Citation Nr: 21073791 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 21-00 732 DATE: December 10, 2021 ORDER Service connection for a dental disability for compensation purposes is denied. Service connection for left knee disability is granted. Service connection for right knee disability is granted. REMANDED Entitlement to service connection for left great toe disability is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for unspecified residuals of car accident is remanded. Entitlement to service connection for right hip disability is remanded. Entitlement to service connection for left shoulder disability is remanded. Entitlement to service connection for congestive heart failure, to include as due to exposure to lead, asbestos, and/or herbicidal agents, is remanded. Entitlement to service connection for residuals of cat scratch fever is remanded. INTRODUCTION The Veteran served on active duty from March 1945 to July 1946 and from December 1947 to September 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). During the pendency of this appeal, claims of entitlement to service connection for eczema and residuals of basal cell/squamous cell carcinoma were granted. As the benefit sought on appeal has been granted, and the Veteran has not perfected appeals as to the initial ratings or effective dates for these disabilities, the Board does not have jurisdiction to consider them herein. In a November 2021 brief, the Veteran's representative raised the issue of entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU). The Board does not have jurisdiction to consider this claim herein and, thus, it is referred to the RO for the appropriate development and consideration. FINDINGS OF FACT 1. The evidence does not demonstrate the current presence of a dental disability subject to service connection for compensation purposes. 2. Resolving reasonable doubt in the Veteran's favor, right knee disability is at least as likely as not related to his service. 3. Resolving reasonable doubt in the Veteran's favor, left knee disability is at least as likely as not related to his service. CONCLUSIONS OF LAW 1. The criteria for service connection for a dental disability for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1131, 1712, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.381, 4.150, 17.161. 2. The criteria for service connection for right knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for left knee disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Dental Disability The salient issue with respect to the Veteran's claim is whether the evidence demonstrates a current diagnosis of a dental disability subject to service connection for compensation purposes. Under current VA regulations, compensation is only available for certain types of dental and oral conditions, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. See 38 C.F.R. § 4.150. Compensation is available for loss of teeth if such is due to loss of substance of body of maxilla or mandible, only if such bone loss is due to trauma or osteomyelitis, and not to the loss of the aveolar process as a result of periodontal disease, as such loss is not considered disabling. Id. at Note. Replaceable missing teeth are not considered disabling for VA compensation purposes. See 38 C.F.R. § 3.381(a); see also 38 C.F.R. § 4.150. The evidence of record does not show that the Veteran currently has a dental disability for which VA compensation is available. During the pendency of this appeal, the Veteran reported that several of his teeth were extracted during service, both upper and lower. He then stated that he needed "partial plates" installed. The post-service evidence of record did not reflect a current diagnosis of a dental disability, such as osteomyelitis or osteoradionecrosis of the maxilla or mandible; loss of the mandible, maxilla, ramus, or coronoid process; loss of the hard palate, not replaceable by prosthesis; nonunion of the mandible; or limited motion of the temporomandibular articulation, which was incurred in service. See 38 C.F.R. §§ 3.381, 4.150. Under these circumstances, service connection for a dental disability for compensation purposes is not warranted. A claim of entitlement to service connection for dental disability for compensation is also accepted by VA as a claim of entitlement to service connection for dental disability for treatment purposes. 38 C.F.R. § 20.202; see Mays v. Brown, 5 Vet. App. 302 (1993). According to a November 1946 rating decision, VA already adjudicated and granted the Veteran's claim of entitlement to service connection for a dental disability for treatment purposes. Additional documentation associated with the claims file demonstrates that he was authorized to undergo outpatient dental treatment. As the merits of this claim have already been decided, no further consideration is warranted. Knees Throughout the pendency of this appeal, the Veteran asserted that his right and left knee disability resulted from the rigors of his approximately 26 years of active service, including service aboard several ships. According to a June 2018 VA treatment report, the Veteran experiencing bilateral knee pain, for which he has received steroid injections and takes daily medication. As such, the evidence of record establishes current diagnosis of right and knee disability. See Saunders v. Wilkie, F.3d 2017-1466 (Fed. Cir. 2018) (holding that pain resulting in functional limitation is a disability for VA purposes). Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). The Veteran is competent to report the onset and continuation of his right and left knee problems. As such, the Board finds his assertions to be credible. