Citation Nr: 21005917 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 16-15 136A DATE: February 2, 2021 ORDER Entitlement to service connection for a throat disability is denied. REMANDED Entitlement to service connection for an eye condition is remanded. Entitlement to service connection for loss of teeth, for compensation purposes, is remanded. FINDING OF FACT The Veteran’s throat disability was not incurred during active service and was not caused by active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a throat disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1962 to June 1964. He died in October 2016 during the pendency of the appeal. The Appellant is his surviving spouse, and has been properly substituted for the purposes of claims pending before VA at the time of the Veteran’s death. The Board remanded the matters for further development in March 2020. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To prevail on the issue of service connection, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran’s May 1962 entrance examination and report of medical history were negative for any diagnoses or complaints of a throat condition. In February 1963, the Veteran complained of a sore throat, and he was diagnosed with acute tonsillitis. In the May 1964 report of medical history, the Veteran reported a positive history for ear, nose, or throat trouble. The Veteran’s May 1964 separation examination was negative for diagnoses or complaints of a throat condition. In the March 2014 VA examination, the Veteran was diagnosed with chronic laryngitis. The examiner provided a negative nexus opinion, but the Board affords the opinion minimal probative value because the examiner failed to address evidence of throat complaints in the Veteran’s service treatment records (STRs) and failed to provide an adequate rationale to support the medical nexus opinion. The Veteran was afforded a VA addendum opinion in October 2020. The examiner noted the Veteran was diagnosed with chronic laryngitis during the pendency of the appeal. The Veteran’s STRs show that he was diagnosed with acute tonsillitis, moderate to severe, complicated with abscess of peritonsillar tissue due to staph aureus. The Veteran’s acute tonsillitis was resolved without evidence of sequelae. There is no recorded evidence of recurrent tonsillitis nor peritonsillar abscess in the Veteran’s STRs. The May 1964 separation examination was silent for any chronic throat, tonsils, or pharyngeal conditions. There was no recorded evidence of recurrent tonsillitis, chronic throat conditions, or throat complaints in the VA treatment records to sustain any chronic throat disability. The in-service condition was acute, treated, and resolved without sequelae. The acute tonsillitis with peritonsillar abscess is a different medical condition than chronic laryngitis, and the conditions have different pathophysiological mechanisms. Based on the foregoing reasons, the examiner found the Veteran’s throat condition was less likely than not related to active service. The examiner’s opinion was based on a complete review of the Veteran’s claim file, to include STRs, VA treatment records, the March 2020 remand, and the Mach 2014 VA examination. The Appellant and the Veteran have contended that the Veteran’s throat condition was caused by acute tonsillitis in service. Lay persons are competent to provide opinions on some medical issues. However, the issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Neither the Veteran nor the Appellant have been shown to possess the training, credentials, or other expertise to render a diagnosis that is of comparable probative value to that of the VA examiner’s opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007). Accordingly, the Board assigns greater weight to the opinion of the VA examiner than to the Appellant’s and Veteran’s own lay opinions. The record is negative for a probative positive medical opinion to indicate that the Veteran’s throat condition incurred during or was caused by active duty service. The October 2020 VA examiner reviewed the Veteran’s entire record, and provided a thorough and adequate rationale to support the opinion. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran’s claim for service connection for a throat condition. As the preponderance of the evidence is against this claim, the benefit-of-the-doubt rule does not apply, and the Veteran’s claim for service connection for a throat condition is denied. See 38 U.S.C. § 5107. REASONS FOR REMAND 1. Entitlement to service connection for an eye condition is remanded. The Veteran’s entrance examination and report of medical history were negative for eye or vision problems. The Veteran was afforded a VA addendum opinion in October 2020. The examiner noted the Veteran’s STRs show a report of “blurry and difficulty with vision since 1956” in September 1963 STRs. Although the examiner provided a detailed rationale to support the nexus opinion, the STRs provide evidence that an eye condition may have pre-existed the Veteran’s induction into active duty in 1962. Accordingly, an addendum opinion is necessary to determine if an eye condition preexisted active service, and if such condition was aggravated by active service. 2. Entitlement to service connection for loss of teeth, for compensation purposes is remanded. In March 2020, the Board’s remand directives required a VA addendum opinion to determine if the Veteran’s missing teeth, documented upon entry into active duty, were aggravated by active duty service. In part, the examiner was asked if the pre-existing dental disability was clearly and unmistakably not aggravated by service. The Veteran was provided a VA addendum opinion in October 2020. The examiner did not provide the opinion requested as the examiner found the pre-existing condition “less likely than not” incurred during or was caused by active duty service. The examiner used the incorrect standard of less than likely, when addressing aggravation of the dental disorder by active service. The Board requires compliance with the prior remand directives in order to obtain opinions as to whether the preexisting disability was clearly and unmistakably not aggravated by active service. Stegall v. West, 11 Vet. App. 268, 271 (1998). Under current VA regulations, compensation is only available for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150, such as impairment of the mandible, loss of a portion of the ramus, and loss of a portion of the maxilla. Compensation is available for loss of teeth only if such is due to loss of substance of body of maxilla or mandible due to trauma or disease such as osteomyelitis, but not periodontal disease. Otherwise, a Veteran may be entitled to service connection for dental conditions including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, for the sole purposes of receiving VA outpatient dental services and treatment, if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161; Simington v. West, 11 Vet. App. 41, 44 (1998). The matters are REMANDED for the following action: 1. Forward the Veteran’s claims file to a qualified medical professional to obtain a VA medical opinion as to the nature and etiology of the Veteran’s eye conditions. A full medical history should be documented in the examination report. The claims file should be made available to the examiner. The examiner is reminded that service treatment records are included with the Veteran’s service personnel records. The examiner is asked to address the following: (a.) Identify and diagnose any current (at any point during the appeal period) eye conditions; and (b.) For any diagnosed eye condition, provide an opinion as to whether such disorder clearly and unmistakably preexisted the Veteran’s active service, making sure to address the September 1963 STR which documents eye problems since 1956; (c.) IF any diagnosed eye condition clearly and unmistakably preexisted active service, provide an opinion as to whether the diagnosed condition was clearly and unmistakably NOT aggravated beyond its natural progression by the Veteran’s active service; (d.) IF any diagnosed eye condition did not clearly and unmistakably preexist active service, provide an opinion as to whether the diagnosed condition at least as likely as not (a 50 percent or greater probability) had its onset during or is otherwise related to any event or injury during the Veteran’s active service. All opinions must be supported by a detailed rationale, to include the Veteran’s lay contentions of in-service causation provided during the March 2014 VA examination. 2. Forward the Veteran’s claims file to a qualified medical professional to obtain a VA medical opinion. The VA examiner should indicate whether the Veteran has loss of teeth due to bone loss of the body of the maxilla or the mandible due to trauma or disease such as osteomyelitis. The examiner is reminded that service treatment records are included with the Veteran’s service personnel records. The examiner is asked to address whether the pre-existing loss of teeth was clearly and unmistakably NOT aggravated by active duty service. The examiner should be specific as to the teeth affected and the damage diagnosed. All opinions must be supported by a detailed rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.