Citation Nr: 21013573 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-06 006 DATE: March 9, 2021 ORDER Service connection for a scar on the left elbow is granted. REMANDED Service connection for prostate cancer is remanded Service connection for diabetes mellitus, type II, is remanded. Service connection for bilateral upper extremity peripheral neuropathy is remanded. Service connection for bilateral lower extremity peripheral neuropathy is remanded. Service connection for sleep apnea is remanded. Service connection for strokes is remanded. Service connection for a skin disability other than a scar on the left elbow, including hives, cysts, and residual scarring, is remanded. Service connection for loss of teeth for compensation purposes is remanded. FINDING OF FACT The probative evidence of record shows that the Veteran’s scar on the left elbow was incurred during service. CONCLUSION OF LAW The criteria for establishing entitlement to service connection for a scar on the left elbow have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. § 3.303 (2020) REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1960 to November 1964. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from August 2015 and September 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This matter was previously before the Board in September 2018, at which time it was remanded for further development. The requested development was completed, and the case has been returned to the Board for further appellate action. In the September 2018 remand, it was noted that a claim for service connection for a compensable dental disorder is also considered to be a claim for VA outpatient dental treatment. See Mays v. Brown, 5 Vet. App. 302, 306 (1993). The Board therefore referred a claim for service connection for tooth loss for purposes of obtaining VA outpatient dental treatment to the agency of original jurisdiction (AOJ) for appropriate action. To date, it does not appear that this has been accomplished. Therefore, the issue of entitlement to service connection for tooth loss for purposes obtaining VA outpatient dental treatment is again REFERRED to the AOJ for appropriate action, if still necessary. Service Connection Service connection may be established 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. Generally, to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). 1. Entitlement to service connection for a scar on the left elbow The Veteran seeks service connection for a skin disability manifested by hives, cysts, and residual scarring. Upon review of the record, the Board finds that service connection is warranted for a scar on the left elbow. However, the issue of entitlement to service connection for a skin disability other than a scar on the left elbow is addressed in the remand section below. Service treatment records show that in October 1962, the Veteran was treated for a boil on his left elbow, and the diagnosis was cellulitis with lymphangitis on the left forearm. The Veteran underwent an incision and drainage of the soft tissue abscess and treatment with antibiotics. An October 1964 report of medical examination noted a three-inch scar on the Veteran’s left elbow upon his discharge from active duty. The Veteran underwent a VA skin examination in September 2015, during which the examiner observed a scar on the left elbow from the 1962 treatment for a boil. Based on the foregoing, the Board finds that service connection for a scar on the left elbow is warranted. REASONS FOR REMAND 1. The claim for service connection for prostate cancer is remanded. 2. The claim for service connection for diabetes mellitus, type II, is remanded. 3. The claim for service connection for bilateral upper extremity peripheral neuropathy is remanded. 4. The claim for service connection for bilateral lower extremity peripheral neuropathy is remanded. 5. The claim for service connection for sleep apnea is remanded. 6. The claim for service connection for strokes is remanded. The Veteran asserts that all of his claimed disabilities were caused by in-service exposure to Agent Orange while serving aboard the USS Uhlmann. Service personnel records show that the Veteran was assigned to the USS Uhlmann from approximately June 1961 to November 1964. A veteran who served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to herbicide agents unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). Service in the Republic of Vietnam includes service within 12 nautical miles offshore of the Republic of Vietnam. 