Citation Nr: 21015872 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 19-05 644 DATE: March 18, 2021 ORDER Entitlement to service connection for right hand disability is granted. Entitlement to service connection for headaches is granted. Entitlement to service connection for post-traumatic stress disorder (PTSD) is granted. REMANDED Entitlement to service connection for a bilateral shoulder disability is remanded. Entitlement to service connection for a lumbar disability is remanded. Entitlement to service connection for a neck/cervical disability is remanded. Entitlement to service connection for a bilateral hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for bilateral ankle disability is remanded. Entitlement to service connection for residuals of a right foot injury is remanded. Entitlement to service connection for residuals of a rib injury is remanded. Entitlement to service connection for residuals of facial injuries is remanded. Entitlement to service connection for dental disability for compensation purposes is remanded. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran incurred a right-hand disability due to injury sustained in the line of duty and not due to willful misconduct during a period of inactive duty for training (INACDUTRA). 2. The evidence is at least evenly balanced as to whether the Veteran incurred a headache disability due to injury sustained in the line of duty and not due to willful misconduct during a period of INACDUTRA. 3. The evidence is at least evenly balanced as to whether the Veteran incurred a PTSD disability due to injury sustained in the line of duty and not due to willful misconduct during a period of INACDUTRA. CONCLUSIONS OF LAW 1. The criteria for service connection for right hand disability have been met. 38 U.S.C. §§ 105, 1131, 5107(b); 38 C.F.R. §§ 3.1 (n), 3.102, 3.301, 3.303. 2. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 105, 1131, 5107(b); 38 C.F.R. §§ 3.1 (n), 3.102, 3.301, 3.303. 3. The criteria for service connection for PTSD have been met. 38 U.S.C. §§ 105, 1131, 5107(b); 38 C.F.R. §§ 3.1 (n), 3.102, 3.301, 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training (ACDUTRA) from August 1984 to December 1984 and had periods of inactive duty for training (INACDUTRA) during his National Guard service from May 1984 to July 1987. This case comes before the Board of Veterans’ Appeals (Board) on appeal of June 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In an August 2019 decision, the Board denied entitlement to service connection for right hand disability, headaches, PTSD, a bilateral shoulder disability, lumbar spine disability, cervical spine disability, bilateral hip disability, right knee disability, bilateral ankle disability, residuals of a right foot injury, residuals of a rib injury, facial injuries, and dental injuries. The Veteran appealed the Board’s August 2019 decision to the U.S. Court of Appeals for Veterans Claims (Court), and in a September 2020 Joint Motion for Partial Remand (JMPR), the parties requested that the Court Vacate the August 2019 decision that denied entitlement to service connection for right hand, headaches, PTSD, bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, residuals of a right foot injury, residuals of a rib injury, facial injuries, and dental injuries. In an October 2020 Order, the court granted the JMPR, vacated in part the August 2019 Board decision, and remanded the matter to the Board for action consistent with the terms of the JMPR. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection can be granted only when a disability was incurred or aggravated in the line of duty not as a result of the Veteran’s own willful misconduct or, for claims filed after October 31, 1990, the result of his abuse of alcohol or drugs. 38 C.F.R. § § 3.301 (c) (2). Willful misconduct means an act involving conscious wrongdoing or known prohibited action. 38 C.F.R. § § 3.1 (n). It involves deliberate or intentional wrongdoing with knowledge of or wanton and reckless disregard of its probable consequences. Id. at (1). Mere technical violation of police regulations or ordinances will not per se constitute willful misconduct. 38 C.F.R. § 3.1(n)(2). Willful misconduct will not be determinative unless it is the proximate cause of injury, disease, or death. 38 C.F.R. § 3.1(n)(3). The applicable regulations also exclude from the line of duty any injury or disease incurred during active military, naval, or air service that was the result of the abuse of alcohol or drugs. 38 U.S.C. § 105 (a); 38 C.F.R. § 3.301 (a). However, the simple drinking of alcoholic beverage is not of itself “willful misconduct.” The deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person’s willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin. 38 C.F.R. § 3.301 (c)(2). The abuse of alcohol is defined as the use of alcoholic beverages over time, sufficient to cause disability to, or death of, the user. 38 C.F.R. § 3.301 (d). For the purpose of 38 C.F.R. § 3.301 (d), alcohol abuse means the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability of the user; drug abuse means the use of illegal drugs (including prescription drugs that are illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. Id. