Citation Nr: 21075267 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-00 239 DATE: December 20, 2021 REMANDED Entitlement to service connection for tinnitus, to include as secondary to right temporomandibular joint disorder with malocclusion, severe anterior open bite, and bruxism, or allergic rhinitis, is remanded. REASONS FOR REMAND The Veteran had active service from May 1984 to March 1988. This matter comes before the Board of Veterans' Appeals (BVA or Board) from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in June 2019 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In October 2019 and January 2021, the Board remanded this claim as well as entitlement to service connection for sinus problems, diagnosed as allergic rhinitis, for additional development. Service connection for allergic rhinitis was granted in an August 2021 rating decision, and as such, is no longer before the Board. Entitlement to service connection for tinnitus, to include as secondary to right temporomandibular joint disorder with malocclusion, severe anterior open bite, and bruxism, or allergic rhinitis. The Veteran seeks entitlement to service connection for tinnitus. He asserts his tinnitus is due to exposure to acoustic trauma during service, or in the alternative, is secondary to his service-connected right temporomandibular joint disorder with malocclusion, severe anterior open bite and bruxism, or his service-connected allergic rhinitis. In the January 2021 Board remand, the RO was directed to obtain an addendum opinion regarding whether the Veteran's tinnitus is proximately due to or aggravated by his service-connected dental disability. A VA medical opinion was obtained in July 2021; however, the opinion only discussed direct service connection. Addendum VA opinions were received in September 2021 and October 2021. In the September 2021 opinion, the VA audiologist stated that it was outside the scope of practice to comment on tinnitus in regard to a dental disorder and indicated the request should be sent to an ear, nose, and throat (ENT) provider. The October 2021 VA opinion was provided by a general practitioner and failed to give an opinion regarding aggravation. Given the complex medical nature of the medical question at issue and controversy, the Board has determined that in accordance with 38 U.S.C. § 5109, a remand is required for VA to request an advisory medical opinion from an independent medical expert. While this case is in remand status, the Veteran and/or his representative is also free to obtain additional medical evidence/opinion, if he so desires. Finally, the Board notes that the most recent supplemental statement of the case (SSOC) was returned as undeliverable. Although the correct address was listed on the SSOC, the envelope was addressed to an incorrect address. On remand, the Veteran should be provided a copy of the October 2021 SSOC and the RO should ensure that all subsequent correspondence is sent to the correct mailing address. The matters are REMANDED for the following action: 1. Mail a copy of the October 2021 supplemental statement of the case to the Veteran at the correct, current mailing address. 2. Obtain and associate with the claims file all updated treatment records. 3. Pursuant to 38 U.S.C. § 5109 (the AMO should follow its established procedures for requesting an advisory opinion furnished by a medical school, university, clinic, or medical institution (i.e., an independent medical expert who is not an employee of the Department)), the file should be sent to an otolaryngologist to offer an independent medical opinion regarding the relationship between the Veteran's claimed tinnitus and his dental disability and/or allergic rhinitis disability. The entire claims file, including a copy of this remand, must be reviewed by the otolaryngologist. After review of the following, please answer the following: The specialist should opine as to whether it is at least as likely as not (i.e., 50 percent or greater probability) that: a) the Veteran's tinnitus is proximately due to his service-connected dental disability of right temporomandibular joint disorder with malocclusion, severe anterior open bite, and bruxism; or, b) the Veteran's tinnitus is aggravated (beyond a natural progression) by his service-connected dental disability of right temporomandibular joint disorder with malocclusion, severe anterior open bite, and bruxism; or, c) that the Veteran's tinnitus is proximately due to his service-connected allergic rhinitis; or, d) that the Veteran's tinnitus is aggravated (beyond a natural progression) by his service-connected allergic rhinitis. *In rendering these opinions, the specialist is asked to consider whether there is a medically sound basis to attribute in any way (causation or aggravation) the Veteran's tinnitus to his dental disability or allergic rhinitis. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. After the claim is readjudicated, ensure that a new supplemental statement of the case is sent to the Veteran, and his representative, at the correct address. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Andersen, 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.