38 U.S.C. § 1116A(d); see also Procopio v. Wilkie, 913 F.3d 1371, 1380-1381 (Fed. Cir. 2019). In September 2018, the Board remanded the claim to attempt to verify whether the USS Uhlmann was in the official waters of Vietnam between January 9, 1962 and November 3, 1964, to particularly include at any point from August 1964 through November 3, 1964, when the Veteran asserted that he participated in illumination missions off the coast of Vietnam following the Gulf of Tonkin incident. A September 2019 response from the Joint Services Records Research Center (JSRRC) indicates that the USS Uhlmann’s ship history shows no evidence that the USS Uhlmann served in Vietnamese waters at any time during 1964, and it was back in the United States by April 1964, where it remained until January 1965. The AOJ also obtained information from the Blue Water Navy Ship Locator Dashboard which indicates that deck logs from the USS Uhlmann do not show that the ship was in the territorial seas of Vietnam between August 5, 1962 and November 3, 1964. However, no information was obtained with respect to the location of the USS Uhlmann from January 9, 1962 through August 4, 1962. Therefore, another remand is necessary in order to comply with the terms of the Board’s remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 7. The claim for service connection for a skin disability other than a scar on the left elbow, to include hives, cysts, and residual scarring, is remanded. Service treatment records show that the Veteran was treated for cellulitis with lymphangitis on the left forearm during service. In August 2015, the AOJ requested a VA skin examination for the Veteran. In that request, the AOJ identified the Veteran’s in-service treatment for cellulitis with lymphangitis and asked the examiner to provide an opinion as to whether a current skin disability was related to that in-service event or injury. The Veteran underwent a VA skin examination in September 2015, during which he reported intermittent bouts of hives on his head, trunk, and extremities and various cysts on his foot, thigh, and liver, which he attributed to alleged in-service herbicide exposure. A physical examination revealed a scar from a ganglion cyst that was removed from the left foot, and the examiner indicated that the Veteran’s chronic urticaria was not symptomatic at the time of the examination. The examiner provided an opinion as to whether the Veteran’s urticaria was related to his claimed in-service herbicide exposure. However, the examiner did not provide an opinion as to whether a current skin disability was related to the Veteran’s in-service cellulitis with lymphangitis. Accordingly, the Board finds that a remand is necessary in order to obtain another medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 8. The claim for service connection for loss of teeth for compensation purposes is remanded. Service connection for compensation purposes can only be established for certain types of dental and oral conditions listed under 38 C.F.R. § 4.150. These disabilities include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is available for loss of teeth only if such is due to bone loss caused by trauma or disease, such as osteomyelitis, but not the loss of the alveolar process as a result of periodontal disease. 38 C.F.R. § 4.150, Note to Diagnostic Code 9913. Replaceable missing teeth are not compensable disabilities. 38 C.F.R. § 3.381(b). The Veteran has not asserted that he suffered bone loss due to trauma or disease such as osteomyelitis during service. However, a November 1960 report of medical examination notes no missing teeth upon the Veteran’s entrance into active duty, and an October 1964 report of medical examination appears to indicate that teeth # 19, # 20, and # 32 were missing upon the Veteran’s discharge from active duty. As it is not clear whether the Veteran has a compensable dental disability due to bone loss caused by in-service trauma or disease, the Board finds that remand is necessary in order to provide the Veteran with a VA dental examination and to obtain a medical opinion. The matters are REMANDED for the following action: 1. Attempt to verify through official sources whether the USS Uhlmann was in the official waters of Vietnam (within 12 nautical miles offshore of Vietnam) at any point from January 9, 1962, through August 4, 1962. All requests should be documented in the claims file and the Veteran notified of a negative response. 2. Provide the claims file to an appropriate examiner to obtain a supplemental opinion pursuant to the Veteran’s claim for service connection for a skin disability other than a scar on the left elbow, including hives/urticaria, cysts, and residual scarring. Do not schedule the Veteran for another examination unless it is deemed necessary to respond to the question presented. After a review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or higher probability) that a current skin disability other than a scar on the left elbow (including hives/urticaria, cysts, and residual scarring) is related to the Veteran’s in-service cellulitis with lymphangitis. A complete rationale for all opinions must be provided. 3. Schedule the Veteran for a VA dental examination. After an examination and a review of the claims file, the examiner should answer the following: (a.) Does the Veteran have any of the following: chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, or loss of teeth due to the loss of substance of the body of the maxilla or mandible? (b.) If the Veteran has any of the above-listed conditions, for each condition identified, the examiner should provide an opinion as to whether it at least as likely as not (a 50 percent or greater probability) caused by in-service trauma or disease (such as osteomyelitis, but not periodontal disease). A complete rationale for all opinions must be provided. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Banister, 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.