Citation Nr: 21075021 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-46 291 DATE: December 17, 2021 ORDER Service connection for a facial deformity (claimed as residuals of dental surgery) is granted. FINDINGS OF FACT 1. The Veteran has a current disability of a facial deformity. 2. The facial deformity is etiologically related to the in-service extraction of tooth #3 in April 1966 and subsequent infection that required surgery for that same tooth in April and June of 1966. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a facial deformity have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303(a), 3.326. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from January 1966 to December 1967. This matter is on appeal from an August 2017 rating decision issued by the Regional Office (RO). The Veteran testified in San Juan, Puerto Rico, at a Board videoconference hearing in January 2019 before the undersigned Veterans Law Judge. The hearing transcript has been associated with the record. In a June 2019 Board decision, the Board remanded the issue of service connection for a noncompensable dental disorder for the loss of tooth #3 due to caries for the purpose of obtaining VA dental examinations and outpatient dental treatment under 38 C.F.R. § 17.161 and the instant issue of service connection for facial deformity (claimed as residuals of dental surgery). The Board remanded in order to send notice to the Veteran to inform him of the relevant dental regulations outlining the requirements to receive service connection for dental treatment purposes under 38 C.F.R. § 17.161, then directed VHA to adjudicate Class eligibility in the first instance under 38 C.F.R. § 3.381 (effective February 29, 2012). See 38 C.F.R. § 17.161. The Board also remanded in order to schedule a VA examination to assess the claim for service connection for a facial deformity. A VA examination was conducted in April 2021. In a July 2021 rating decision, the RO established that basic eligibility for service connection for dental treatment purposes of loss of tooth #3 as due to the noncompensable service-connected pathological dental condition of caries is warranted. A July 2021 supplemental statement of the case denied service connection for a facial deformity. In October 2021, the Board remanded the instant issue in order to obtain a VA examination addendum opinion. A VA examination opinion was rendered in April 2021. A supplemental statement of the case was issued in October 2021. Legal Authority for Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. See 38 C.F.R. § 3.303(d). Service Connection for a Facial Deformity The Veteran contends that he has a facial deformity that was caused by the in-service tooth #3 extraction and follow up surgery. The Veteran explains that the stitching from the in-service extraction and surgery on the inside of the jaw noticeably pulls the facial muscles and the muscles become tender. See January 2019 Transcript. The evidence shows a current facial deformity. The Veteran credibly testified during the January 2019 Board hearing that he had a facial deformity inside the mouth that was caused by the in-service tooth #3 extraction and subsequent surgery. See January 2019 Transcript. The Veteran is competent to report the facial deformity because he can feel and see the deformity. See Layno v. Brown, 6 Vet. App. 465, 469 (1994) ("Personal knowledge is that which comes to the witness through the use of his senses that which is heard, felt, seen, smelled, or tasted"). The Board also finds that the facial deformity is etiologically related to the in-service extraction of tooth #3 in April 1966 and subsequent infection that required surgery for that same tooth in April and June of 1966. According to April 1966 service dental treatment records, tooth #3 was extracted. The Veteran also received follow up in-service treatment in April 1966 and June 1966 to treat a secondary infection in tooth #3 following the extraction. As previously stated, the Veteran credibly testified during the January 2019 Board hearing that he has had the deformity since the in-service dental surgeries. See January 2019 Transcript. The Board finds that the October 2021 VA examination opinion is of little probative value as the examiner does not recognize lay reports of symptoms, instead recognizing only medical evidence. The VA examination report shows little recognition of a long history of symptoms including intermittent pain and discomfort, facial disfigurement, and intermittent sinus problems. Such symptoms provide a basis for the later diagnosis of a facial deformity. The Veteran is competent to report any symptoms of the facial deformity he has witnessed at any time, and lay evidence can be sufficient evidence of a diagnosis where lay testimony is describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); cf. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Although the Veteran was not specifically diagnosed with a facial deformity disability in active service, such is not required to meet the requirements for service connection for a facial deformity under any theory of service connection, including direct service connection. See 38 C.F.R. § 3.303(d) (providing service connection may be granted for any disease diagnosed after service when the evidence establishes in-service incurrence). Based on the foregoing and resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a facial deformity have been met. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Costantino, 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.