Citation Nr: 21070266 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 18-27 659 DATE: November 23, 2021 REMANDED Entitlement to service connection for hearing loss (claimed as hearing disorder) is remanded. Entitlement to service connection for skin cancer is remanded. Entitlement to service connection for cracked two front teeth (also claimed as dental issue) for compensation purposes is remanded. Entitlement to service connection for dental issue for treatment purposes is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Navy from September 1966 to August 1968. These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with claims file. 1. Entitlement to service connection for hearing loss (claimed as hearing disorder) is remanded. The Veteran was afforded a VA examination in March 2018 to determine the nature and etiology of his bilateral hearing loss. The VA examiner opined that the Veteran's bilateral hearing loss was less likely than not due to military noise exposure. As rationale, he stated that the Veteran's history of noise exposure included serving in the Navy for 2 years as a signalman. He noted that this occupational specialty has a moderate probability for hazardous noise exposure. The Veteran reported that his ship was in the Vietnam theater of operations during the Vietnam War and that his ship had 5- and 6-inch guns which reportedly fired quite frequently. The examiner noted that after separation from service, the Veteran served as a police officer for thirty years. The examiner explained that the Veteran passed a whispered voice test on both his entrance and separation audiograms, but noted there were no other in-service audiograms of record. He stated that the Veteran presented with a mild to moderate, sensorineural hearing loss from 3000-8000 Hertz (Hz) from the right ear, and a mild to moderately severe, sensorineural hearing loss from 1000-8000 Hz for the left ear. He explained that this type of hearing loss is more consistent with presbycusis than occupational noise exposure, as 8000 Hz is the worst frequency for each ear. He noted that the Veteran was 71 years old. The Board finds that the March 2018 medical opinion to be conclusory as the examiner failed to provide adequate rationale and medical literature to support his conclusion that the Veteran's bilateral hearing loss was due to age-related hearing loss (presbycusis) rather than in-service noise exposure. Additionally, service treatment records show that the Veteran was treated for an abrasion of his left ear in July 1968. The March 2018 VA examiner did not discuss whether this in-service abrasion had any effect on the Veteran's left ear hearing loss. Consequently, the Board finds that remand for an addendum VA medical opinion is warranted to determine the nature and etiology of the Veteran's bilateral hearing loss. 2. Entitlement to service connection for skin cancer is remanded. The Veteran contends that his skin cancer is related to military service, specifically due to sun exposure he incurred while serving as a signalman. During his May 2020 Board hearing, he testified that due to his position as a signalman he was on the deck of a ship every day for the two years he was in service. Post service treatment records show that the Veteran has a history of basal cell carcinoma on his neck, nose, and scalp. He also has a history of squamous cell carcinoma on his nose and scalp. Treatment records indicate that the Veteran sees a private dermatologist approximately every six months for skin checks to make sure that the actinic keratoses and other scaly papules he has on his neck, nose, scalp, and face have not turned cancerous. See Medical Treatment Record Non-Governmental Facility, received August 2017; CAPRI, received February 2020. The Veteran has not yet been afforded a VA examination with respect to his claim for service connection for skin cancer. VA's duty to assist includes providing a medical examination or obtaining a medical opinion when necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Board finds that there is sufficient evidence of record for this duty to assist to attach. Accordingly, a remand for a VA medical examination and medical opinion is necessary to determine the nature and etiology of the Veteran's skin cancer. 3. Entitlement to service connection for cracked two front teeth (also claimed as dental issue) for compensation purposes is remanded. The Veteran seeks entitlement to service connection for dental trauma for compensation purposes. During his May 2020 Board hearing, the Veteran testified that while working as a signalman aboard the U.S.S. Providence, a large clip at the end of a halyard line struck his mouth and chipped his two front teeth. He reported that the dentist onboard the ship installed fillings. Compensation may be paid for loss of teeth due to loss of substance of the body of maxilla or mandible without loss of continuity (as a result of trauma) or due to disease such as osteomyelitis, and not the loss of alveolar process as a result of periodontal disease, since such loss is not considered disabling. Here, the Board finds that the evidence is currently insufficient to render an informed decision on the Veteran's claim. First, it appears that the Veteran's service dental records may be incomplete, as only the enlistment dental examination is available. As mentioned above, the Veteran testified that he received dental treatment for his cracked teeth while serving aboard the U.S.S. Providence, but the records of such treatment are not in the claims file. Accordingly, remand is warranted to attempt to obtain any missing dental records and confirm whether the Veteran has suffered bone loss of the maxilla or mandible caused by trauma or disease. 4. Entitlement to service connection for dental issue for treatment purposes is remanded. The RO, which is a part of the Veterans Benefits Administration (VBA), adjudicated the claim for treatment purposes when it should have referred the issue to the Veterans Health Administration (VHA) for an initial determination on regarding eligibility under the requirements of 38 C.F.R. § 17.161. See 38 C.F.R. § 3.381(a). To date, there has been no eligibility determination by the VHA. In order to afford the Veteran due process, the issue must be returned for this purpose. The Board finds that remand to the RO for referral is appropriate here. A remand with instructions to the RO to refer the claim to the VHA, which the regulation provides must make the initial determination on the claim, will better ensure that the claim is addressed promptly and efficiently and is therefore consistent with the uniquely pro-claimant principles underlying the veterans' benefits system. Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs, 710 F.3d 1328, 1330 (Fed. Cir. 2013). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA medical and dental treatment records. 2. After completing directive #1, forward the claims file to a qualified clinician to obtain an addendum medical opinion regarding the nature and etiology of the Veteran's bilateral hearing loss. If the examiner determines that another physical examination is necessary, such an examination should be scheduled. Following a review of the claims file, the examiner is asked to opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral hearing loss is related to his active service. In regard to the Veteran's left ear hearing loss, the examiner is asked to consider and address whether the Veteran's July 1968 abrasion of the left ear had any effect on his current left ear hearing loss. The examiner is reminded that the absence of documented hearing loss during service cannot serve as the sole basis for a negative finding. A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. 3. After completing directive #1, schedule the Veteran for a VA examination with a qualified clinician to determine the nature and etiology of his skin cancer. The examiner must review the claims file and should note that review in the report. The examiner should obtain a complete history from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. The examiner should provide the following opinion: Is it at least as likely as not (50 percent or greater probability) that the Veteran's skin cancer was caused by or is related to service, specifically his daily exposure to the sun while serving on the deck of a ship? A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. 4. Take all appropriate actions to obtain complete service dental treatment records, to include treatment while serving aboard the U.S.S. Providence. 5. After completing directives #1 and #4, schedule the Veteran for a VA examination with a qualified clinician to determine the nature and etiology of his dental disability. The examiner should clearly identify and diagnose all dental disabilities (to include periodontal disease and loss of teeth) currently present. The examiner is asked to give a clear layout of the mouth and clarify whether the Veteran has ever suffered bone loss of the maxilla or mandible as a result of trauma or disease. For each current dental disability involving teeth loss due to loss of substance of the body of the maxilla or mandible, the examiner should opine as to whether it is as likely as not (a 50 percent or greater probability) that the disability had its onset during or is otherwise related to service. The examiner is asked to specifically discuss whether the current dental disability is due to Veteran's reported in-service trauma of having a large clip at the end of a halyard line strike his mouth. A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. 6. Refer the claim for dental treatment to the appropriate VA Medical Center (VAMC) of the VHA to determine if the Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.