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. “Active military, naval, or air service” includes any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred in line of duty. 38 U.S.C. § 101 (24); 38 C.F.R. § § 3.6 (a). Active duty for training is, inter alia, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101 (22); 38 C.F.R. § § 3.6 (c). Active military, naval, or air service also includes any period of inactive duty for training during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebral vascular accident occurring during such training. 38 U.S.C. § 101 (24); 38 C.F.R. § § 3.6 (a). Inactive duty training means, inter alia, duty other than full-time duty prescribed for Reserves or the National Guard of any state. 38 U.S.C. § 101 (23); 38 C.F.R. § § 3.6 (d). There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304 (f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD generally requires: (1) medical evidence diagnosing the condition in accordance with applicable criteria; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f). If a PTSD claim is based on in-service personal assault, evidence from sources other than the Veteran’s service records may corroborate the Veteran’s account of the stressor incident. See 38 C.F.R. § 3.304 (f)(5). 1. Right Hand / Headaches / PTSD The Veteran’s right hand and headaches disabilities are associated with an altercation with two National Guard members that took place on September 19, 1986 while on a period of INACDUTRA. During the altercation the Veteran was beaten, and he subsequently received medical attention at a civilian hospital emergency room. The Veteran sustained injuries to his face, teeth, ribs and chest, right hand, right wrist, right knee and right ankle, in addition, alcohol ingestion was noted. A September 20, 1986 report of medical examination and duty status indicated that the Veteran’s injuries were incurred in line of duty. A line of duty (LOD) investigation commenced. In a September 20, 1986 sworn statement, the Veteran reported the following: while he was sleeping on the back of an extremely large and heavy truck when mosquitos started to bother him and he was getting warm, so he decided to get up and find a cooler place to sleep inside the building. He left and found a spot in the classroom. The Veteran then returned to the truck to retrieve his duffel bag, when there were two white male G.I.'s from Gonzales Unit sitting on the back of a pickup truck drinking alcohol. One said something and the other snuck up behind him and hit him on the left side of his head. The Veteran ran and got a piece of wood and threw it and broke the rear window of an automobile in the parking lot. The men ran after the Veteran and one held him while the other beat him badly, then he tried to drown the Veteran as he screamed for help. The Veteran told them one of his teeth had been knocked out, they then left, and we walked about four miles to his sister’s house. In a September 30, 1986 written statement, the Veteran reported the following: upon arriving in Gonzales, LA, he was assigned to unload equipment until 11:00 pm, then afterwards he participated in a game of dominos until 2:30 am, then he decided to sleep on a ton vehicle near the only other driver. When the humidity and mosquitos became unbearable, he left the vehicle and proceeded to go inside. He noticed two guys sitting on the back of a pickup truck, drinking from a bottle which appeared to be a fifth of an alcoholic beverage and 32-ounce bottle of Coke. The Veteran walked to where privates [REDACTED] and [REDACTED] were sitting a chatting, then they all decided to go inside, and as they passed the two men sitting on the back of the truck, one of men said something using profanity. The Veteran stated they replied with a similar remark and kept going. The Veteran stated that when he returned to get his pack, one of the guys asked him what that smart remark was, and the Veteran replied, the he did not say anything to them. The Veteran asserts that he was then pushed and hit on the left side of his face, knocking him to the ground. The Veteran ran about 15 yards from the original site, picked up a piece of lumbar, went back and threw it, breaking the window of a vehicle owned by one of the guys. The Veteran indicated that he was chased to a field behind the parking lot, and when he slipped and fell to the ground, the guys began to stomp the back of his head and back. The Veteran managed to get up, then ran about 20 yards to the other side of the building, where there was a small lake, approximately 4 to 5 feet deep. The two guys caught up with him, and one dove on the Veteran, knocking him to the ground, where one guy held him while the other guy kicked him in the rib area. They dragged the Veteran to the water, kicked and beat him, then held his head under water for about three minutes, leaving