Citation Nr: 21074212 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-41 779 DATE: December 14, 2021 REMANDED Entitlement to service connection for loss of teeth is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1969 to June 2003, to include service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the proceeding has been associated with the claims file. 1. Entitlement to service connection for loss of teeth is remanded. The Board finds that a remand is warranted to obtain a complete VA opinion. Specifically, the RO obtained a VA opinion with regards to the nature and etiology of the Veteran's loss of teeth claim and provided a negative nexus with regards to service-connected Frey's Syndrome. However, during the August 2021 hearing, the Veteran and his representative testified that the Veteran had not sought a secondary service connection on Frey's Syndrome. Instead, the Veteran and his representative are seeking service connection for loss of teeth as due to the removal of facial tumors that resulted in malfunctioning salivary gland, poor gingival and periodontal health which combined could have led to decay of teeth, bone loss, and loss of teeth as stated by a private dental record submitted in March 2016. Thus, an addendum VA opinion is warranted to address the Veteran and his representative's contention with regard to the nature and etiology of the Veteran's loss of teeth claim. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A (b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, the claims file, including a copy of this remand, should be sent to an appropriate examiner for opinion as to the nature and etiology of the Veteran's claimed loss of teeth. The opinion should be rendered by an appropriate medical professional. The examiner should review the record and note such review in the examination report. The examination should include a review of the Veteran's history and current complaints as well as a comprehensive evaluation and any tests deemed necessary. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Identify all of the Veteran's diagnosed tooth or mouth disorder(s). If a condition is not diagnosed, does the Veteran's reported teeth loss cause functional impairment or loss? (B) For any diagnosed tooth or mouth disorder, is it at least as likely as not (50 percent probability or greater) that the loss of teeth its onset in service or is otherwise etiologically related to service, to include any incident thereof? (C) Is any of the Veteran's loss of teeth at least as likely as not (50 percent probability or greater) that the disorder proximately caused by or aggravated by the removal of facial tumors in relation to the Frey's Syndrome? The examiner is directed to the March 2016 private dental treatment record showing that the removal of the tumors could cause loss of teeth and bone. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.J. Kim, 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.