also advised that a lack of post-service treatment records demonstrating a continuity of care cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Waite 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.