him unconscious. The Veteran stated that when he regained consciousness, he staggered to his sister’s home, arriving at about 5:20 am, and she immediately placed ice on his swollen face, after which he lost vision in his left eye. He returned to the Armory to report the incident at 9:20 am, and the captain had him admitted to a civilian hospital for x-rays and treatment. In an October 5, 1986 oral interview, one of the accused men reported the following: the altercation occurred because the Veteran kept demanding a drink out of their bottle of alcohol, and they refused and told the Veteran to leave them alone. He stated that the Veteran grabbed for the bottle, and the Veteran’s hand was shoved away. He stated that the Veteran cursed, then took a swing and hit him on the side of the nose. He stated that he grabbed the Veteran and pushed him away, then the Veteran stumbled and fell to the ground and then got up and ran away towards the back of the Armory. The Veteran came back 3 or 4 minutes later and threw a two by four in their direction and hit the back window of the one of the men’s car and broke the rear window. He reported that the Veteran ran towards the front of the Armory, cursing, screaming, and hollering, and they chased and caught him near the maintenance yard. The other man tackled the Veteran and knocked him to the ground. He stated that he pulled the other man off, then he began hitting the Veteran. The other man also hit and kicked the Veteran. He denied that one held the Veteran while the other one beat him. He also denied throwing the Veteran in the bayou or attempting to hold him under the water to drown him. He stated that the Veteran jumped into the bayou on his own to get away from them. He noted that the incident happened around 3:30 am, and that neither he or the other man involved reported the incident to the company commander or first sergeant of the unit because they did not think it was important. He declined to provide the investigator with a written statement. On the oral interview report, the investigator noted that the other man involved declined to provide a written statement. An oral interview of the other man involved is not of record. The investigator noted that the other man involved verbally related the same story with minor discrepancies which were not considered to be essential to the overall investigation. In December 1986, a Report of Investigation regarding LOD status was issued. The investigator made the following conclusions: The Veteran and the two men involved in the incident had been drinking alcohol prior to the incident in question, contrary to the command’s orders. One of the men reported that the incident occurred in part because the Veteran demanded that he be given alcohol by the other two men. The Veteran and both men were absent without authority from the designated unit area at time of the incident. The Veteran could not provide the name of a single witness to substantiate his version of the incident. The examiner noted several inconsistencies in the two written statements submitted and his verbal account given to the investigator. For example, in verbal conversation, the Veteran stated that he had not been drinking, while the evidence shows he was in fact under the “influence of alcohol.” Additionally, there was no lake 4 to 5 feet deep behind the Armory or near it, however, a shallow depression just to the north of the Armory 10 to 12 inches of water standing in it. The Veteran’s initial account of the incident was undermined by the appearance of the participants’ uniforms shortly after the incident. The Veteran did not satisfactorily explain why he did not run into the Armory to elude pursuers, immediately report the incident to his commander, or why it took him five and a half hours to return to the Armory, technically, making the Veteran AWOL during that period of time. The investigator made a final determination that the Veteran’s injuries were sustained due to misconduct while all three soldiers were under the influence of alcohol (against the Commander’s verbal orders) and engaged in a fistfight off the Armory Grounds. In April 2018, the Veteran underwent a VA hand and finger examination. The examiner noted diagnoses of healed fracture right 5th metacarpal head/neck and healed fracture right 5th right finger middle phalanx base. The examiner opined that it is very likely that the Veteran’s current right-hand condition is directly related to the assault he described that occurred while he was in service. The examiner explained that the Veteran reports being assaulted, and records contained in STR confirm his statements. Emergency room records indicate multiple injuries in 1986 as a result of an attack by other service members. One of the injuries listed on the records was his right hand. The examiner noted that the fracture was not specifically diagnosed at the time, but the Veteran denies any other injuries to his hand that could account for an old fracture evident on x-ray. In an April 2018 VA headaches examination report, the examiner