Citation Nr: 21028142 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-67 514 DATE: May 10, 2021 REMANDED Entitlement to service connection for a low back disorder, to include scoliosis, is remanded. Entitlement to service connection for a right-side rib cage injury is remanded. Entitlement to service connection for Hepatitis C is remanded. Entitlement to service connection for periodontal disease is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Air Force from May 1991 to October 1995. He also had periods of Reserve and National Guard service. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a November 2014 rating decision of a regional office (RO) of the Department of Veterans Affairs (VA) (hereinafter agency of original jurisdiction or AOJ). The Veteran testified before the undersigned Veterans Law Judge at a January 2021 virtual hearing. A transcript of the hearing has been associated with the record. Right Side Rib Cage and Low Back During the January 2021 Board hearing, the Veteran reported that he injured his right-side rib cage during his service with the National Guard. In October 2015 correspondence, the Veteran indicated that this occurred during qualification training in June 2000. In a November 2014 Report of General Information, the Veteran indicated that his rib cage injury occurred during a drill weekend. March 2001 private treatment records note that the Veteran had pain in his right-side lower rib cage for the past several months. A November 2014 Information Report shows that the Veteran had Reserve service from April 2001 to April 2002 and from October 1995 to January 1996, and that he had service with the National Guard from January 1996 to March 2001. It is unclear from the record when the Veteran had periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) during his Reserve and National Guard service. Thus, prior to any further adjudication, the Board finds that the AOJ should obtain clarification as to the specific dates and character of the Veteran's service including his Military Master Pay Account (MMPA) with the Defense Finance and Accounting Service (DFAS) pay records. The claims file also does not contain the Veteran's complete Reserve and National Guard service treatment and personnel records, including any annual examinations that were performed. On remand, the AOJ should obtain a complete copy of the Veteran's Reserve and National Guard military personnel and treatment records to ensure that all relevant service records are in the claims file. During the hearing, the Veteran also reported that he injured his back during service in 1994 as a result of having to lift heavy equipment. He indicated that he did not seek treatment in service because he did not want to be rated negatively, but that he had experienced recurrent back pain since then. However, as noted above, the Veteran also had periods of Reserve service following his period of active duty service. An October 2008 private treatment record also shows that the Veteran had reported that he was experiencing back pain for the last year. Thus, the Board defers consideration of any examination and opinion pending clarification of the periods of ACDUTRA and INACDUTRA service and, thus, the applicable standard of review to apply to each claim. See generally Kahana v. Shinseki, 24 Vet. App. 428 (2011) (discussing the "chicken-or-egg" dilemma faced by VA when requesting opinions and making credibility determinations with an undeveloped record, and recognizing that fact-finding is a responsibility that is ultimately committed to the Board and not a VA medical examiner). Hepatitis C During the January 2021 Board hearing, the Veteran reported that he was diagnosed with Hepatitis C in 1999, after he experienced an episode of fainting. He reported that he had started to experience periods of fainting and fatigue during service. He also indicated that he did not possess any of the risk factors for Hepatitis C, but that he did have to share protective suits with other servicemembers during his active service which may have caused his Hepatitis C. September 1992 service treatment records show that the Veteran reported having difficulty sleeping and experiencing weight loss. He indicated that he was concerned about having a parasite. Given the Veteran's reports of weight loss and possible fatigue in service, the Board finds that a remand is necessary to obtain a VA examination that addresses the nature and etiology of the Veteran's Hepatitis C. Periodontal Disease In October 2015 correspondence, the Veteran reported that he had three of his teeth removed in 1991, which were replaced with a post and crown due to discharge from the teeth. He indicated that he later had to have oral surgery to stop the discharge from the same area, at which time he was told that he had early stage periodontal disease. During the January 2021 Board hearing, the Veteran reported that the dental procedures performed in service may have caused his periodontal disease. September 1991 service dental treatment records show that the Veteran had unresolved periacpical infection with draining. He also reported having periodontal problems during an October 1995 assessment. The Board notes that service connection will be granted for a dental disease or injury of individual teeth and the investing tissue, shown by the evidence to have been incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.381(a). However, replaceable missing teeth, treatable carious teeth, dental or alveolar abscesses, and periodontal disease are not disabling, and may be considered service-connected solely for the purpose of determining entitlement to VA dental examination or outpatient dental treatment. 38 C.F.R. § 3.381. 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, 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 due to loss of substance of the body of the maxilla or mandible. See Simmington v. West, 11 Vet. App. 41 (1998). For loss of teeth, bone loss through trauma or disease such as to osteomyelitis must be shown. The loss of the alveolar process as a result of periodontal disease is not considered disabling. See 38 C.F.R. § 4.150, Note to Diagnostic Code 9913. As there may be outstanding pertinent service records, the Board defers finally adjudicating this issue at this time. The matters are REMANDED for the following action: 1. The AOJ should contact the National Personnel Records Center (NPRC), the Records Management Center (RMC), the Veteran's Reserve and National Guard units, and any other appropriate location, to request the Veteran's complete service personnel and treatment records from his Reserve and National Guard service. As set forth in 38 U.S.C. § 5103A (b)(3) and 38 C.F.R. § 3.159 (c)(2), the AOJ should continue efforts to locate such records until it is reasonably certain that such records do not exist or that further efforts to obtain those records would be futile. If appropriate records are deemed to be unavailable, the claims file must be properly documented as to the unavailability of these records. All such available records should be associated with the claims file. The Veteran should be notified of any actions taken. 2. The AOJ should then verify the dates of the Veteran's ACDUTRA, INACDUTRA, and any other type of reserve service. Specifically, attempt to obtain the Veteran's MMPA (Master Military Pay Account) from the Defense Finance and Accounting Service (DFAS). 3. The AOJ should then secure any outstanding private and VA medical records. 4. After the above development is completed, schedule the Veteran for an examination with an appropriate VA examiner to determine the nature and etiology of his Hepatitis C. The examiner should opine as to whether it is at least as likely as not that (i.e. 50 percent or greater probability) that Hepatitis C began during service or is otherwise etiologically related to such service. In rendering this opinion, the examiner should address the September 1992 treatment record where the Veteran reported weight loss, as well as his testimony during the January 2021 Board hearing that he had to share protective suits with fellow servicemen. A complete rationale is required for any opinion provided. (continued on the next page) 5. The AOJ should conduct any other development that may be indicated as a consequence of the actions taken in the preceding paragraphs. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Saikh, 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.