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran was not provided a VA examination pursuant to these claims, and the record is otherwise negative for evidence that specifically disassociates his current right and left knee disability from his service. The Board finds that the evidence of record is at least in equipoise as to whether the Veteran's right and left knee disabilities were incurred in or due to his active service. Giving the Veteran the benefit of the doubt, service connection for right and left knee disability is warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102. REASONS FOR REMAND The Veteran's representative asserts that the evidence of record does not include all of the Veteran's service treatment records. A remand is warranted in order for the RO to undertake efforts to obtain the records specifically identified by the representative and any other outstanding service records. Left Great Toe, Left Shoulder, and Right Hip The Veteran asserts that he currently experiences left great toe, left shoulder, and right hip disability. See Saunders v. Wilkie, F.3d 2017-1466 (Fed. Cir. 2018) (holding that pain resulting in functional limitation is a disability for VA purposes). He generally asserts that these disabilities were incurred in or due to his active service due to the rigors thereof. The Board finds that there is an indication of an associated between the Veteran's service and his claimed disability. Consequently, a remand is warranted in order to provide the Veteran a VA examination. GERD The evidence of record includes a current diagnosis of GERD. The Veteran asserts that his GERD was caused or aggravated by medication taken/prescribed to treat service-connected disabilities. The Veteran was not provided a VA examination to evaluate this etiological connection, and the evidence of record is otherwise negative for probative etiological opinions. As such, a remand is warranted to provide the Veteran a VA examination. PVA/Car Accident Residuals The Board is unable to discern the significant of "PVA," as the Veteran does not provide unabbreviated version. However, he explains that he was involved in a car accident wherein his vehicle struck a deer. The Veteran asserts that this accident occurred during his active service and resulted in residuals, but he has not specified the nature of those residuals. In a November 2021 brief, the Veteran's representative appears to substitute residuals of a car accident for two separate claims of entitlement to service connection: one for lumbar spine disability, the other for a left hip disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The Board is unable to discern from the correspondence whether this substitution was intentional or if the scope of the residuals is limited to lumbar spine and left hip disability. Consequently, the Board finds that a remand is warranted to obtain clarification and to provide the Veteran with VA examination. Residuals of Cat Scratch Fever The Veteran is claiming entitlement to service connection for residuals of "cat scratch fever." The Board was unable to locate any specific diagnosis of or treatment for "cat scratch fever" in his service treatment records. However, the Veteran's service treatment records demonstrated that he experienced "catarrhal fever" in March 1945, as well as other instances of fever during his service. It is unclear from the evidence of record what, if any disability, the Veteran asserts are residual from his alleged "cat scratch fever," catarrhal fever, or any other in-service fever. The Board finds that a remand is warranted in order to obtain clarification from the Veteran and to ascertain whether there are any current residuals from an in-service fever, to include the March 1945 catarrhal fever. Heart The evidence includes a current diagnosis of mild congestive heart failure and hypertension. The Veteran's service treatment records include a January 1970 electrocardiograph that demonstrates "[first] degree heart block," among other abnormalities. Further, the Veteran asserts that he was exposed to lead, asbestos, and chemicals associated with his service aboard varies ships and while working in a laundry. He was not provided a VA examination with respect to this claim, but the Board finds that there is an indication of an association between his current disability and his service. Thus, a remand is required. The matters are REMANDED for the following action: 1. Review the November 2021 brief from the Veteran's representative, and then undertake efforts to obtain the specific service records identified therein. Attempt to obtain any service treatment records not already associated with the claims file. 2, Request that the Veteran provide a statement with as much detail as possible regarding the timing of the reported motor vehicle accident, as well as the claimed residuals, to include, but not limited to, whether these residuals include lumbar spine and left hip disability. 3. Request that the Veteran provide a statement with as much detail as possible regarding the timing of his claimed "cat scratch fever," to include a description of the claimed residual disability that he currently experiences. 4. Provide the Veteran with VA examinations to assess his right and left hips, left shoulder, left great toe, back, GERD, and heart (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). Whether an in-person physical examination is necessary should be left to the discretion of the examiner. The examiner should provide opinions that address the following: (a) Does the Veteran currently experience right hip, left hip, left shoulder, left great toe, and/or back disability? The examiner is advised that pain resulting in functional limitation is a disability for VA purposes. (b) For any current right hip, left hip, left shoulder, left great toe, and/or back disability, is it at least as likely as not that it was incurred in or due to the Veteran's extensive active service, to include the rigors of service aboard various ships and/or a motor vehicle accident? (c) Is it at least as likely as not that the Veteran's GERD was caused or aggravated by a service-connected disability, to include medication prescribed/taken to treat these disabilities? (d) Is it at least as likely as not that any current heart disability was incurred in or due to the Veteran's active service, to include consideration of January 1970 electrocardiograph? The examiner is asked to consider congestive heart failure and hypertension, but not necessarily limit the evaluation to these diagnoses. The examiner is asked to consider and discuss the Veteran's assertions as to in-service exposure to lead, asbestos, and chemicals associated with laundry. (e) Is it at least as likely as not that any current heart disability was caused or aggravated by a service-connected disability? In addressing this claim, the examiner is asked to consider and discuss the Veteran's assertion that his service-connected disabilities resulted in inactivity leading to his heart disability. (Continued on the next page) For any rendered opinion, a thorough rationale is required. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean G. Pflugner, 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.