noted a diagnosis of migraine including migraine variants. The examiner opined that the Veteran’s headaches condition was at least as likely as not incurred in or caused by the claimed in-service injury, event or illness. The examiner explained that prior to enlisting the Veteran had no migraine, and it started after he was assaulted by other soldiers hitting his head and breaking his jawbone. The Veteran underwent a VA examination in April 2018. The examiner indicated the Veteran has a diagnosis of PTSD the meets the full DSM-5 criteria. The examiner opined that it is at least as likely as not that the Veteran’s PTSD was the result of the in-service personal assault/trauma he experienced. In a May 2018 statement, Mr. [REDACTED] reported that he was present at the Armory on or about September 20, 1986, when the Veteran and he prepared an area to sleep before deployment for summer camp. The Veteran realized he left his Alice-pac on the truck they traveled in and mentioned to him that he was going to retrieve his item and never returned. Mr. [REDACTED] stated that when he awoke the following morning, he noticed the Veteran was not present. After an hour, he noticed a group of fellow soldiers gathered in the lobby area of the Armory, where he noticed the Veteran was in the commander’s officer, where he could see the Veteran had been brutally severely swollen, with bloody lips, face, and head. Mr. [REDACTED] spoke with other members of their unit, and they mentioned that he could barely walk. He noted that when he returned from summer camp, he went to check on the Veteran at his home where he was bed side, and still in drastic shape. The Veteran told him what happened, and Mr. [REDACTED] noticed the Veteran’s front teeth were missing, a broken right hand, both legs and knees severely bruised and swollen, and his right foot. He further noted that he continued to follow-up with the Veteran’s recovery weeks after, and it seemed as if he had gotten worse. In a May 2018 statement, B.F. reported that he served as a 2nd Lieutenant Combat Engineer Platoon Leader in the Veteran’s unit at the time of the incident. The Veteran was in the process of being deployed for summer camp when an incident was brought to his attention during a commander briefing that he was requested to attend. B.F. stated that he could see through the glass wall of the Armory office into the commander’s office and observed the Veteran looking extremely disheveled and in a state of distress, as he was surrounded by many officers. Upon entering the office, it was apparent that something catastrophic happened as the Veteran was barely recognizable from his bloodied swollen head and face. His eyes were so inflamed and red they were forced shut. The Veteran’s face was in a deplorable state with his lips, eyes, and face, as if he had been bludgeoned and beaten repeatedly. B.F. indicated that the Veteran could barely talk or open his mouth as you could visibly see teeth missing. The Veteran’s lips were swollen, bruised, and cut. There was also bloody gum tissue exposed from several teeth that were evenly knocked out of his mouth. B.F. noted that it was evident the Veteran had suffered an extreme injustice and it was reported to the commander regarding the specifics of the incident. In a May 2018 statement, the Veteran’s sister reported that early in the morning in September 1986, she and her husband were awakened by loud banging on her back door. When she opened the door, the Veteran fell forward in the door, bleeding and unrecognizable. His eyes were swollen shut, front teeth were missing, and his lips were swollen. She indicated the Veteran had multiple contusions and bruises on his torso. They picked him off the floor and got a cold towel to soothe him. The Veteran was barely conscious. He was taken to the emergency room and treated. He had missing teeth, a broken hand, broken ribs, right fractured foot, and bruised knees. When the Veteran was released, her husband took him back to the Armory to see the commander. The Veteran’s sister noted that as the years have passed, the Veteran is fearful of crowds, unable to keep a job, has severe bouts of depression, night sweats, flashbacks, and severe headaches. His knees and right foot still swell. In May 2018 Administrative decision, VA determined that all injuries related to the September 1986 incident were “deemed to have not been incurred in the line of duty as it was due to the wanton and reckless disregard of its probable consequences.” In a July 2019 brief, the Veteran’s attorney argued that the LOD discounted the Veteran’s statement that he was assaulted, and his assailants attempted to drown him, as the investigator found there is no “lake” 4 to 5 feet deep behind the Armory or near it; only a depression with approximately 10 to 12 inches of water in it. The attorney asserts, however, there is a body of water that is at least 4 to 5 feet deep adjacent to the Armory. The attorney submitted an article in which students at the East Ascension High School are shown floating and standing in a pond