Citation Nr: 21028068 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-23 806 DATE: May 10, 2021 REMANDED Entitlement to service connection for a dental condition, to include as secondary to arthralgia of the temporomandibular joint, is remanded. Entitlement to an evaluation in excess of 10 percent prior to December 2, 2020, and in excess of 70 percent thereafter for the right wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marine Corps from October 1968 to August 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2012 and July 2012 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2017. This case was previously before the Board in February 2018 and July 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. 1. Entitlement to service connection for a dental condition, to include as secondary to arthralgia of the temporomandibular joint, is remanded. The prior Board remand found the December 2019 VA opinion inadequate, which left no adequate opinions in the record. The Board directed the RO to obtain a new opinion addressing the Veteran's contentions regarding tooth loss and dental care during service. Service connection for compensation is available for dental conditions including loss of teeth due to bone loss of the body of the maxilla or mandible due to trauma or disease, though not periodontal disease. 38 C.F.R. §§ 4.150, 17.161. The Board has previously determined that this claim is for service-connected compensation, and not for eligibility for outpatient dental care, which is a decision made by a veteran's VA medical facility. 38 C.F.R. § 17.161. In July 2020, a VA examiner provided opinions regarding direct and secondary service connection. However, the examiner did not identify any current dental conditions, and commented only upon the reported jaw pain, opining that this was insufficient to render an actual diagnosis. The examiner further commented that no diagnosis was made because the missing teeth are not due to the temporomandibular joint disorder, but did not provide any explanation supporting this conclusion. This opinion is inadequate, as it does not provide adequate rationale for the opinion regarding jaw pain, and does not provide any rationale for the opinion regarding tooth loss. Therefore, this opinion does not fulfill the Board's remand directives, and another remand is necessary to obtain an adequate opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (remand by Board confers upon claimant, as a matter of law, the right to compliance with remand order). 2. Entitlement to an evaluation in excess of 10 percent prior to December 2, 2020, and in excess of 70 percent thereafter for the right wrist disability is remanded. At the December 2020 VA wrist examination, the Veteran reported that he is unable to bend his right wrist and thumb, and the examiner noted a May 2012 x-ray finding cystic areas about the metacarpal head of the thumb. The Board notes the Veteran has also consistently complained of a reduction in grip strength. Therefore, given the new complaint of limitation of motion of the thumb due to the right wrist disability, it appears an examination of the right thumb and/or hand is in order to properly assess the extent of the right wrist disability. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician to determine whether any current dental condition, including tooth loss, is related to the Veteran's military service. If the examiner determines that an additional in-person examination is required, one should be scheduled. Please note, if the examiner deems it reasonable, an alternate format such as telehealth interview is acceptable. Following review of the claims file and, if indicated, examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the dental condition began in or is otherwise caused by the Veteran's active service. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the dental condition is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran's service-connected arthralgia of the temporomandibular joint. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner should specifically address the Veteran's lay statements regarding tooth loss and dental care during and since service, particularly the August 1973 treatment record reflecting the Veteran's report that several root canals received during service failed within the first year after separation. The examiner should also comment upon the October 1997 x-ray showing reduced joint space in the right and left temporomandibular joint. The examiner should address any other pertinent evidence of record. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Schedule the Veteran for an examination or examinations with an appropriate clinician to determine the current severity of the Veteran's service-connected right wrist disability, to include any limitation of motion or other functional limitation of the right thumb and/or hand. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The joints involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). (Continued on next page) Finally, if the examiner finds functional limitation in the right thumb and/or hand, including but not limited to limitation of motion or reduction in muscle/grip strength, the examiner should provide an opinion regarding the cause of this functional limitation. In particular, the examiner must opine whether it is at least as likely as not a symptom of or caused by the Veteran's service-connected wrist disability. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Josey, 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.