Citation Nr: 21071603 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-32 479 DATE: November 30, 2021 ORDER Service connection for Bell's Palsy is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's Bell's Palsy began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for Bell's Palsy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.3.09. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Army from April 1969 to January 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision. The Veteran testified before a, now retired, Veterans' Law Judge in February 2020; a transcript of this hearing is of record. The Board notes that the Veteran was provided the opportunity to testify at a new hearing due to the retirement of the previous Veterans' Law Judge, however, he did not indicate any desire to have a new hearing. The Board remanded the claim in August 2021 to obtain an addendum medical opinion. The Board finds that there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Bell's Palsy Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that it was incurred in service. 38 C.F.R. § 3.303(d). The term "herbicide agent" means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 (the Vietnam Era), specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307(a)(6). Regulations create a presumption of service connection for certain diseases found to be associated with exposure to a herbicide agent such as that used in Agent Orange. See 38 U.S.C. §§ 1113, 1116; 38 C.F.R. §§ 3.307(d), 3.309(e). Absent affirmative evidence to the contrary, such diseases will be service connected even if there is no evidence of the disease during service, provided that herbicide exposure is established. Bell's Palsy is not one of the diseases listed under 38 C.F.R. § 3.309. Regardless of the applicability of the presumption, a claimant is not precluded from establishing service connection with proof of direct causation. Proof of direct service connection between exposure and disease requires a showing that exposure during service actually caused the condition which developed years later. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In the August 2021 remand, the Board conceded that the Veteran has a current diagnosis of Bell's Palsy. Further, the Board conceded that the Veteran's experienced trench mouth while in-service through the Veteran's competent and credible testimony during his February 2020 Board hearing. Therefore, the first two elements of a service connection claim have been met. The Board concludes that, while the Veteran has a current diagnosis of Bell's Palsy the preponderance of the evidence weighs against finding that the Veteran's current disabilities began during service or are otherwise related to any in-service injury, event, or disease. Medical records show the Veteran was not diagnosed with Bell's Palsy until 2014, decades after his separation from active service. Further, the Veteran underwent a VA examination in October 2020 to determine the etiology of his Bell's Palsy. The examiner ultimately concluded that it was less likely than not that the claimed condition was incurred in or caused by the claimed in-service injury, event, or illness. Specifically, the examiner reasoned that there is no medical evidence of an etiological connection between Bell's Palsy and exposure to Agent Orange. The Veteran then underwent another VA examination in September 2021 to address the Veteran's contention that his Bell's Palsy is the result of his trench mouth in-service. However, the examiner opined that the Veteran's Bell's Palsy is less likely than not incurred in or caused by the claimed in-service trench mouth. Specifically, the examiner noted that there are no articles or studies that link dental infections to Bell's Palsy or any neurological disorders. Therefore, it is less likely than not that the Veteran's Bell's Palsy is the result of trench mouth. There is no competent medical opinion to refute this conclusion or otherwise link the Veteran's Bell's Palsy to his service. The Board acknowledges the Veteran's own assertions in support of his claim. However, as a layperson without the appropriate medical training and expertise, the Veteran has not demonstrated the competency to opine as to the etiologies in this matter. Rather this question requires medical expertise due to the complex nature of the disabilities. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As a result, the Board affords the October 2020 and September 2021 VA examinations great probative weight. (Continued on the next page) Therefore, the Board finds that the preponderance of the evidence is against the claim. As such, the benefit of the doubt rule is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jorge Barroso, 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.