that is “across form the campus” in Gonzales. The attorney also submitted a google map showing that East Ascension High School is adjacent to the LA National Guard Armory. The Veteran’s attorney further argued that even if the pond did not exist near the Armory; which it does, that does not mean that the Veteran was not assaulted, and that his assailants did not make the Veteran feel that his life was at risk by either attempting to drown him, or convincing him they would drown him. The attorney noted that it takes any amount water to cover the mouth and nose to drown. An article of YMCA drowning facts was submitted in support of the Veteran’s claim. In this case, the evidence reflects that the Veteran’s right hand disability, headaches, and PTSD are attributable to the September 19, 1986 injury. See April 2018 VA examination reports. The dispositive issue is thus whether the evidence shows that being under the influence of alcohol was the proximate cause of the injury to make its incurrence outside the LOD. 38 U.S.C. § 105 (a); 38 C.F.R. §§ 3.1 (n), 3.301. The parties to the JMPR found that the Board’s analysis was deficient for two reasons. First, it did not weigh, as the fact-finder, the evidence on which the LOD investigation was based, specifically, the conflicting statements of the Veteran and witnesses and statements of the investigator, to include a credibility determination. Second, the Board did not identify the willful misconduct, why it was the proximate cause of the assault, and that the injuries were the probable consequence of the misconduct. Based on its review of these facts pursuant to the instructions of the parties to the JMPR, the Board finds, for the following reasons, that the Veteran was generally credible and therefore the Veteran’s injuries, including those which resulted in his right hand disability, headaches, and PTSD were incurred in the line of duty and were not the result of willful misconduct due to alcohol abuse. The LOD investigator indicated that there were inconsistencies in both the Veteran’s written statements and his verbal interview. However, the evidence of record shows that the Veteran’s sworn statement provided on September 20, 1986 and written statement provided on September 30, 1986 concerning the incident are consistent. In addition, the LOD investigation report is void of documentation of a verbal interview with the Veteran which would be contrary to his written statements, specifically, as to whether the Veteran denied he ingested alcohol. The investigator indicated that the Veteran could not name one witness who could substantiate his version of the incident. However, in the Veteran’s September 30, 1986 written statement, he references fellow soldiers [REDACTED] and [REDACTED], and his sister. May 2018 statements submitted by the Veteran’s sister, Mr. [REDACTED], and B.F. are consistent with Veteran’s statements provided in September 1986 and are found credible. The investigator found that the Veteran’s initial account of the incident was undermined by the appearance of the participants’ uniforms shortly after, based on there being no lake 4 to 5 feet deep behind the Armory or near it. However, the investigator conceded the presence of a shallow depression just to the north of the Armory with 10 to 12 inches of water standing. In addition, the Board find’s the attorney’s argument set forth in the July 2019 brief highly persuasive. Specifically, that it any amount water which covers the mouth and nose can cause drowning. Notably, although one of the soldiers accused denied holding the Veteran under the water, he stated the Veteran jumped into the bayou on his own to get away from them. The only verbal interview in the LOD is dated on October 5, 1986 for one of the accused soldiers involved, who stated that the Veteran instigated the altercation between them. Unlike the Veteran, both soldiers involved declined to provide the investigator with a written statement. The investigator noted that the other man involved verbally related the same story with minor discrepancies which were not considered to be essential to the overall investigation. The negative LOD report was premised upon circumstantial inferences that alcohol intoxication was the proximate cause of the injury. The investigation substantially relied upon the two soldiers’ verbal statements that the Veteran instigated the incident resulting in his injuries, even though discrepancies in their statements were noted. Based on the evidence of record, it cannot be concluded that the Veteran’s actions constituted willful misconduct. While there is evidence of record that the Veteran had alcohol ingestion when treated at the hospital emergency room for injuries which resulted in his right hand disability, headaches, and PTSD, he indicated the injuries were caused by being assaulted by two soldiers. Regardless of the Veteran’s state of inebriation, it is reasonable to conclude that the Veteran’s conduct did not rise to the level that would justify injuries to his face, teeth, ribs chest, right hand, right