Citation Nr: 21020729 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 20-28 907 DATE: April 8, 2021 REMANDED Entitlement to service connection for headaches to include as secondary to epilepsy is remanded. Entitlement to service connection for a dental condition to include as due to medications taken to treat the service-connected epilepsy is remanded. Entitlement to service connection for a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from August 1963 to July 1966. Although the Board regrets the delay, remand is required to ensure there is a complete record on which to decide the Veteran’s claims. 1. Entitlement to service connection for headaches to include as secondary to epilepsy In October 2020, the Board remanded the Veteran’s claim for entitlement to service connection for headaches in order to obtain a VA opinion regarding if the Veteran’s headaches were caused or aggravated by the service-connected epilepsy. In November 2020, the Veteran was afforded a VA examination and the examiner opined the Veteran’s headaches were less likely than not caused or aggravated by the service-connected epilepsy. The Board notes that the Veteran has also contended his headaches are directly related to service. In an October 2017 statement, the Veteran stated that he has had headaches on a daily basis since sustaining a head injury during military service. Accordingly, an additional VA examination is warranted to consider whether the Veteran’s headaches are directly related to active duty service. 2. Entitlement to service connection for a loss of teeth to include as due to medications taken to treat the service-connected epilepsy is remanded. The Veteran has asserted that his dental condition is due to the use of medications taken to treat his service-connected epilepsy. The Veteran stated his service-connected epileptic seizures have been treated with phenytoin and phenobarbital, which have softened his gums and resulted in a loss of all but two of his teeth. See October 2017 Veteran’s Statement in Support of Claim. In October 2020, the issue was remanded to obtain relevant dental treatment records. The treatment records obtained showed the loss of teeth. The Veteran has not been afforded a VA examination. Therefore, the question remains as to whether the Veteran’s loss of teeth is due to the use of medication for treatment of his service-connected epilepsy. Given this evidence of loss of teeth, the Board finds an opinion is needed to determine if the Veteran’s use of medication to treat his epilepsy resulted in loss of mandible or loss of teeth due to the loss of substance of the body of the maxilla or mandible, as contemplated by 38 C.F.R. § 4.150. The law and regulations also provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are considered non-disabling conditions and may be considered service-connected solely for the purpose of determining entitlement to VA dental examination or outpatient dental treatment. See 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 17.161 (2020); Woodson v. Brown, 8 Vet. App. 352, 354 (1995). A claim for service connection for a dental disorder is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). Under 38 C.F.R. § 3.381, VBA will adjudicate a claim for service connection of a dental condition for treatment purposes after the VHA determines that a Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161 and requests that VBA make a determination on relevant questions. 38 C.F.R. § 3.381(a). In this case, the RO did not refer the claim of service connection for a dental disability for purposes of VA outpatient treatment purposes. Therefore, a remand is appropriate for the claim to be referred to the VHA to make the initial determination on the claim. Furthermore, a pre-requisite for receiving VA dental treatment under 38 C.F.R. § 3.381 is a VA dental examination. The Veteran has not yet been afforded an examination. On remand, the Veteran should be afforded a dental examination, to include an etiological opinion in association with his claim for service connection for compensation purposes. 3. Entitlement to service connection for a total disability rating due to individual unemployability (TDIU) is remanded. With respect to the Veteran’s TDIU claim, the Board notes that, because adjudication of the Veteran’s service connection claims remanded herein will impact adjudication of his TDIU claim, these claims are inextricably intertwined. Thus, the TDIU issue will be held in abeyance pending the completion of the remand instructions. See Harris v. Derwinski,1 Vet. App. at 183(1990) (holding that two issues are inextricably intertwined when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). The matters are REMANDED for the following actions: 1. Ask the appropriate examiner to review the Veteran’s file regarding his headaches. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The entire claims file must be made available to the designated examiner, including this remand. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the headaches were incurred in service or is otherwise medically related to service. The examiner is advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account. The examiner must address the Veteran’s October 2017 statement that he has been experiencing daily headaches since sustaining a head injury during service. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) 2. Schedule the Veteran for a VA dental examination. The examiner is requested to review the Veteran’s electronic claims file prior to examination, and such review must be noted in the examination report. After reviewing the record, including this remand, the examiner should respond to the following: (a.) For each identified dental disorder, is it at least as likely as not (a 50 percent or greater probability) that any identified dental disorder is related to the Veteran’s active military service? (b.) Is it at least as likely as not (a probability of 50 percent) that the Veteran’s use of medications to treat his epilepsy resulted in the loss of teeth or mandible? A rationale must be provided for all opinions. 3. Refer the claim for dental treatment to the appropriate VA Medical Center (VAMC) of VHA for initial dental treatment consideration. The claim must then be sent to VBA will adjudicate a claim for service connection of a dental condition for treatment purposes after the VHA determines that a Veteran meets the basic eligibility requirements of 38 C.F.R. § 17.161. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura C. Owens 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.