wrist, right knee and right ankle perpetrated by the two soldiers who did not deny causing such injuries. It is also reasonable to conclude that the Veteran acted sensibly when he sought help at his sister’s house, away from the Armory, as he had just been assaulted there by two fellow soldiers. There is no evidence to suggest that the Veteran’s contentions lack sincerity or that the Veteran himself lacks credibility. In sum, after considering the Veteran’s injuries in the entire context of the record, the Board finds the evidence reflects that the proximate cause of the Veteran’s injuries is not attributable to willful misconduct from alcohol ingestion. Therefore, the Veteran’s injuries were not due to willful misconduct or alcohol abuse. The Veteran’s right hand, headaches, and PTSD were therefore incurred in the line of duty. Other than the line of duty issue, there is no controversy regarding the general service connection elements with regard to these claims, including PTSD due to an in-service stressor. Accordingly, service connection for right hand, headaches, and PTSD disabilities is warranted. REASONS FOR REMAND Bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, right foot, rib, facial, and dental disabilities. The Veteran contends his bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, right foot, rib, facial, and dental conditions are related to the September 1986 in-service assault. The Veteran’s service treatment records show complaints and treatment for injuries to his face, teeth, ribs and chest, right hand, right wrist, right knee and right ankle due to an in-service assault. Post service treatment records shows complaints and treatment for bilateral shoulder pain, knee pain, ankle pain, lower back pain, neck pain, and hip pain. As this evidence indicates that the Veteran has current disabilities that may be associated with service, and the Board has found above that the injuries sustained were incurred in the line of duty and not the result of willful misconduct, a remand is warranted to obtain an opinion as to the etiology of the bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, right foot, rib, facial, and dental disabilities, to the extent that the dental disabilities are those for which compensation is warranted. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board notes that, in Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018), the Federal Circuit held that pain can constitute disability under 38 U.S.C. § 1110 if it causes impairment in earning capacity and a diagnosis is not required to meet the current disability requirement. However, entitlement to service connection for dental disability for compensation purposes is only available for dental disabilities that are the result of osteomyelitis or osteoradionecrosis, or due to the loss, malunion, or limited motion of the mandible, maxilla, ramus, condyloid process, or hard palate, or due to the loss of teeth due to loss of substance of the upper or lower jaw. 38 C.F.R. § 4.150. 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. See Simmington v. West, 11 Vet. App. 41 (1998). Compensation is not available for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease. 38 C.F.R. § 3.381. The matters are REMANDED for the following action: Obtain opinions from appropriate clinicians to determine the nature and etiology of any bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, right foot, rib, facial, and dental disabilities. If examinations are deemed necessary, they should be conducted, to include via telehealth if warranted. The clinicians should provide opinions as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral shoulder, lumbar spine, cervical spine, bilateral hip, right knee, bilateral ankle, right foot, rib, facial, or compensable dental disabilities are related to the in-service injury described above that occurred on September 19, 1986 during a period of INACDUTRA. Disability may exist even in the absence of a specific diagnosis, and pain can constitute disability if it causes impairment in earning capacity. In this regard, the Board notes that entitlement to service connection for dental disability for compensation purposes is only available for dental disabilities that are the result of osteomyelitis or osteoradionecrosis, or due to the loss, malunion, or limited motion of the mandible, maxilla, ramus, condyloid process, or hard palate, or due to the loss of teeth due to loss of substance of the upper or lower jaw. 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. Compensation is not available for treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, or periodontal disease. The clinicians must provide a complete rationale for any opinion set forth. In addressing this matter, the clinicians should address the pertinent evidence in the service treatment records, post service medical records and examinations, as well as the lay evidence provided by the Veteran. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Walker, 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.